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Viral Load (VL) Toolkit.

Project Description

HIV viral load (VL) testing has been the gold standard for monitoring the response to antiretroviral therapy (ART) in high-income settings for many years and is increasingly recognized as an important tool for the management of ART in resource-limited settings. Benefits of VL monitoring include the ability to diagnose poor adherence and treatment failure early, prevent unnecessary switches to second-line ART and to allow optimization of treatment response in order to avoid development of resistance and prevent transmission.

Guidelines for ART management issued by the World Health Organization (WHO) have recognized the importance of VL monitoring since 2003 and routine VL monitoring is now strongly recommended as the monitoring strategy of choice.

This HIV Viral Load Toolkit (available by clicking here) has been designed to provide implementers with a set of tools to aid in implementation of VL monitoring including aspects related to sample preparation, activities for clinical and counselling staff, and education and empowerment of the patients themselves. The tools and algorithms form a basis for implementation, but will need to be adapted to the local context.

Note that this toolkit now has an updated training package (called ‘Annex 4+5’) that covers details related to lab implementation of viral load, along with training for clinicians and counsellors, plus (most importantly) tools and guidance for patient education. The overview slide in Annex 4+5 highlights which sections may be useful for the different cadres.

Each section in Annex 4+5 has a slide set that contains notes beneath each slide to guide you on the key messages, a support manual, and a set of implementation tools given as examples of the topics discussed in the session. These slides are aimed at giving a structure and a foundation for your viral load implementation trainings but of course must be locally adapted.

Please send us feedback as to whether these tools are useful and what can be done to improve them for use in your settings.

Annexes (available by clicking here) include:

1.  Sample preparation

2.  Viral load request form

3.  Enhanced adherence session content

4 + 5.  Training package for clinicians, counsellors, and laboratorians (as mentioned above)

6.  Advocacy tools

  • A report entitled ‘Undetectable: How VL monitoring can improve HIV treatment in developing countries’
  • ‘Putting HIV and HCV to the test: A Product Guide for point-of-care CD4 and lab-based and point-of-care virological HIV and HCV tests’
  • 3 Issue Briefs by MSF’s Access Campaign
    • ‘How Low Can We Go?’, which describes pricing for VL testing in low- and middle-income countries
    • ‘HIV status undetectable’, which describes 4 essential interventions to improve HIV treatment, save lives, and reduce transmission
    • ‘Getting to undetectable’, which describes usage of VL monitoring in 5 countries
  • A 2-minute video called ‘Reaching Undetectable: Why I need Viral Load’, telling the story of a woman from Malawi
  • Designs for promotional materials such as stickers, badges, t-shirts, pens, etc

7.  Patient education tools including a flipchart, poster and leaflet, in both English et en Français

SAMU would like to thank all of the field teams that have contributed to the materials used for developing this updated  viral load toolkit. The toolkit has now been shared with a number of partners and we hope will be developed further for use outside MSF programmes.

If you would like more details about introducing HIV viral load testing and/or electronic versions of any of the above tools in a format that can be modified, please contact

Helen Bygrave

Emmanuel Fajardo

Saar Baert

Project Details

  • Date December 2, 2013
  • Tags ARV, HIV, Monitoring, Viral load testing
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