Title

Compounding factors that affected viral load scale-up and viral load coverage in Kenya, before and during the COVID-19 pandemic

Presenter

Daniel Kimani

Authors

D. Kimani¹, N. Bowen², F. Basiye¹, R. Langat³, E. Nyakeriga⁴, K. Ouma⁵, E. Kirui⁵, K. Masamaro¹, M. Junghae¹, D. Maangi¹, J. Mwangi¹

Institutions

¹Centers for Disease Control and Prevention (CDC), Division of Global HIV and TB (DGHT), Nairobi, Kenya, ²Ministry of Health, National Public Health Laboratories (NPHL), Nairobi, Kenya, ³United Sates Army Medical Research Unit (USAMRU), HIV/TB, Nairobi, Kenya, ⁴United Sates Agency for International Development (USAID), Health, Population and Nutrition (HPN), Nairobi, Kenya, ⁵Amref Health Africa, HIV/TB, Nairobi, Kenya

BACKGROUND: Viral load (VL) testing among people living with HIV (PLHIV) receiving antiretroviral treatment (ART) is key to measuring progress towards achieving the last 95 in the 95:95:95 global goal. Kenya scaled-up VL testing through a network of ten national laboratories which were also used for COVID-19 testing after the first case was reported in March 2020. We compared VL testing before and during COVID-19 pandemic.
METHODS: Retrospective data on VL testing volumes and mean turnaround time (TAT) from sample collection, laboratory testing to results release, were abstracted from the national VL dashboard for 2014-2022. Additionally, data on proxy viral load coverage (VLC) - number of clients with documented VL test results divided by eligible clients on treatment in previous reporting period, for 2020-2022 were abstracted from the PEPFAR Panorama dashboard. Frequencies and trend analysis were performed.
RESULTS: During VL testing scale-up (2014-2019), the number of ART clients increased from 727,072 to 1,138,386 while VL tests increased from 240,008 to 1,502,950 (Figure 1). This dropped to 496,131 tests in 2021 but recovered to 1,003,125 in 2022. The mean TAT fell from 49 to 10 days between 2014 and 2019. This rose to 56 days in 2021 but recovered to 36 days in 2022. The proxy VLC dropped from 1,022,869 (89%) in 2021 Quarter One (Q1) to 337,751 (27%) in 2022 Q2 before recovering to 624,819 (49%) in 2022 Q4.

CONCLUSIONS: Reduced VL testing during the COVID-19 pandemic disrupted monitoring of viral suppression among PLHIV which impacted quality of care. The disruption could have been compounded by staffing and commodity constraints, and increased laboratory equipment breakdown due to additional COVID-19 testing. Careful consideration on using VL testing platforms and staff for other disease testing in addition to VL testing and ensuring commodity security could be made to avoid such program impacts during a pandemic.

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