BACKGROUND: Adult and pediatric viral load (VL) coverage in Chegutu, Kadoma, and Mhondoro districts of Mashonaland West province in Zimbabwe ranged from 80.2% to 87.8%, below the PEPFAR program target of 95% within 3 months. Contributing factors include limited reminder systems for routine VL and long turn-around times (up to 3 months) In June and July of 2022 Zimbabwe Ministry of Health and Child Care (MOHCC) Quality Improvement Unit implemented pragmatic interventions to better identify clients needing annual VL, efficiently collect and process specimens, and improve documentation of results in these three districts
DESCRIPTION: VL interventions in the three districts included:
1) Reviewing and organizing clients’ charts by cohorts using month of antiretroviral therapy initiation;
2) Flagging clients without current VL results using designated stickers;
3) Increasing proactive contacting of clients to attend VL collection in collaboration with community health workers; and
4) Using mobile laboratory equipment to collect and prepare both plasma and DBS samples on-site prior to transporting and processing at central laboratories.
Clients could choose between sample collection at facility or during community outreach closer to their homes, including as part of differentiated service delivery models, such as community and family ART refill groups.
LESSONS LEARNED: On-site sample processing increased number of samples suitable for VL testing at central laboratories. Turn-around time between laboratory and facility decreased from an average of 90 days to 1 day. The availability of dedicated VL mobile phones at facility level improved turn-around time. Overall, after 2 months implementation the proportion of clients with a current VL increased by 5% - 16% across the three districts, resulting in each district achieving coverage within reach of the 95% target (Table1).

Table 1: Comparison of Viral Load Coverage in Three Districts in Western Zimbabwe Before and After Implementing, Client Cohorting, Community Outreach, and On-site Sample Preparation, 2022
	Q2, 2022	Q4, 2022
District	Baseline	Achievement	% Improvement
Mhondoro	80.2%	96.7%	16.5%
Sanyati	87.8%	93%	5.2%
Chegutu	81.1%	92%	10.9%

CONCLUSIONS: An intensive two-month effort reorganizing existing program resources improved VL coverage and resulted in more timely feedback on viral suppression. Augmenting routine quality improvement efforts with periodic catch-up campaigns increases program performance.

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