BACKGROUND: In 2020, UNAIDS established the 95-95-95 goal of 95% of all people living with HIV to know their HIV status, 95% of all people diagnosed with HIV to receive sustained antiretroviral treatment (ART), and 95% of all people receiving ART will achieve viral suppression. Attainment of the third 95% remains a huge challenge to the National HIV response of low and middle-income countries (LAMICS). Most of the research and programmatic attention has focused on above-site and individual-level barriers to access. This approach has not sufficiently recognized facility-based challenges. According to a 2019 study by the USAID Ghana Strengthening the Care Continuum Project, implemented by JSI Research & Training Institute, Inc., over 50% of low viral load coverage was caused by poor facility-based viral load management practices, provider oversight, and multi-month dispensing, without alignment to viral load due dates. Here we illuminate a strategic approach to addressing this critical programmatic gap in Ghana’s Western Region.
DESCRIPTION: The Project designed a “person-centered viral load management plan” (PVLM) as an addendum to ART client’ folders. This was a major component of the Project’s Quality Improvement (QI) activities. From October 2021 to October 2022, a team of facility-based service providers and QI project officers conduced quarterly assessments facility-based viral load coverage and viral load management culture, in 21 ART sites in the Western region
LESSONS LEARNED: The intervention was successful and resulted in a significant improvement of viral load coverage and suppression. Data from Ghana’s national electronic e-Tracker HIV service database showed that viral load testing coverage improved from 54% in December 2016 to 90% for all eligible clients by December 2022. There was a corresponding increase in viral suppression from 64% in December 2020 to 95% in December 2022.
CONCLUSIONS: Viral load is not only a key determinant of a successful HIV treatment program, but also is key to achieving the 3rd 95%. Closely monitoring facility- and provider-based challenges and developing person-centered viral load management plans are effective strategies to achieve higher viral load coverage and suppression. The results of this intervention can inform national level policy and management for scaled implementation.

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