Background: Accurate estimation of viral suppression among people living with HIV is essential to measuring progress toward UNAIDS'' 90-90-90 goals. Many countries in sub-Saharan Africa, however, face challenges in scaling up to universal viral load (VL) testing. In 2017, an assessment of the rollout of “treat all” guidelines at ten health facilities in northern Namibia reported that over one-third of client health records contained no VL measurements during the previous 12 months. Following this finding, we conducted a qualitative assessment of practices and challenges related to VL testing.
Methods: Ten focus group discussions were conducted with medical officers, nurses, and counselors at ten district hospitals and ART clinics in northern Namibia. Additionally, 22 in-depth interviews were conducted with facility clients who either had no VL test results recorded in their health passports in the prior 12 months (n=12), or whose most recent VL test results indicated treatment failure (>1,000 copies/ml; n=10). A thematic analysis of interview transcripts was conducted using Atlas.ti 7 to assess ART providers'' and clients'' understanding of, and experiences with, VL testing.
Results: Results showed that while providers recognized clients'' need for education about VL testing, they believed that most clients understood the process and should be ultimately responsible monitoring their own testing schedule. However, many clients interviewed lacked even basic correct knowledge of VL testing. Some clients understood the link between VL and treatment effectiveness, but more had never heard of VL testing. Of those who received VL test results, several confused their results with results from other tests. Others indicated that providers gave only cursory explanations of their results, leaving some feeling frustrated.
Conclusions: Our findings illustrate challenges at the selected health facilities with ensuring providers complete VL testing at recommended intervals, as well as need to strengthen client participation in own care. As clients demonstrated interest in understanding VL testing and monitoring their health, ensuring that clients are educated about VL measurement may help to increase VL testing rates. Simultaneously, it is essential that providers proactively discuss VL results?and the ramifications thereof?with their clients.