Utilisation Of HIV Viral Load Testing Services At Kamuli General Hospital

Abstract

Introduction. Uganda adopted the HIV viral load (VL) test as a preferred approach for monitoring response to ART and to diagnose/confirm ART treatment failure in 2014. However, its utility in most of the ART clinics in Uganda, including Kamuli General Hospital, is lower than the expected 100% as per Ministry of Health guidelines of 2020. In addition, the VL is used to monitor patients on ART. This helps ART clinic teams take subsequent clinical decisions, including switching patients from one regimen to another or carrying out adherence counselling. Objective. The objective of this study was to assess utilisation of VL testing services in the management of HIV patients on ART at Kamuli General Hospital to improve routine monitoring to ensure VL suppression is achieved. Methods. A cross-sectional study was conducted at Kamuli General Hospital in the ART clinic and utilised both quantitative and qualitative data collection methods. A systematic sampling technique was used to select participants for the study. Percentages were used to present categorical findings and median (interquartile range) for the duration on ART. Thematic analysis was used to present qualitative findings from the three key informants. Results. A total of 304 patient ART charts were included in the study, and of these, 194 (63.8%) were females. The median duration on ART was nine months with an interquartile range (IQR) of 7 to 10 months. Of the eligible patients on ART, 261 (86%) had a viral load test done, and 215 (82%) had suppressed VL (<1000 copies/ml). Regarding documentation of VL and having their cards updated, 218 (83.5%) had their cards updated, 25 (9.6%) not updated, 18 (6.9%) had incomplete data. Low staffing levels/work overload, overwhelming numbers of patients, lack registers, request forms and ART cards were the major healthcare provider factors while lack of designed refrigerator to handle VL samples was the main laboratory services related factor that influenced VL utilization at Kamuli general hospital. Conclusions. Eligible patients on ART with a viral load test at Kamuli General Hospital were lower than the targeted proportion of 90%, and VL suppression was also lower than the acceptable National target of 90%. Low staffing levels/work overload, overwhelming numbers of patients and lack of registers, request forms contributed to the performance that is lower than the acceptable National targets. Therefore, the hospital needs to employ more health workers, provide standard registers and requisition forms for better performance.