Journal de médecine légale

HIV Viral Load Assessment in the South African Public Health Landscape: Navigating Changing ART Guidelines and Technological Progression, 2013-2022

Abstract

Ndlovu Sarang

HIV Viral Load (VL) assessment serves as a pivotal tool in HIV clinical management, offering insights into adherence and antiretroviral effectiveness. Over time, both national and global antiretroviral treatment guidelines have evolved to recommend regular VL testing. South Africa (SA) has advocated for routine VL testing since 2004. The centralized HIV VL program, overseen by the National Health Laboratory Service (NHLS), has experienced substantial expansion. An analysis of de-identified retrospective VL data spanning from 2013 to 2022 was conducted to assess program performance. The volume of tests performed exhibited remarkable growth, surging from 1,961,720 tests in 2013 to an impressive 45,334,864 tests in 2022. Median total in-laboratory Turn Around Times (TAT) fluctuated, ranging from 94 hours in 2015 to 51 hours in 2022. The introduction of two novel assays contributed to enhanced median TATs across all laboratories. The occurrence of VL levels exceeding 1000 copies/ mL exhibited a steady decline. While experiencing initial growth, instances of VL counts below 50 copies/mL plateaued at around 70% starting in 2019, gradually decreasing to 68% by 2022. Some discrepancies among assays were noted. In summation, South Africa's VL program has achieved significant success. Remarkably, the program stands as the world's largest of its kind, offering valuable insights for future public health initiatives reliant on laboratory support for patient outcomes and program performance assessment.