A study of outcomes of seven years' viral load testing at the National Public Health Laboratory, Nepal

The benefits of antiretroviral therapy (ART) in patients living with HIV (PLWH) in Nepal have been obvious. However, their viral load (VL) and the effects of VL testing scale-up on the outcomes of HIV treatment have not been adequately investigated. In Nepal, VL tests were performed since 2009 at National Public Health laboratory. VL testing for monitoring scale up was introduced in 2014. The present study was undertaken to find out the virological failure (VF) and virological suppression (VS) rates in PLWH on ART in Nepal and to assess the effect of VL testing coverage on ART outcomes. A total of 8,230 blood/plasma samples were collected from among 11,922 patients on ART during 2009 to 2015. The VL testing coverage in 2009 was 2.9% which increased to 48.3% in 2015. VF was 35.9% in 2009 (mean for 2009-2013 was 27.5% and for 2014-2015 the mean VF was 10.2%). Decrease in VF to nearly one third in 2015 coincided with the rise in VL testing coverage (from 2.9 to 48.3%). Improvement in VL testing coverage for ART monitoring coincided with decline in VF, indicative of ART optimization. VL testing of ART treatment failure cases only in the first segment of the study (2009-2013), accounted for initial low VL coverage. However, 48.3% coverage in the last year of scale-up period, with a mean VF of 10.2% and nearly 90% of all those receiving ART having VS, was very encouraging.