Improving Viral Load Sample Collection in Blantyre District

Background

The World Health Organization recommends viral load (VL) testing as crucial for monitoring how People Living with HIV respond to antiretroviral therapy (ART). However, Malawi encounters difficulties with achieving comprehensive viral load sample collection coverage which is below 70%, despite having established policies. Challenges in VL sample collection within ART clinics in Malawi include:

• Poor clinic workflow
• Lack of screening tools
• Absence of standardized VL health talk procedures
• Over-reliance on electronic systems for client identification

This study evaluates an intervention implemented at three Blantyre health centers: Bangwe, Ndirande, and Chilomoni.

Intervention Design

The May-July 2023 intervention included four key components:

1. Active pre-clinic screening: Identifying eligible clients one hour before clinic opening
2. Standardized health talks: 20-minute sessions using newly developed SOPs
3. Workflow redesign: VL sample collection before ART refill
4. Daily data feedback: WhatsApp-based reporting system

The intervention replaced the previous system where staff relied on electronic flags or patient cards after ART refill. The new approach featured:

• Reception screening using a new tool
• Pre-visit client flagging
• Health passport reviews for missed clients
• Pre-appointment reminders

Results

Conclusion

This study demonstrates that simple, cost-effective interventions can significantly improve VL sample collection rates. Key lessons include:

• Systematic identification of workflow gaps enables targeted solutions
• Standardized procedures combined with staff training enhance performance
• Real-time data feedback maintains intervention effectiveness

These findings underscore the importance of recognizing system limitations and implementing tailored interventions for effective HIV program implementation in resource-limited settings.