Crisis looms as HIV patients miss viral load tests 

Laboratories in government health facilities have a backlog of samples for vital HIV tests, some of which date back two years, the Nation has learnt.

This means that in all this time, people living with HIV who depend on public hospitals for their testing and treatment have not been able to tell their viral load.

A viral load (VL) test is done to determine the amount of HIV in one’s blood. When one is first diagnosed, doctors will order the test to determine if they need to recommend antiretrovirals. The higher your viral load, the faster your CD4 cell count will drop, and the more likely you are to become ill due to HIV.

A low or undetectable viral load means there is very little HIV in the blood. Without any virus to replicate, it is much harder to transmit the disease.

Viral load monitoring 

Routine viral load monitoring is an integral part of treatment to keep HIV under control. When one keeps a close eye on their viral load, they can help doctors determine the best way to take care of them. Viral load checking has decreased the number of Aids-related deaths.

Some samples taken by government facilities for two years have not been tested and patients have not received their results.

Speaking during this year’s National Leadership Summit of People Living with HIV in Nairobi, many patients said they have not been able to get their VL test done and this is affecting how they respond to their treatment.

Many of them said hospitals did not give them the reason for not getting results, with some reporting that they had been told there were no reagents for the test. Some have had to pay for the services in private health facilities.

One of the challenges in viral load testing is the price of the test, which is relatively high. The cost per test is estimated at anything between Sh10,000 and Sh20,000, depending on the hospital.

As we mark World Aids Day tomorrow, HIV patients asked the government to ensure that public hospital laboratories are stocked with viral load test reagents.

“I have been taking my drugs diligently, but they seem not to be working because I have been down with illness for the past two months. My doctor recommended that I go for a viral load test to determine the problem,” said Mr Omondi. “I am not able to have the test done in the government facilities in Homa Bay and Migori counties. In one of the private hospitals, I was told it would cost Sh10,000. I don’t have the money.”

Mr Erick Okioma, director of the Nelson Mandela TB HIV Community-Based Organisation, said his members have not been able to be tested for viral load because hospitals have been reporting a shortage of reagents. “Before one is placed on any drugs once they have tested positive, then we need to test and get to know their viral load and also to know which drug to give them. Without this test, then we are missing our target,” he said

Mr Nelson Otwoma, executive director of the National Empowerment Network of People Living With HIV/Aids in Kenya, said testing for viral load in the body is critical to ensuring that more people receive HIV care and treatment.

“Giving the drugs alone is not enough; we need to monitor how we are doing. This is a crisis in the making. We take samples and it takes too long to get results. The patients are told there is a backlog and they have to wait for long. Some of my members have not tested for their viral load for the past two years. We don’t even know whether they are transmitting the virus,” he said

“If you are thinking of having children, you should keep track of your viral load. Pregnant women with a high viral load are more likely to pass the infection to their children,” Mr Otwoma said.

He said viral load monitoring is an effective way to prevent virus transmission. For a discordant couple (where one partner is HIV-positive), having regular viral load testing will keep the risk of transmission low. 

Treatment response

Dr Jacob Bulimo, the Elizabeth Glaser Paediatric Aids Foundation senior technical lead of HIV care and treatment, said through viral load testing, one is able to check whether the patient is responding well to prescribed drugs. This should be done after every six months for all HIV patients.

“If the viral load is more than 200 copies per millilitre, then definitely there is a problem. There could be non-adherence to medication, lack of caregiver support, poor clinic visits, and even stockouts. We tease out everything and move to non-adherence counselling training,” he says.

A repeat viral load test is done after three months. In case of a failure, then the patient is eligible to proceed to the next line of medicine.