Implementation of CD4 and viral load testing in decentralized, remote and resource-limited settings

A community health worker at Bvumbe Health Centre in Malawi pricks a man’s finger for a sample to use in a dried blood spot (DBS) viral-load test (Image: Médecins Sans Frontières)

Demonstrating the feasibility of CD4 and viral load testing in resource-limited settings.


Periodic viral-load testing is critical to ensure that HIV treatment is working effectively. In resource-limited settings, most HIV diagnostic facilities are centralized and require trained staff as well as specialized infrastructure. They are often located far from patients’ homes, so results can be lost or delayed due to the distance between sample collection and testing sites.


The project was implemented in DRC, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Uganda, and Zimbabwe to establish best practices for the use of new point-of-care diagnostic technologies in resource-poor settings. It also aimed to demonstrate the feasibility and cost-effectiveness of viral-load monitoring in remote areas, thereby giving manufacturers an incentive to invest in this market. The objective is to encourage more manufacturers to enter the market, which would bring prices down.

Impact achieved

The project generated a wealth of evidence demonstrating the feasibility of viral-load testing, which helped to encourage partners and low-income countries to establish programmes. The project provided guidance and ready-to-use tools for implementation of viral load testing programmes.

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