Evaluation of Viral Load Testing Services for HIV Monitoring in Antiretroviral Therapy Clinics in Rivers State

Routine viral load monitoring is an essential component of antiretroviral therapy (ART) program management, enabling timely detection of treatment failure and prevention of HIV drug resistance. This operational evaluation assessed the quality, availability, and utilization of viral load testing services across seven ART clinics in Rivers State, in the South South geopolitical zone of Nigeria. A mixed-methods approach was employed, incorporating service delivery audits, laboratory infrastructure assessment, review of viral load data from 1,500 patients on ART, and key informant interviews with clinic managers and laboratory staff. Viral load testing coverage, defined as the proportion of eligible patients receiving a viral load result within the recommended period, was 61.7 percent across all clinics. Turnaround time from sample collection to result delivery averaged 21.4 days, significantly exceeding the national 14-day target. Sample rejection rates due to inappropriate handling were 8.3 percent. Viral suppression, defined as viral load below 1,000 copies per mL, was achieved in 78.2 percent of patients with a documented result. Staff reported inadequate training in sample transportation and result interpretation in 43 percent of clinics. The study recommends decentralization of viral load testing capacity, point-of-care viral load technology adoption, and standardized sample transport logistics to strengthen ART monitoring across Rivers State. Keywords: viral load, HIV monitoring, antiretroviral therapy, Rivers State, laboratory services.