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1. Viral Load
Surge
Part 2

2. Brief overview on the rationale for VL surge in South Sudan
Determine VL eligibility using the VL surge tool
Describe contact tracing of clients for VL sample collection
Briefly describe other operational considerations for VL surge
Objectives

3. • In FY21 Q1, PVLS (D) reported across all ICAP supported facilities stood
13,634 (56%) with an annual target of 24,439
• In comparison to FY20 Q3, findings showed Viral Load Coverage (VLC)
across supported health facilities declined from 67% in FY20 Q3 to 56% in
FY21 Q1.
• The decline in VLC necessitated the deployment of the ART Viral Load Surge
across all facilities aimed at rapidly improving VLC and VLS across all health
facilities in South Sudan
Introduction

4. • Missed opportunity by providers by not ordering VL test for eligible clients
• Poor understanding of VL eligibility and sample cascade amongst providers
• Lack of eligibility line list to ensure optimal sample collection for all eligible
clients
• Poor tracking of VL eligible clients by tracking teams and CoVs
• Weak monitoring of VL sample collection achievements viz-a-viz targets
Rationale for VL surge in South Sudan

5. How to use the VL surge tool
Operationalizing Viral Load
Surge

6. • Extract folders of all active clients
a) Using the ART database, the Data Clerk will create a line-list of UANs of “ACTIVE” clients
b) VL focal persons will systematically extract folders of “ACTIVE” clients according to the
developed line-list.
c) The VL focal person(s) will review each “ACTIVE” client’s folder and fill the VL surge
abstraction tool.
• Filling the VL surge abstraction template
a) The VL focal person(s) will review each “ACTIVE” client’s folder and fill the VL surge
abstraction tool
b) As client data is filled into the template, analyze to identify ELIGIBLE or Not-Eligible
clients.
Operationalizing Viral Load Surge at Facility level

7. • The surge tool is titled: Viral Load Surge
Tool_05 02 2021_FINAL
• Click to open tool.
• Enable MACROS
Using the Viral Load Surge Tool

8. Date of assessment
Insert the DATE of assessment on which the VL
chart review is being carried out
[Date format- DD/MM/YYYY]
Filling Viral Load Surge Tool

9. Facility column:
Fill in the name of facility in which the
assessment is taking place e.g., JTH, ALS, RSH
Filling Viral Load Surge Tool

10. Unique ART Number (UAN)
Insert the client’s UAN as reported in the
database
Filling Viral Load Surge Tool

11. Age (current)
Fill in the client’s current Age (in Years for
Adults and Months for children)
Filling Viral Load Surge Tool

12. ART start date
Document the date client was initiated on ART.
This is the recorded date on which client was first initiated on ART
[Date format- DD/MM/YYYY]
Filling Viral Load Surge Tool

13. Regimen (ARV regimen)
Indicate client’s current regimen from the drop-down option. (TLD or Non-TLD).
Regimens which do not contain DTG will be categorized under “Non-TLD” e.g. TLE
Filling Viral Load Surge Tool

14. Regimen/transition start date
Document the date on which client was started/ transitioned to current regimen
For ALL regimen (TLD or Non-TLD), Start or transition date may be the same as ART
start date
[Date format- DD/MM/YYYY]
Filling Viral Load Surge Tool

15. PMTCT – Pregnancy status of client
Use the drop down menu to indicate if Yes or No.
If YES, insert PMTCT start date in the next column (if NO leave
PMTCT start BLANK)
Note: Patient must be currently pregnant or breastfeeding
Filling Viral Load Surge Tool

16. PMTCT enrolment date
If PMTCT is YES, insert the date patient was started on PMTCT
(if NO leave PMTCT start BLANK)
Note: Patient must be currently pregnant or breastfeeding
[Date format- DD/MM/YYYY]
Filling Viral Load Surge Tool

17. High Viral Load (HVL)
Use the drop down menu to indicate “NO” if patient is NOT a HVL client.
However, the EAC-3 completed will change automatically to NA.
If client is a HVL client, indicate “YES”
If HVL is “Yes”, EAC-3 completed can take 2 possible options “Yes or No”
(next slide)
Filling Viral Load Surge Tool
Attention!

18. EAC-3 completed
For client with known HVL, use the drop down menu to indicate:
• “Yes” if client has completed EAC-3
• “No” if client has not completed EAC-3
Note: NA is ONLY applicable to clients without HVL (automated).
Filling Viral Load Surge Tool
Attention!

19. EAC 3 date
Insert the date on which client completed EAC-3.
[Date format- DD/MM/YYYY]
If client is yet to complete EAC-3, do not insert any dates, leave as
BLANK
Filling Viral Load Surge Tool
Attention!

20. Last clinic visit date (LCVD)
Insert client’s Last Clinic Visit Date (known or recorded last clinic visit
date)
[Date format- DD/MM/YYYY]
Filling Viral Load Surge Tool

21. Next appointment date
Insert client’s Next Appointment Date (next visit date)
[Date format-DD/MM/YYYY]
Filling Viral Load Surge Tool

22. Most Current Viral Load Date
Insert client’s Most Current Viral Load Date
[Date format- DD/ MM/ YYYY]
If client does NOT have any VL results, leave BLANK and
skip to next column
Filling Viral Load Surge Tool
Attention!

23. Most current VL result
Insert Most Current VL Results
Insert absolute figures if available (Do not include the units-copies/ ml)
Insert “LDL” if this is the documented result
If not done, insert “Nil”
Filling Viral Load Surge Tool
Attention!

24. Eligibility VL status
This section is automated.
Do not attempt to fill this section or delete any data from
this section
Filling Viral Load Surge Tool

25. 2
nd
(Last) VL date & Result
Insert 2
nd
VL Date & Results (previous VL)
Insert absolute figures if available (Do not include the units-copies/ ml)
Insert “LDL” if this is the documented result
If not done, insert “Nil”
Filling Viral Load Surge Tool

26. 2
nd
(Last) VL date & Result
Insert 2
nd
VL Date & Results (previous VL)
Insert absolute figures if available (Do not include the units-copies/ ml)
Insert “LDL” if this is the documented result
If not done, insert “Nil”
Filling Viral Load Surge Tool

27. 3
rd
(Last) VL date
Insert 3
rd
VL Date & Results (previous VL)
Insert absolute figures if available (Do not include the units-copies/ ml)
Insert “LDL” if this is the documented result
If not done, insert “Nil”
Filling Viral Load Surge Tool

28. 3
rd
(Last) VL date
Insert 3
rd
VL Date & Results (previous VL)
Insert absolute figures if available (Do not include the units-copies/ ml)
Insert “LDL” if this is the documented result
If not done, insert “Nil”
Filling Viral Load Surge Tool

29. Viral Load Eligibility: Determination of client eligibility for VL sample collection
This section is automated.
Do not attempt to fill this section.
Filling Viral Load Surge Tool

30. Interruption in treatment (IIT Status)
This section is automated.
Do not attempt to fill this section.
It shows, in months (range), client’s ART status (Active or IIT)
Filling Viral Load Surge Tool

31. Comments
This section is automated.
Do not attempt to fill this section.
It shows if client is a PMTCT or general ART client
Filling Viral Load Surge Tool

32. • Do’s
• Always maintain date format: DD/MM/YYYY
• Regimen: Use the drop-down menu to select Regime (TLD or Non-TLD)
• PMTCT: Use the drop-down menu to select PMTCT Status (Yes or No)
• HVL: Use the drop-down menu to select HVL status (Yes or No)
• If “No” is selected, EAC-3 completed changes automatically to “NA”
• If ”Yes” is selected skip to EAC-3 completed column
• EAC-3 Completed: Use the drop-down menu to select EAC-3 completed Status ONLY
IF HVL is YES (Yes or No)
• Most Current Viral Load Date: if not done, leave Blank
• Most Current Viral Load Result: if not done, insert “Nil”
• Don’ts
• Do NOT delete any information shown in Viral Load Status
• Do NOT delete any information shown in Eligibility Status (VL)
• Do NOT delete any information shown in Clinic Visit Status (IIT)
• Do NOT delete any information shown in Comment section
• Do NOT attempt to modify the surge tool for any reason whatsoever (document your
observations and share)
Viral Load Surge Tool: Do’s and Don’ts

33. • Tracking eligible VL clients
a) Transfer all identified “ELIGIBLE” clients (UAN) to the VL appointment
log.
b) Update contact details (phone numbers if available) of all “ELIGIBLE”
clients in the VL appointment log
c) Hand over the VL appointment log to the tracking team to commence
tracking activities immediately.
d) The VL focal person will pre-fill VL request forms and insert in client’s
folders, while awaiting return of client for sample collection.
Viral Load Surge at Facility level

34. • Tracing officer/ COVs
• Phone call script:
• Hello, my name is ____
• May I speak with ___________ (client name)?
• (if client not home, ask individual if they know when the client will be home
to call again.)
• I’m _______ and I work with _________ health facility
• I’m calling because you are scheduled/over due to have your treatment
monitored and we want to give you instructions how to do so.
• (If the client is not able to talk now, ask them when a convenient time is the
same day/or tomorrow to call back)
Contact tracing of clients: Phone call

35. • Tracing officer/ COVs
• Home visit script:
• Hello, my name is ____
• May I speak with ___________ (client name)?
• (if client not home, ask attending individual if they know when the client will
be home to visit again.)
• I’m _______ and I work with _________ health facility
• I’m visiting because you are scheduled/over due to have your treatment
monitored and we want to give you instructions how to do so.
• (If the client is not able to receive the visit now, ask them when a
convenient time is the same day/or tomorrow to return)
Contact tracing of clients: Home visit call

36. • Document the outcome of
every phone call or home
visit in the client tracking
register (for VL tracing)
• During phone calls and
Home visits refer to the VL
cue cards for guided
discussions
Contact tracing of clients

37. • VL request form
a) The VL focal person will pre-fill VL request forms and insert in client’s folders, while awaiting
return of client for sample collection.
• Sample collection:
a) As clients return to the facility for VL sample collection, clients are fast-tracked and escorted
to the sample collection point
b) The VL phlebotomist will verify correctness of the VLRF and immediately collect VL sample
Viral Load Surge: Returning clients for VL sample collection

38. The clinical provider should review the pre-filled VL Requisition Form.
Patient demographic information should be reviewed and updated to
ensure if contact tracing is needed in future; telephone number, address
and treatment supporter information are updated in the patient care card.
The clinical provider should document that S/he has ordered a VL test in
the HIV care and ART patient card under the “investigations” column by
writing “VL”.
The clinical provider should send the client for sample collection (or
collect the specimen).
Clients Returning for VL sample collection…

39. Returning clients will be provided with the minimum package of service
• Optimized ART: TLD transition and patient education
• Adherence counselling: ARV, VL sample collection, HVL-EAC, ART clinic
appointment.
• Treatment supporter services
• Client contact verification and update
Viral Load Surge: Minimum Standard of Services for Returning
clients

40. The sample collection person should review the VL requisition form, and if any
sections of the form are incomplete, to immediately send the form back to the
ordering provider for completion.
The sample collection focal person should fill out the Daily Sample Log/VL
Register, (kept at the site of sample collection), prepare the sample for dispatch,
and enter the relevant information in the Viral load Dispatch Form.
The VL focal person should review the Daily Sample Log every week to
determine and follow
up on outstanding results (>21days) and progress status of clients yet to return for
VL.
Clients Returning for VL sample collection

41. VL focal person will pre-fill the VL
laboratory request form
Viral Load Request Form

42. • The M&E focal person will review and report weekly achievements:
• Identify total TX_CURR per facility
• Upload TX_CURR into surge tool (to be completed within days or few weeks) to
determine eligibility for VL
• Number identified as eligible every week = denominator (b)
• Number of eligible cases (per week) whose samples were collected =
Numerator (a)
• VL sample collection coverage: Number of eligible clients (this week) whose
samples were collected (a) ÷ Total number of eligible cases identified this
week
• Application of VL monitoring
• Proxy to monitor success of client tracking
• Monthly target projection per facility per subpopulation
• Lab quantification (utilization prediction) of GeneXpert cartridges at POCs
Viral Load Surge: Monitoring VL Surge

43. • Anticipate an increase in VL requests as clients return to facility
• Expect a transient increase in sample collection workload for VL
Phelobotomist
• Expect an increase in sample assays carried out in the NPHL (ensure
adequate supply of reagents and or activate POCs)
• Anticipate an increase in phone calls for client tracing and reminder
calls to VL eligible clients by VL focal person and tracing teams
• NPHL dashboard to provide analysis of received, rejected samples and
improved result TAT.
Other VL surge operational considerations

44. • Create facility EID/VL email to reduce TAT for result dissemination.
• Anticipate an increased in frequency of sample transfer from
facilities to sample pooling hubs or NPHL by dispatch riders.
Other operational considerations

45. • To improve viral load coverage in-country, the
NPHL is planning to scale up GeneXpert POC
machines in seven (7) facilities.
• List of facilities with GeneXpert POCs
1. Mary Immaculate Mapuordit
2. Yirol Hospital
3. Tambura Hospital
4. Ezo Hospital
5. Maridi Hospital
6. Lui County Hospital
7. Magwi PHCC
• Cartridges for operationalizing these POC
machines will be arriving in-country in March
2021.
• Upon arrival, the cartridges will be distributed
to these POC facilities.
• VL testing will be carried out in these facilities
with POCs.
Viral Load Surge: POCs

46. Thank you for listening