Routine HIV VL Monitoring on ART
A dispensing cycle is defined as the number of days for which a client would have treatment if a single standard “monthly” quantity of tablets was dispensed. The term ‘dispensing cycle (DC)’ is preferred to the previously used term ‘month’ due to the potential discrepancy that may arise between the days of treatment dispensed (if 28 day pack sizes are used) and the days in a month (on average, 30
A dispensing cycle is defined as the number of days for which a client would have treatment if a single standard “monthly” quantity of tablets was dispensed. The term ‘dispensing cycle (DC)’ is preferred to the previously used term ‘month’ due to the potential discrepancy that may arise between the days of treatment dispensed (if 28 day pack sizes are used) and the days in a month (on average, 30 days). However, the term dispensing cycle can be applied to single pack sizes of 28 tablets (1DC) or larger pack sizes of 90 tablets (3 DCs).
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Routine VL Monitoring |
Intervention | EAC indicated? |
| First VL after ART initiation | Do 1st VL after 3 dispensing cycles | • Allows for earlier detection of factors influencing viral suppression • Allows for earlier decanting for suppressed clients to minimise visits and promote continued engagement in care • This VL will form part of the 6 month VL completion cohort in Tier.net |
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Second routine VL after ART initiation (in clients who remain virally suppressed) |
This VL can be done from 10 dispensing cycles but should be aligned with the clients scripting cycle | • This VL will form part of the 12 month VL completion cohort in Tier.net |
| Third routine VL after ART initiation (in clients who remain virally suppressed) | This VL can be done from 22 dispensing cycles, but should be aligned with the clients scripting cycle | • This VL will form part of the 24 month VL completion cohort in Tier.net |
| Fourth and all subsequent VLs | VLs will be taken at intervals of 12 dispensing cycles for all clients who remain virally suppressed | |
The timing of dispensing cycles, follow-up visits, and VL monitoring is illustrated in the diagram below
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- For the 1st VL taken after 3 dispensing cycles, clients should be requested to return to the facility one DC later to review results and so that the client can be assessed for RPCs eligibility.
- For all subsequent VL monitoring (and other routine monitoring investigation) in clinically well clients: Clients should be rescripted at the same visit that their VL is taken. Clients should not be required to come back to the facility the following month for VL result review prior to rescript. Rather, recall to the facility only those clients with an elevated VL or other abnormal result.
- Facilities should ensure that results management processes are in place to ensure that results are reviewed by a clinician, that abnormal results are identified, and the client is appropriately actioned. The NHLS Results for Action (RfA) reports are a useful tool to facilitate the review of results.
Breastfeeding women should have their VL monitored every 6 months starting from the time of delivery.
2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates
June 2023 Version 4
Upload date: 31/07/2023