GuidelinesIMCI

Routine Laboratory Tests

IMCI - Anti-retroviral therapy (ART)

Laboratory Tests

Adherence Principles

Laboratory test

Laboratory tests that should be routinely sent are shown in the table below
Always make sure that the results are correctly recorded in the child’s records and Paediatric and Adolescent Stationery
Make sure that you act on the tests: if you are unsure discuss the test results with a colleague or refer the child

Test	When should it be done
CD4 count and percentage	At ART initiation After 12 months on ART Thereafter every 6 months until the child meets the criteria to discontinue cotrimoxazole prophylaxis If not virally suppressed, monitor CD4 count 6 monthly
Viral load (VL)	After 6 months on ART Thereafter, if virally suppressed, every 12 months If not virally suppressed, address adherence,repeat VL after 3 months and reassess
Hb or FBC	At initiation/ before change to 2nd line ART If less than 8 g/dl refer to next level of care If on AZT (1st or 2nd line ART)
Non-fasting total cholesterol and triglycerides	For children on Protease Inhibitor based regimens (LPV/r, ATV/r, DRV/r) After 3 months on ART Then every 12 months thereafter, if within normal/ acceptable range
Creatinine and creatinine clearance (Cr Cl)	For children/ adolescents on tenofovir (TDF) At initiation At month 3, 6 and 12 Thereafter, repeat every 12 months

Viral Load

Viral load (VL)	Response
Lower than detectable limits (LDL) or <50 copies/mL	Praise the patient and caregiver (s) Continue VL monitoring according to normal schedule Continue routine follow up and adherence support.
50 - 1 000 copies/mL	Begin step up adherence package Repeat VL in 3 months Thereafter monitor VL according to normal schedule if adherence support is effective
>1 000 copies/mL	Begin step-up adherence package Repeat VL in 3 months: - If <50: Return to routine monitoring as above - If 50 - 1 000: Continue step up adherence support and repeat VL after 6 months - If VL still >1000: Refer to doctor visiting the clinic or local hospital if no visiting doctor
Creatinine and creatinine clearance (Cr Cl)	For children/ adolescents on tenofovir (TDF) At initiation At month 3, 6 and 12 Thereafter, repeat every 12 months

Adherence Principles

Very high levels of adherence (>95%) should be attained for adequate virological response and prevention of viral resistance
This can be achieved with regular education and support
All efforts to encourage this level of adherence should be made
Viral load measurements are useful for monitoring adherence

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Integrated Management of Childhood Illness 2022; Anti-Retroviral Therapy; Routine Laboratory Tests

Last checked for updates: June 2023