Exploring the knowledge and perceptions of viral load testing and low-level viremia among health-care workers in Uganda: A qualitative study

Abstract

Provision of human immunodeficiency virus (HIV) care including viral load (VL) testing and management of low-level viremia (LLV) depends on the knowledge and perceptions of health-care workers. This qualitative study was conducted in Uganda and aimed to provide health-care worker perceptions and knowledge gaps that need to be addressed to improve VL testing and management of LLV. We conducted 15 key informant interviews with health-care workers (clinicians, nurses, laboratory staff, and counselors). Participants were purposively selected from 8 high-volume HIV clinics across Uganda. The clinics were purposively selected based on provision of VL services and having high numbers of people with LLV. All the interviews were audio-recorded and transcribed verbatim. Thematic analysis was used for data analysis, with the help of ATLAS.ti 6. We identified 7 main themes, and these included: understanding of VL testing, perceived benefits of VL testing, best practices in improving VL testing, challenges to VL testing, strengthening VL testing, understanding LLV, and implications of LLV. All the health-care workers were proficient in VL testing and its associated benefits. Different best practices like the use of linkage facilitators among others were reported to be useful in VL testing. The main challenges to VL testing were lack of transport, long waiting times at the clinics, delayed return of results, and HIV-related stigma. Health-care workers could not define the term, “low-level viremia.” However, most of them were aware that a VL range between 50 and 999 copies/ml was not desirable. LLV was perceived to be caused by suboptimal drug adherence. There is need for centralized VL testing to be complemented with point-of-care testing to reduce results turnaround time. Similarly, there is also an imminent need to establish comprehensive interventions to manage LLV such as targeted health education of health workers in Uganda.