A targeted approach for routine viral load monitoring in Malawian adults on antiretroviral therapy

Objectives WHO recommends HIV viral load (VL) testing 6 months after antiretroviral therapy (ART) initiation and every 12 months thereafter, but cost prohibits routine, universal VL testing in many developing countries. We sought to devise a targeted approach to routine VL monitoring that could reduce cost and identify those at low risk for virologic failure (VF). Methods We analysed screening data from a clinical trial enrolling adults on ART in Malawi. We identified risk factors associated with VF and employed the Knill–Jones method to assign summary score identifying persons at lower risk for VF. Results Among 957 adults, prevalence of VF was 9.4%. Factors independently associated with VF included age 2.5 years (OR 2.98, 95% CI 1.79–4.96), ART adherence