Toward Empowering Women in HIV Care: A Peer-Supported Patient-Initiated Viral Load Testing Cluster-Randomized Trial...

BackgroundRoutine viral load testing (VLT) is critical for monitoring HIV treatment effectiveness, yet adherence to annual testing and patient engagement remain suboptimal, particularly among women. We evaluated a peer educator-supported, patient-initiated VLT approach in Dar es Salaam, Tanzania.MethodsIn 2024, a two-arm cluster-randomized trial was conducted across six public HIV clinics. Intervention sites implemented a 4-6-month peer-supported program promoting patient-initiated VLT, while control sites continued routine care. Data from adult PLHIV were analyzed using regression models.ResultsAmong 567 participants, 14.8% had not tested within 12 months, with higher non-testing among men (19.7% vs. 12.2%, p=0.019). Intervention sites showed higher mean numbers tested for men (65 vs. 26) and women (146.4 vs. 57). Although patient-initiated testing was infrequent overall (2.8%), the intervention arm demonstrated higher odds of patient-initiated viral load testing than the control arm (aOR=4.69; 95% CI: 1.30-16.95).ConclusionPeer-supported strategies improved patient-initiated VLT and female engagement but require stronger health system support.