Table 4 Health facility and patient related challenges encountered in the provision of viral load testing services

Transport related reasons

 Lack of safe and reliable mode of transport for laboratory specimens

 Fuel shortages impeded sample collection

 Irregular sample collection from facilities

 Transport challenges adversely affected VL turnaround time

Sample related issues

 Shortage of EDTA tubes for collecting whole blood samples for viral load testing

 High rejection rate as a result poor sample quality due to delays in transporting whole blood samples from facilities to the laboratory

 Not enough space for privacy to attend to a patient's needs (e.g., counselling a patient on HIV-related issues including need for viral load testing)

Data issues

 Non-availability of viral load registers to document when viral load tests were conducted, when viral load results were received and if clients received their results. Nurses improvised and utilised notebooks which resulted in incomplete entries

 For those facilities with electronic systems, systems were not customised to capture viral load results; hence pregnant women living with HIV who were in the ePMS would not have any results highlighted in the systems, even though results may have been available at the facility. The information system showed the patients as not having viral load tests done

Patient-related problems

 Patients sometimes gave health care providers incorrect contact information

 Challenges with contacting and follow-up of patients living outside the health facility catchment area

 Some patients do not return for antenatal care visits and do not collect viral load results on time

 Late booking for antenatal care and hence delays in having first VL tests

 Failure of patients to understand their results