# RAPID-VL: Optimizing HIV Viral Load Monitoring and Outcomes for High-Risk Populations

> **NIH ALLCDC U01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $1

## Abstract

PROJECT SUMMARY/ABSTRACT:
HIV viral load (VL) monitoring is a crucial component of the ongoing scale-up of antiretroviral therapy (ART) in
Sub-Saharan Africa. Uganda recently launched a nationwide VL testing system; however, significant
implementation gaps have emerged in three critical areas: (1) inadequate VL ordering, (2) slow generation and
reporting of VL results, and (3) suboptimal interpretation of VL results for adherence counseling. Additionally,
significant disparities exist in sub-populations at high-risk of virologic failure including (1) pregnant women, (2)
children and adolescents, (3) persons whose last VL was detectable, and (4) persons missing a VL test. To
address the implementation gaps on how best to improve VL ordering, speed up VL turnaround time, and
improve VL counseling, we propose a comparative effectiveness, clinic-level cluster randomized trial of a
targeted, multi-component intervention package called “RAPID-VL” among 1,200 high-risk and non-high-risk
patients in 20 PEPFAR-supported ART clinics in southwest Uganda. Anchored in the PRECEDE
implementation science framework, “RAPID-VL” consists of (1) a VL ordering flowsheet to increase correct VL
ordering, coupled with a performance feedback system to reinforce best practices, (2) a point-of-care VL
machine at a hub near the clinics that will speed up the generation and delivery of VL results to clinicians, and
(3) a VL counseling package that teaches clinicians an efficient method for counseling patients on VL results.
Aim 1: Determine the comparative effectiveness of the RAPID-VL intervention on VL ordering and VL
turnaround time: We will randomize HIV clinics to RAPID-VL vs. standard VL procedures (n=10 clinics each,
60 patients/clinic, comprised of 20 non-high risk patients plus 10 high risk patients in each of 4 categories), and
will compare (1) guideline-indicated VL ordering, (2) VL turnaround time, (3) VL suppression, (4) VL re-
suppression after a detectable result, and (5) switching to 2nd line ART. Aim 2: Identify facilitators and
barriers to implementation, as well as perceived utility of RAPID-VL from both patient and clinician
perspectives. We will measure fidelity to each RAPID-VL component via in-clinic observations and training
assessments. We will perform qualitative interviews of 20 clinicians and 40 patients to capture facilitators,
barriers, acceptability and sustainability of RAPID-VL and examine its perceived utility.  Aim 3: Determine the
costs, cost-effectiveness, and incremental gain costs of RAPID-VL: We will conduct micro-costing
analyses of key cost inputs including training, clinician effort, point-of-care VL machinery, and transportation
costs. We will compare these to costs of the current standard of care DBS-based system on unit cost and
“cost-per-added success.” We will also estimate cost per disability-adjusted life year (DALY) averted for
RAPID-VL. Our overall objective is to rigorously test a novel intervention to improve VL operatio...

## Key facts

- **NIH application ID:** 10004545
- **Project number:** 5U01GH002119-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Vivek Jain
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2020
- **Award amount:** $1
- **Award type:** 5
- **Project period:** 2016-09-30 → 2021-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10004545

## Citation

> US National Institutes of Health, RePORTER application 10004545, RAPID-VL: Optimizing HIV Viral Load Monitoring and Outcomes for High-Risk Populations (5U01GH002119-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10004545. Licensed CC0.

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