Feasibility of antiretroviral treatment monitoring in the era of decentralised HIV care

In many low and middle income countries mostly affected by the HIV epidemic, decentralisation of HIV treatment and care linked with task-shifting has been implemented in response to the need of scaling up service provision.

Evidence from existing systematic reviews suggest that provision of antiretroviral therapy services closer to patients’ home through decentralised care could improve patient access and adherence to HIV treatment with non-inferior quality of care as compared to centralised, hospital-based care.

Current WHO guidelines on use of antiretroviral drug for treatment and prevention of HIV recommends regular virological monitoring, or immunological and clinical monitoring for all patients who are receiving antiretroviral therapy to monitor patient response to treatment and identify potential treatment failure.

However, these challenges may not be well documented and may even be overlooked in the current literature. While scaling up of ART programs should and will be intensified in the years to come, the question of how to effectively and efficiently implement these programs depends on country-specific HIV epidemic and health system infrastructure.

Our review aimed to assess the feasibility of antiretroviral treatment monitoring in settings of decentralised HIV treatment and care in low and middle income countries.

More specifically, we aimed to assess the proportion of patients receiving clinical monitoring, CD4 count, and viral load monitoring at regular treatment follow-ups and to assess factors (enablers, barriers) and other implementing issues associated with provision of antiretroviral therapy monitoring services.


Sept 2015 -


The search strategy identified 5,363 titles after duplicates were removed. Screening of title, abstract and exclusion of clearly irrelevant studies resulted in 58 eligible studies for full text review, of which 19 studies met all of the inclusion criteria, and were included in the review. Further analysis is ongoing.

Health Issue

Contact Details

For any general enquiries relating to this project, please contact:

Doctor Minh Duc Pham

Senior Research Officer