Using Mobile Phone Infrastructure Provides Evidence of a Reduction in Diagnostic Turnaround Times and Improved HIV Viral Load Monitoring in Malawi

BackgroundMalawi has 991,600 people living with HIV and has expanded access to annual HIV viral load (VL) testing to enhance care quality for clients. However, significant delays persist in returning VL results from laboratories to facilities and from sample collection to client receipt. To address this, we implemented a digital viral load results return (VLRR) application, using existing mobile phone platforms (SMS/USSD), to expedite results return to clients and healthcare providers (HCPs). MethodsVLRR is a digital SMS/USSD platform leveraging mobile phones to reduce turnaround time (TAT) and improve access to VL results. To evaluate the VLRR intervention, we: (1) estimated the TAT for digital results return and compared it to the paper-based process, (2) calculated open rates for digital results, (3) conducted a qualitative evaluation with VLRR users, and (4) estimated the potential cost savings from avoiding unnecessary sample redraws. ResultsFrom April 2022 to June 2024, HCPs registered 4,067 clients. Before VLRR implementation, the average TAT for clients to receive VL results was 128 days. After VLRR enrollment, it was 48.5 days (a 62.4% improvement) using electronic medical record data. By Q2 2023, VLRR clients and HCPs received results in an average of 30 and 38 days. The overall open rate for digital results (opened by either a client or HCP) was 72%. Of the clients interviewed, 98% expressed a desire to continue using VLRR, and 100% of HCPs recommended expanding the platform to other HCPs. ConclusionVLRR is effective in reducing TAT and improving access to VL results for both clients and HCPs. To enhance uptake and achieve national scale, VLRR can be integrated into Malawis existing EMR systems, further reducing TAT and enabling HCPs to deliver higher quality care and improve long-term clinical outcomes.