Conclusions and recommendations
We found that in rural Zimbabwe, the clinic-based SAMBA II assay for VL testing can achieve high testing coverage in rural Zimbabwe and reduced TAT for VL results. However, the rapid TAT did not allow for a more efficient drug switch constrained by the bimonthly visit schedules. Despite access to VL monitoring, VL suppression among these CALWH did not reach 90%. A study-adapted visit schedule is recommended in future trial. This study design would help ascertain the effectiveness of clinic-based VL testing in reducing TAT for VL results and drug switch and consequently improving VL suppression among CALWH in rural Zimbabwe.VL testing remains important to identify those with adherence and access issues to mitigate the selection of drug resistance. Monitoring VL using a mixture of clinic-based assays and central laboratory testing, adapted to HIV programs serving vulnerable populations, will simplify ART with the widespread use of more effective drug regimens to end the HIV pandemic.