Advancing Resilient and Equitable HIV Viral Load Monitoring through Home Testing with Feedback

Project Summary:

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In Wisconsin, 81% of people living with HIV are virally suppressed, falling short of the state’s goal of 90% by 2026. Black and Hispanic Wisconsinites, younger adults, and those with economic hardship or prior injection drug use experience lower suppression rates. Regular viral load (VL) monitoring confirms that treatment is working, detects viral rebound early, and supports timely adherence or medication adjustments to maintain suppression. However, transportation barriers, distance to clinics, mobility limitations, stigma, and privacy concerns often prevent consistent laboratory testing. This pilot project will test the feasibility and acceptability of home-based VL monitoring using self-collected dried blood spot (DBS) samples with personalized feedback. Fifty Wisconsin participants who face barriers to care will collect DBS specimens at home and receive individualized feedback through their preferred format (secure online portal, phone, or mail). Feedback will summarize VL results, reinforce antiretroviral adherence, and highlight the health and prevention benefits of Undetectable = Untransmittable (U=U). The study will evaluate return rates, specimen adequacy, satisfaction with self-collection and feedback, and preliminary changes in adherence, care engagement, and viral suppression over six months. Findings will guide protocol refinement and inform a future implementation study of home VL monitoring as a scalable tool to strengthen HIV care continuity. By expanding access to VL monitoring and empowering participants with timely, understandable results, this project supports the Wisconsin Integrated HIV Prevention and Care Plan goals of improving viral suppression and reducing disparities in care engagement. Demonstrating feasibility of home DBS testing may also inform broader applications of this technology for other health conditions statewide.