Toward Empowering Women in HIV Care: A Peer-Supported Patient-Initiated Viral Load Testing Cluster-Randomized Trial in Dar es Salaam, Tanzania

Background Routine viral load testing (VLT) is critical for monitoring HIV treatment effectiveness, yet adherence to annual testing and patient engagement remain suboptimal, particularly among women. We evaluated a peer educator–supported, patient-initiated VLT approach in Dar es Salaam, Tanzania. Methods In 2024, a two-arm cluster-randomized trial was conducted across six public HIV clinics. Intervention sites implemented a 4–6-month peer-supported program promoting patient-initiated VLT, while control sites continued routine care. Data from adult PLHIV were analyzed using regression models. Results Among 567 participants, 14.8% had not tested within 12 months, with higher non-testing among men (19.7% vs. 12.2%, p=0.019). Intervention sites showed higher mean numbers tested for men (65 vs. 26) and women (146.4 vs. 57). Although patient-initiated testing was infrequent overall (2.8%), the intervention arm demonstrated higher odds of patient-initiated viral load testing than the control arm (aOR=4.69; 95% CI: 1.30–16.95). Conclusion Peer-supported strategies improved patient-initiated VLT and female engagement but require stronger health system support.