Strengthening Panama’s HIV Viral Load Testing Network through a Phased Optimization Strategy: A Retrospective Program Assessment, 2021-2025

Background: In 2021, Panama identified structural and operational gaps in its national HIV viral load (HIV VL) testing network, in the context of low testing coverage. A phased strategy was implemented to strengthen testing capacity, quality, geographic access, and referral pathways. Setting: Panama’s national HIV VL testing network. Methods: We conducted a retrospective program assessment of the national HIV VL network optimization strategy implemented from 2021–2025. A 2021 baseline assessment included two HIV VL reference laboratories and 13 antiretroviral therapy (ART) clinics representing 93% of the ART cohort reported in the programmatic data used for the assessment. Findings informed phased optimization, including redistribution of testing, establishment of regional capacity, and differentiated use of GeneXpert for priority HIV VL testing. Programmatic data were used to assess HIV VL coverage, viral suppression, testing distribution, and turnaround time. Results: HIV VL testing increased from 6,967 tests in 2021 to 15,897 in 2025, while the ART cohort increased 25%, from 14,560 to 18,200. HIV VL coverage increased from 47% to 89%, and viral suppression from 78% to 94%. Testing was redistributed across the laboratory network. Post-optimization routine turnaround time was approximately 1 week at the regional Veraguas laboratory and 10 days at ICGES; priority GeneXpert testing provided results in approximately 24 hours. Conclusion: Panama’s phased optimization was associated with expanded HIV VL testing access, increased coverage, redistributed testing capacity, and more timely testing pathways. These findings represent programmatic trends and should not be interpreted as causal effects of the strategy.