Antiretroviral therapy (ART) has become widely available in resource limited settings (RLS) due to large increases in available resources through the President s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund for AIDS, Tuberculosis, and Malaria (GFATM). The number of people accessing ART in RLS doubled in 2005 alone. Whereas viral load testing is done routinely for individuals on ART in the western hemisphere, this is not the case elsewhere. The World Health Organization (WHO) has recommended only clinical and CD4 count monitoring as the standard of care in RLS during the ART scale-up. As a result, there is a growing population of individuals in Africa currently on ART whose treatment is monitored only using clinical evaluations and CD4 counts.