ITAL (Viral Load Triggered ART care in Lesotho) is a differentiated care model taking into account the viral load results, clinical conditions and personal preferences of patients taking ART in Lesotho. In the VITAL model, various eHealth tools help nurses in bundling information and clinical decision making. Patients are empowered through automated direct communication of viral load results via SMS and, depending on their preference, they may receive further eHealth and telemedical support, such as reminder messages, advice via cell phone and automated phone-based screening for tuberculosis symptoms. In a pragmatic cluster randomized trial, we will assess if the VITAL model results in improved care and if it is cost-effective.