Towards the third 90: improving viral load testing with a simple quality improvement program in health facilities in Malawi. Issue 3 (1st November 2018)

• Record Type: Journal Article
• Authors: Hubbard, Julie; Kakwesa, Gift; Nyirenda, Mike; Mwambene, James; Bardon, Ashley; Balakasi, Kelvin; Dovel, Kathryn; Kalua, Thokozani; Hoffman, Risa M
• Is Part Of: International health. Volume 11:Issue 3(2019)
• Page Start: 215
• Page End: 220
• Publication Date: 2018-11-01
• Subjects: health services -- HIV infections -- Malawi -- mentors -- quality improvement -- viral load; World health -- Periodicals; Public health -- Developing countries -- Periodicals; Medical care -- Developing countries -- Periodicals; Medical policy -- Developing countries -- Periodicals; 362.1091724
• DOI: 10.1093/inthealth/ihy083
• Languages: English
• ISSNs: 1876-3413

Abstract

Abstract: Background: Viral load (VL) scale-up efforts have largely focused on laboratory systems, with less attention on facility-level strengthening of staff who facilitate VL testing. To address this gap we implemented a quality improvement (QI) program at 13 health facilities in central and southern Malawi. Methods: QI program tools focused on patient and provider VL knowledge and clarification of site-level roles and responsibilities, including the designation of a VL 'focal person' to oversee all VL activities. T-tests were used to compare differences in VL testing before (November 2016–April 2017) and after (May 2017–November 2017) the intervention. Results: The mean number of VL tests performed significantly increased after implementation of the QI program. Overall there was a 164% increase in the mean number of routine VL tests performed per month (p<0.001). Increased VL testing was sustained during the 6 months of follow-up. Conclusions: A simple QI program focused on improving VL knowledge among patients and providers, and clarifying staff roles at a facility level increased VL testing over a 6-month period. Further investigation is needed on whether this program can be scaled in different settings across sub-Saharan Africa and on the duration of follow-up required for sustained improvements in VL testing.