Continuous quality improvement (CQI) Institutionalization to reach 95:95:95 HIV targets: a multicountry experience from the Global South

Abstract

Background Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south. Methods The HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or ‘change packages’, (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous ‘plan-do-study-act’ (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation. Results Our selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %. Conclusions Adopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.

The effectiveness and sustainability of peer support interventions for persons living with HIV: a realist synthesis

“…This evidence indicates the huge value of peer support for PLHIV’s health management, and the necessity of the GIPA principle for promoting the ‘95-95-95’ goal and improving health-related quality of life for PLHIV. 8 9 22 Of these outcomes, behavioural outcomes, such as medical follow-up adherence, risky behaviour and medication adherence, were more frequently tested in clinical trials. 12 14 57 58 61–65 68 89–92 Future studies could attempt to evaluate other types of outcome effects.…”

“…We also summarised that peer support could help PLHIV improve various outcomes, including physiological, psychological, behavioural, cognitive and social outcomes. This evidence indicates the huge value of peer support for PLHIV’s health management, and the necessity of the GIPA principle for promoting the ‘95-95-95’ goal and improving health-related quality of life for PLHIV 8 9 22. Of these outcomes, behavioural outcomes, such as medical follow-up adherence, risky behaviour and medication adherence, were more frequently tested in clinical trials 12 14 57 58 61–65 68 89–92.…”

“… 4 5 Moreover, the issue of HIV-related discrimination also acts as a barrier to PLHIV seeking medical and psychosocial support. 6 7 Therefore, more medical care resources, especially those that can lower PLHIV’s psychological defences, are needed to improve PLHIV’s quality of life, thus promoting the achievement of the ‘95-95-95’ goal (95% of PLHIV know their HIV infection, 95% of PLHIV with HIV-positive diagnosis receive ART, 95% of PLHIV on ART achieve viral load suppression) 8 and improving health-related quality of life for PLHIV at any stage. 9 …”

Systems Analysis and Improvement Approach to optimize the pediatric and adolescent HIV Cascade (SAIA-PEDS): a pilot study

“…Had this been feasible, we could have assessed whether this indicator began with high coverage and did not have opportunity to increase, as was noted in the original SAIA trial [ 8 ]. Other studies have noted that quality improvement has increased HIV testing coverage substantially [ 24 ]; it is unlikely that this implementation strategy would be detrimental to these services.…”