Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa

Abstract

IntroductionRapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa.Material and methodsWe conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic’s compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05.ResultsNine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics’ average rating score for compliance to the WHO guidelines ranged between 64.4% (CI: 44%– 84%) and 89.2% (CI: 74%– 100%).Ten out of eleven of the clinics were rated as moderate (70–89%). All clinic have scored highest for the following audit component: equipment; process control and specimen management; and facility ad safety, with 100%. Clinics obtained the lowest scores for the assessment audit component followed by process improvement and organisation, with 40.9% (CI: 15.7–66.1%), 45.5% (CI: 10.4–80.5%) and 56.8% (CI: 31.8 81.8%), respectively. A statistically significant correlation was observed between the following: category of staff performing the HIV rapid tests in the audited clinics and service and satisfactory audit component; weekly average number of patients using the audited PHC clinics and service and satisfactory audit component; number of HIV lay counsellors in the audited clinics and quality control audit component with p<0.05.DiscussionIn the small audit of primary healthcare clinics located within the rural part of KwaZulu-Natal, results revealed an overall moderate rating of the q...

Evaluation of antenatal rapid human immunodeficiency virus testing in rural South Africa

“…21 The evaluation study showed that there is poor quality supply chain management and poor adherence to standards among staff in rural PHC clinics. 21 These findings are also supported by Mbachu et al, 29 Pavie et al 30 and Moodley et al, 31 who showed the accuracy of HIV rapid testing services in resource-limited settings. To ensure sustainable accuracy of the HIV rapid test services provided, it is important that evidence-based guidelines are followed, particularly in high HIV-prevalence regions.…”

“…A parallel study was conducted to access quality systems management for HIV rapid testing services in rural KZN. 21 …”

“…15 Our recent study aimed at evaluating the quality management systems, including quality control measures for HIV rapid testing services in rural primary healthcare (PHC) clinics in KwaZuluNatal, revealed that there is a need for improving quality control measures for rapid HIV testing, particularly staff competency. 21 However, this evaluation study did not include assessment of HIV test accuracy. It has been recommended that the accuracy of rapid HIV tests should be evaluated by the actual test user and in the appropriate clinical settings.…”

Experiential Learning Curriculum Delivery Approach for Quality Improvement in Resource Limited Settings: Mobile Learning for Point-of-Care Technologies

“…With continuous advances in technologies for prevention and treatment of HIV and TB, continuous professional development (CPD) of health care workers (HCWs) remains a high priority especially, in countries with a dual burden of TB/HIV epidemics (Feldacker et al, 2017;Wirtz et al, 2016). The World Health Organisation (WHO) recommends training and competency assessments for personnel, including initial and follow up trainings as components of a quality management system (QMS) necessary for provision of quality POC diagnostic services (Jaya, Drain, & Mashamba-Thompson, 2017). Studies have been conducted to evaluate compliance to the QMS in LMIC, specifically on HIV and TB testing in South Africa (Jaya et al, 2017;Mwisongo, Peltzer, Mohlabane, & Tutshana, 2016).…”

“…The World Health Organisation (WHO) recommends training and competency assessments for personnel, including initial and follow up trainings as components of a quality management system (QMS) necessary for provision of quality POC diagnostic services (Jaya, Drain, & Mashamba-Thompson, 2017). Studies have been conducted to evaluate compliance to the QMS in LMIC, specifically on HIV and TB testing in South Africa (Jaya et al, 2017;Mwisongo, Peltzer, Mohlabane, & Tutshana, 2016). These studies highlighted knowledge gaps and barriers to the provision of quality services in resource limited settings, which include challenges concerning test user perspectives and competency (Jaya et al, 2017;Mwisongo et al, 2016).…”