Evaluation of a health system intervention to improve virological management in an antiretroviral programme at a municipal clinic in central Durban

Abstract

BackgroundWith the largest antiretroviral therapy (ART) programme globally, demand for effective HIV management is increasing in South Africa. While viral load (VL) testing is conducted, VL follow-up and management are sub-optimal.ObjectivesThe objective of this study was to address gaps in the VL cascade to improve VL testing and management.MethodsAntiretroviral therapy records were sampled for an in-depth review. The study team then reviewed individual records, focusing on ART management, virological suppression and retention. Multifaceted interventions focused on virological control, including a clinical summary chart for ART care; streamlining laboratory results receipt and management; monitoring VL suppression, flagging virological failure and missed visits for follow-up; down-referral of stable patients eligible for the chronic club system; and training of personnel and patients.ResultsPre-intervention, 78% (94/120) of eligible patients had VL tests, versus 92% (145/158) post-intervention (p = 0.0009). Pre-intervention, 59% (71/120) of patients accessed their VL results, versus 86% (136/158) post-intervention (p < 0.0001). Post-intervention, 73% (19/26) of patients eligible for ART change were appropriately managed, versus 11% (4/36) pre-intervention (p < 0.0001). Only 27% had no regimen changes (7/26) post-intervention, versus 81% (29/36) pre-intervention (p < 0.0001).ConclusionService delivery was streamlined to facilitate HIV services by focusing on VL test monitoring, protocol training and accessibility of results, thereby improving clinical management.

Equity dimensions in initiatives promoting urban health and wellbeing in east and southern Africa

“…These participatory forms of assessment and analysis not only enhanced recognitional equity, but were also reported to strengthen voice in claims over rights and social accountability. This was found, for example in the use by SDI in informal settlements of a ‘right to the city’ lens to map rights violations and duty bearer deficits ( 65 ) as well as in forms of appreciative mapping to identify local options and assets that contribute to addressing rights deficits ( 32 , 66 ). In Maputo’s Monitoria Participativa Maputo (MOPA) example described earlier, the integration of participatory methods within a smartphone based platform helped marginalized communities to link evidence to response from authorities, strengthening social accountability over waste collection in the city ( 36 ).…”

“…Most initiatives poorly captured the relative gains for different social groups through monitoring or routine data. Some initiatives included research to formally assess differential health outcomes related to specific urban services, albeit without attributing to specific features of interventions ( 4 , 13 , 54 , 66 ). Embedding more systematic and distributional performance and outcome monitoring in initiatives for urban wellbeing and improving the within-area disaggregation of routine data systems would appear to be a significant area for further development.…”

“…Such gains were not simply outcomes in their own right, but also appeared to be important levers for other dimensions of equity. 13,54,66). Embedding more systematic and distributional performance and outcome monitoring in initiatives for urban wellbeing and improving the within-area disaggregation of routine data systems would appear to be a significant area for further development.…”

Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

“…With respect to workload, the opinions were divided. Half of the healthcare professionals felt that it would decrease their workload as patients would be treated early whereas the remainder felt this would increase their workload as all other tests would have to be completed before ART initiation, particularly at Lancers Road PHC, the reason being that it is an extremely busy clinic with a heavy patient load [8].…”