Improving Utilization of HIV Viral Load Test Results Using a Quality Improvement Collaborative in Western Kenya

Rabkin, Miriam; Achwoka, Dunstan; Akoth, Steve; Boccanera, Rodrigo; Kimani, Murungaru; Leting, Isaac; Madevu-Matson, Caitlin; Mutei, Redempta; Nyaga, Lilly; Onyango, Christian; Ouma, C; Rondinelli, Ilka; Rumunyu, Peter; Tsiouris, Fatima; Wakoli, Anne; Walker, Lauren; Dougherty, Gillian

doi:10.1097/jnc.0000000000000158

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…QIC methods then enabled sites to adapt the best practices toolkit to their specific contexts, and to sustain and institutionalize their early progress. These findings are consistent with studies showing that the use of QI methods and the QIC approach can empower health facility teams to identify and address process and management barriers to attaining high quality health services [19,20,23,27]. Contexts in which national guidelines and standards exist and quality challenges can be addressed at the facility level are optimal settings for QI interventions, which have been used successfully to address other quality challenges in Sierra Leone [28,29,30].…”

Section: Plos Onesupporting

confidence: 85%

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone

et al. 2020

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Background/setting Only 47% of HIV-positive Sierra Leoneans knew their status in 2017, making expanded HIV testing a priority. National guidelines endorse provider-initiated HIV testing and counselling (PITC) to increase testing coverage, but PITC is rarely provided in Sierra Leone. In response, a Quality Improvement Collaborative (QIC) was implemented to improve PITC coverage amongst adult inpatients. Methods Ten hospitals received the intervention between October 2017 and August 2018; there were no control facilites. Each hospital aimed to improve PITC coverage to � 95% of eligible patients. Staff received training on PITC and QIC methods and a package of PITC best practices and tools. They then worked to identify additional contextually-appropriate interventions, conducted rapid tests of change, and tracked performance using shared indicators and time-series data. Supportive supervision bolstered QI skills, and quarterly meetings enabled diffusion of innovations while spurring friendly competition. Results Baseline PITC coverage was 4%. The hospital teams tested diverse interventions using QI methods, including staff training; data review meetings; enhanced workflow processes and supervision; and patient education and sensitization activities Nine hospitals reached and sustained the 95% target, and all saw rapid and durable improvement, which was sustained for a median of six months. Of the 5,238 patients tested for HIV, 311 (6%) were found to be HIV-positive and were referred for treatment. HIV rapid test kit stockouts occurred during the project period, limiting PITC services in some cases.

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Section: Plos Onesupporting

confidence: 85%

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone

et al. 2020

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“…While many facilities had already existing meetings for review and improvement, the SAIA-PEDS CQI meetings gave HCW teams a structured process for addressing existing goals through group decision-making. These findings align with previous studies noting the impact of CQI as a tool for directing locally driven improvement in resource-limited settings across the HIV testing, treatment, and suppression cascade [ 20 – 22 ], as well as the theoretical models informing the SAIA-PEDS strategy (Donabedian’s model of quality in healthcare [ 23 ] and Deming’s theory of profound knowledge [ 24 ]). These flexible tools are useful to teams with diverse cadres, foci, and settings.…”

Section: Discussionsupporting

confidence: 87%

Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya

Beima‐Sofie

Wagner

Soi

et al. 2022

Implement Sci Commun

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Background Children and adolescents living with HIV have poorer rates of HIV testing, treatment, and virologic suppression than adults. Strategies that use a systems approach to optimize these multiple, linked steps simultaneously are critical to close these gaps. Methods The Systems Analysis and Improvement Approach (SAIA) was adapted and piloted for the pediatric and adolescent HIV care and treatment cascade (SAIA-PEDS) at 6 facilities in Kenya. SAIA-PEDS includes three tools: continuous quality improvement (CQI), flow mapping, and pediatric cascade analysis (PedCAT). A predominately qualitative evaluation utilizing focus group discussions (N = 6) and in-depth interviews (N = 19) was conducted with healthcare workers after implementation to identify determinants of implementation. Data collection and analysis were grounded in the Consolidated Framework for Implementation Research (CFIR). Results Overall, the adapted SAIA-PEDS strategy was acceptable, and the three tools complemented one another and provided a relative advantage over existing processes. The flow mapping and CQI tools were compatible with existing workflows and resonated with team priorities and goals while providing a structure for group problem solving that transcended a single department’s focus. The PedCAT was overly complex, making it difficult to use. Leadership and hierarchy were complex determinants. All teams reported supportive leadership, with some describing in detail how their leadership was engaged and enthusiastic about the SAIA-PEDS process, by providing recognition, time, and resources. Hierarchy was similarly complex: in some facilities, leadership stifled rapid innovation by insisting on approving each change, while at other facilities, leadership had strong and supportive oversight of processes, checking on the progress frequently and empowering teams to test innovative ideas. Conclusion CQI and flow mapping were core components of SAIA-PEDS, with high acceptability and consistent use, but the PedCAT was too complex. Leadership and hierarchy had a nuanced role in implementation. Future SAIA-PEDS testing should address PedCAT complexity and further explore the modifiability of leadership engagement to maximize implementation.

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“…Lower performing HF teams learn from higher performing HF teams and are able to quickly and rapidly implement changes that demonstrate clear improvement. Our analysis shows that the QIC results are consistent with other published reports of QI projects and QICs, which have shown significant success in enabling facility-level QI teams to design, test, and scale contextually appropriate interventions that improve the quality of health services ( Dougherty et al, 2019 ; Hargreaves et al, 2019 ; Kassa et al, 2020 ; Rabkin et al, 2019 ).…”

Section: Discussionsupporting

confidence: 87%

A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia

Dougherty¹,

Boccanera²,

Boyd³

et al. 2021

J Assoc Nurses AIDS Care

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HIV testing with rapid antiretroviral therapy (ART) initiation are life-saving interventions for adolescents living with HIV. However, in Zambia, HIV diagnosis and immediate ART initiation among adolescents living with HIV is lagging. In collaboration with the Zambian Ministry of Health, the U.S. Health Resources and Services Administration, the U.S. Centers for Disease Control and Prevention in Zambia, and ICAP at Columbia University designed and implemented a quality improvement collaborative (QIC) to improve adolescent immediate ART initiation at 25 health facilities in Lusaka. Over the 12-month implementation period, quality improvement teams tested and identified targeted intervention, that significantly improved ART initiation within 14 days of receiving positive test results, from 24% at baseline to more than 93% for the final 6 months of implementation. The quality improvement collaborative approach empowered health care workers to innovate addressing the root causes of suboptimal performance and produced a package of successful interventions that will be shared throughout Zambia.

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Improving Utilization of HIV Viral Load Test Results Using a Quality Improvement Collaborative in Western Kenya

Cited by 7 publications

References 8 publications

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone

Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone

Providing “a beam of light to see the gaps”: determinants of implementation of the Systems Analysis and Improvement Approach applied to the pediatric and adolescent HIV cascade in Kenya

A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia

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