Improving viral load utilisation to enhance care for Kenyan adolescents with HIV
Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains subo...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-08-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/11/3/e001900.full |
| _version_ | 1811322088753987584 |
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| author | Catherine Ngugi Fatima Tsiouris Miriam Rabkin Lauren Walker Mark Hawken Gillian Dougherty Steve Akoth Isaac Leting Redempta Mutei Doris Naitore Anne Wakoli |
| author_facet | Catherine Ngugi Fatima Tsiouris Miriam Rabkin Lauren Walker Mark Hawken Gillian Dougherty Steve Akoth Isaac Leting Redempta Mutei Doris Naitore Anne Wakoli |
| author_sort | Catherine Ngugi |
| collection | DOAJ |
| description | Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation. |
| first_indexed | 2024-04-13T13:28:59Z |
| format | Article |
| id | doaj.art-1d257431eff0441a861042cc4e65e32f |
| institution | Directory Open Access Journal |
| issn | 2399-6641 |
| language | English |
| last_indexed | 2024-04-13T13:28:59Z |
| publishDate | 2022-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj.art-1d257431eff0441a861042cc4e65e32f2022-12-22T02:45:02ZengBMJ Publishing GroupBMJ Open Quality2399-66412022-08-0111310.1136/bmjoq-2022-001900Improving viral load utilisation to enhance care for Kenyan adolescents with HIVCatherine Ngugi0Fatima Tsiouris1Miriam Rabkin2Lauren Walker3Mark Hawken4Gillian Dougherty5Steve Akoth6Isaac Leting7Redempta Mutei8Doris Naitore9Anne Wakoli102Ministry of Health, National AIDS and STIs Control Program, Nairobi, KenyaICAP at Columbia University, Mailman School of Public Health, New York, New York, USAICAP at Columbia University, Mailman School of Public Health, New York, New York, USA1Liverpool University Hospital, Liverpool, UKInternational Centre for Reproductive Health, Mombasa, KenyaICAP at Columbia University, Mailman School of Public Health, New York, New York, USAICAP Kenya, Nairobi, KenyaICAP Kenya, Nairobi, KenyaICAP Kenya, Nairobi, KenyaICAP Kenya, Nairobi, KenyaICAP Kenya, Nairobi, KenyaImproving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation.https://bmjopenquality.bmj.com/content/11/3/e001900.full |
| spellingShingle | Catherine Ngugi Fatima Tsiouris Miriam Rabkin Lauren Walker Mark Hawken Gillian Dougherty Steve Akoth Isaac Leting Redempta Mutei Doris Naitore Anne Wakoli Improving viral load utilisation to enhance care for Kenyan adolescents with HIV BMJ Open Quality |
| title | Improving viral load utilisation to enhance care for Kenyan adolescents with HIV |
| title_full | Improving viral load utilisation to enhance care for Kenyan adolescents with HIV |
| title_fullStr | Improving viral load utilisation to enhance care for Kenyan adolescents with HIV |
| title_full_unstemmed | Improving viral load utilisation to enhance care for Kenyan adolescents with HIV |
| title_short | Improving viral load utilisation to enhance care for Kenyan adolescents with HIV |
| title_sort | improving viral load utilisation to enhance care for kenyan adolescents with hiv |
| url | https://bmjopenquality.bmj.com/content/11/3/e001900.full |
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