ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
ICAP Kenya, Nairobi, Kenya.
BMJ Open Qual. 2022 Aug;11(3). doi: 10.1136/bmjoq-2022-001900.
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.
提高艾滋病毒感染者青少年和年轻人（AYPLWH）对病毒载量（VL）检测的使用是肯尼亚卫生部（MOH）的一个优先事项。尽管扩大了 VL 检测的覆盖范围，并推出了国家政策、准则和培训，但 AYPLWH 的 VL 检测结果的利用仍然不理想，不符合国家准则的建议，即所有未抑制病毒载量（UVL）（≥401 拷贝/毫升）的接受抗逆转录病毒治疗（ART）的人都应接受三次增强型依从性咨询（EAC）和 3 个月内重复 VL 检测。2019 年 3 月，哥伦比亚大学国际疫苗中心（ICAP）与 MOH 合作，在东部省的 22 个卫生机构启动了一个质量改进合作（QIC），以优化对接受 ART 治疗且 UVL 的 AYPLWH 的管理。在 17 个月的时间里，设施 QI 团队测试了针对客户教育、工作流程修改、商品管理、社区参与和改进文档的干预措施。QIC 导致完成三次 EAC 会议和重复 VL 检测的客户比例显著提高。基线时（2018 年 3 月至 2019 年 2 月）的中位完成率为 16%（n=479），实施期间（2019 年 3 月至 2020 年 7 月）上升至 73%（n=755）。在最后一个月（2020 年 7 月），这一比例上升至 90%（n=31）。另一个成功之处是重复检测时 VL 再次得到抑制的客户比例增加，从基线时的 34%（n=273）提高到实施期间的 62%（n=710），最后一个月的 77%（n=44）。QIC 还提高了在记录 UVL 结果后 2 个月内更换一线 ART 方案的 AYPLWH 比例，从基线时的 58%（n=48）上升到实施期间的 94%（n=128）。总之，QIC 帮助设施团队确定和优先考虑了当地的、符合背景情况的创新，这迅速改善了 VL 使用的三个关键指标。
