H Sunpath1,2, T J Hatlen3, K K Naidu4, P Msimango5, R N Adams6, M-Y S Moosa2, V C Marconi7, R A Murphy3, R T Gandhi8, S Pillay9, M Siedner10, K Naidoo1,6. 1. Centre for Aids Program of Research, University of Kwa Zulu-Natal, Durban, South Africa. 2. Infectious Diseases Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. 3. Division of Infectious Diseases, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA. 4. MatCH (Maternal Adolescent and Child Health), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 5. Ethekwini Health District Office, Department of Health, Kwa-Zulu Natal, Durban, South Africa. 6. Medical Research Council-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa. 7. Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA. 8. Harvard Medical School, Boston, Massachusetts, USA. 9. Division of Medical Microbiology and Immunology, National Health Laboratory Services Tygerberg Hospital, Stellenbosch University, Tygerberg, South Africa. 10. Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
Objective: To move closer to achieving the third target of the UNAIDS 90-90-90 goals, we prospectively implemented a viral load (VL) champion (VLC) program aimed at enhancing VL monitoring and recognition of treatment failure. Design: Three clinics in eThekwini, Kwa-Zulu Natal (low-, medium- and high-volume, encompassing 9184 patients overall) were each assigned a VLC. We employed a descriptive analysis (chart audit) to compare the pre-intervention period to a 1-year post-intervention period. The number of patients with a VL test performed 6 and 12 months after the intervention was calculated as a proportion of VL tests due at those time points (VL completion rate). Results: The pre-implementation VL completion rate at the three sites was respectively 68% (140/205 patients), 54% (84/155 patients) and 64% (323/504 patients), and the 6-month post-implementation completion rate increased to 83% (995/1194 patients), 90% (793/878 patients) and 99% (3101/3124 patients) (P < 0.0001 for each site). VL completion rates remained significantly higher at 12 months post-implementation, with an average cumulative VL completion rate of >90% across all facilities. Conclusion: We demonstrate a successful, multifaceted, quality-improvement intervention centered on a clinic-level VLC which, taken to scale, has important implications for attaining the third UNAIDS 90-90-90 target.
Objective: To move closer to achieving the third target of the UNAIDS 90-90-90 goals, we prospectively implemented a viral load (VL) champion (VLC) program aimed at enhancing VL monitoring and recognition of treatment failure. Design: Three clinics in eThekwini, Kwa-Zulu Natal (low-, medium- and high-volume, encompassing 9184 patients overall) were each assigned a VLC. We employed a descriptive analysis (chart audit) to compare the pre-intervention period to a 1-year post-intervention period. The number of patients with a VL test performed 6 and 12 months after the intervention was calculated as a proportion of VL tests due at those time points (VL completion rate). Results: The pre-implementation VL completion rate at the three sites was respectively 68% (140/205 patients), 54% (84/155 patients) and 64% (323/504 patients), and the 6-month post-implementation completion rate increased to 83% (995/1194 patients), 90% (793/878 patients) and 99% (3101/3124 patients) (P < 0.0001 for each site). VL completion rates remained significantly higher at 12 months post-implementation, with an average cumulative VL completion rate of >90% across all facilities. Conclusion: We demonstrate a successful, multifaceted, quality-improvement intervention centered on a clinic-level VLC which, taken to scale, has important implications for attaining the third UNAIDS 90-90-90 target.
Entities:
Keywords:
AIDS; HIV; South Africa; clinical champion
Authors: Helen Bell Gorrod; Richard Court; Michael Schomaker; Gary Maartens; Richard A Murphy Journal: J Acquir Immune Defic Syndr Date: 2020-05-01 Impact factor: 3.771
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