Interventions to Improve HIV Viral Load Suppression among the Adolescents: Evidence of Improvement Science through a Quality Improvement Approach in Eastern Uganda
Introduction: Achieving viral load suppression among the
adolescents living with HIV continues to hold back attainment of sustainable
development goals. TASO Mbale realized a viral load suppression rate of 63.1%
among the adolescents living with HIV in care in quarter 4 of 2016. We
therefore, instituted a quality imrpovement project to improve Viral load
suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. Method: Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes
of low viral load suppression among the adolescents living with HIV at TASO
Mbale. The identified barriers were Knowlegde gap, among the adolescents, on
positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned
adolescent HIV clinic, Inadequate follow-up and Low use of data for informed
decisions. A plan-do-study-act (PDSA) model was applied to implement tested
changes. Strategies that worked included introduction of appointment register
to track appointment behaviour of the adolescents, generating lists of clients
on appointment who were due for Viral Load bleeding, telephone calls for follow
up, increasing the frequency of reviewing adolescents from once a month to
twice a week, committing a dedicated team responsible for adolescent care. Results: The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in
the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third
quarter and 91.4% in quarter 4 of 2017. Conclusion: The use of quality
improvement in addressing gaps in HIV service delivery is highly effective.
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