Evaluation of a health system intervention to improve virological management in an antiretroviral programme at a municipal clinic in central Durban

Christie M Cloete; Jane Hampton; Terusha Chetty; Thando Ngomane; Elizabeth Spooner; Linda M G Zako; Shabashini Reddy; Tarylee Reddy; Nozipho Luthuli; Hope Ngobese; Gita Ramjee; Anna Coutsoudis; Photini Kiepiela

doi:10.4102/sajhivmed.v20i1.985

Evaluation of a health system intervention to improve virological management in an antiretroviral programme at a municipal clinic in central Durban

South Afr J HIV Med. 2019 Sep 26;20(1):985. doi: 10.4102/sajhivmed.v20i1.985. eCollection 2019.

Affiliations

¹ HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa.
² eThekwini Health Unit, eThekwini Municipality, Durban, South Africa.
³ School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa.
⁴ Department of Biostatistics, South African Medical Research Council, Durban, South Africa.

Abstract

Background: With the largest antiretroviral therapy (ART) programme globally, demand for effective HIV management is increasing in South Africa. While viral load (VL) testing is conducted, VL follow-up and management are sub-optimal.

Objectives: The objective of this study was to address gaps in the VL cascade to improve VL testing and management.

Methods: Antiretroviral therapy records were sampled for an in-depth review. The study team then reviewed individual records, focusing on ART management, virological suppression and retention. Multifaceted interventions focused on virological control, including a clinical summary chart for ART care; streamlining laboratory results receipt and management; monitoring VL suppression, flagging virological failure and missed visits for follow-up; down-referral of stable patients eligible for the chronic club system; and training of personnel and patients.

Results: Pre-intervention, 78% (94/120) of eligible patients had VL tests, versus 92% (145/158) post-intervention (p = 0.0009). Pre-intervention, 59% (71/120) of patients accessed their VL results, versus 86% (136/158) post-intervention (p < 0.0001). Post-intervention, 73% (19/26) of patients eligible for ART change were appropriately managed, versus 11% (4/36) pre-intervention (p < 0.0001). Only 27% had no regimen changes (7/26) post-intervention, versus 81% (29/36) pre-intervention (p < 0.0001).

Conclusion: Service delivery was streamlined to facilitate HIV services by focusing on VL test monitoring, protocol training and accessibility of results, thereby improving clinical management.

Keywords: HIV-1 infected; antiretroviral care or management; health strengthening systems interventions; retention in care; virological suppression.