Original Research

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
Southern African Journal of HIV Medicine | Vol 20, No 1 | a985 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.985 | © 2019 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 | This work is licensed under CC Attribution 4.0
Submitted: 21 May 2019 | Published: 26 September 2019

About the author(s)

Christie M. Cloete, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
Jane Hampton, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
Terusha Chetty, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
Thando Ngomane, eThekwini Health Unit, eThekwini Municipality, Durban, South Africa
Elizabeth Spooner, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
Linda M.G. Zako, eThekwini Health Unit, eThekwini Municipality, Durban, South Africa
Shabashini Reddy, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
Tarylee Reddy, Department of Biostatistics, South African Medical Research Council, Durban, South Africa
Nozipho Luthuli, eThekwini Health Unit, eThekwini Municipality, Durban, South Africa
Hope Ngobese, eThekwini Health Unit, eThekwini Municipality, Durban, South Africa
Gita Ramjee, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
Anna Coutsoudis, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
Photini Kiepiela, HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa


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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; virological suppression; retention in care

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