Title

Collaborative quality improvement activities strengthened viral load sample collection in Zimbabwe’s Clinic-Lab Interface Initiative

Presenter

Romana Rugare Katekwe

Authors

R.R. Katekwe¹, B. Makunike - Chikwinya¹, G. Gonese¹, F. Petracca², S. Wiktor², Z. Bangani³, B. McKinney⁴, E. Govha⁵, L. Vere⁶, K. Yao⁷

Institutions

¹Zimbabwe Technical Assistance and Training Education Center for Health (Zim-TTECH), Harare, Zimbabwe, ²University of Washington, Division of Global HIV & TB (DGHT), Seattle, United States, ³U.S. Centers for Disease Control and Prevention (CDC), Harare, Zimbabwe, ⁴Global Health Consulting BCM, Washington, United States, ⁵Ministry of Health and Childcare, Harare, Zimbabwe, ⁶Biomedical Research and Training Institute (BRTI), Harare, Zimbabwe, ⁷U.S. Centers for Disease Control and Prevention (CDC), Atlanta, United States

BACKGROUND: HIV viral load (VL) testing is an important component of HIV care and treatment. The World Health Organization’s (WHO) guidelines recommend annual VL monitoring. In 2019, less than 50% of clients engaged in HIV care met WHO’s VL testing guidelines. To address the low viral load coverage gap, in 2020, the Zimbabwe Ministry of Health and Childcare in 2020 developed a clinic laboratory interface (CLI) quality improvement (QI) initiative with several implementing partners to improve VL sample collection in supported facilities.
METHODS: The Laboratory African Regional Collaborative (LARC) provided CLI training and coordination to health care workers. Sites were selected based on high volume and low sample collection rates. Baseline data on eligible clients were collected from October through December 2021. Change ideas from the driver diagram was used to systematically plan the project to achieve the aim of improving sample collection were tested using Plan-Do-Study-Act cycles. Capacity-building activities such as joint site support, mentorship visits, a tablet-based QI course for self-study, and learning sessions were used to improve viral load sample collection.
RESULTS: The number of sites implementing the collaborative increased from 59 sites in October 2021 to 207 sites by March 2023. Process mapping to identify implementation gaps revealed low adherence to VL guidelines and poor clinic/lab communication. Change ideas found to be most effective included: collecting samples by cohort, synchronizing sample collection with medication pick-up, and sending appointment reminders to clients. The initiative increased VL samples collected from eligible clients from 40% at baseline to 85% between October 2021 and March 2023 within the implementation period.
CONCLUSIONS: The CLI collaborative approach improved VL sample collection through implementation of change ideas adapted to the context of individual clinics. Laboratory/clinic staff phone contact improved sample collection and transportation. Future focus areas could include sustaining the gains and management of clients with high VL.