BACKGROUND: Since 2021, I-TECH and the Ivoirian Ministry of Health (MoH) have collaborated on the Quality Improvement Solutions for Sustained Epidemic Control (QISSEC) project, funded by HRSA, to strengthen provider capacity in quality improvement (QI) for HIV service delivery. I-TECH QI coaches support facility QI teams to implement QI projects, including those that improve pediatric viral load suppression (VLS).
DESCRIPTION: Among all 2022 QI projects in 80 facilities, 7 focused on pediatric VLS. Over 9 cumulative months of data collection, pediatric VLS rates in those 7 QI sites were compared to the average across PEPFAR sites using linear regression models. The QI interventions used and key lessons learned for improving pediatric VLS were explored qualitatively to determine shared themes.
LESSONS LEARNED: The 7 sites followed 350 HIV-infected children and adolescents and the QI projects involved 69 with unsuppressed VL. During the QI intervention period, the monthly number of children with VLS increased from 0 to 36 children after the 6th month (36/69, 52%); 48 children (48/69, 70%) were suppressed at 9 months. VLS rate in the 7 sites increased from 81% to 89%, higher than pediatric VLS at PEPFAR-sites (86%), p-value < 0.0001. The qualitative analysis showed that reminder phone calls to caregivers every week (often daily or multiple times per week), treatment adherence education with parents using ART educational image ‘boxes’ and scheduling home visits to children’s homes when needed were influential. Additional interventions included directly observed therapy, ‘motivations’ provided to children who achieved viral suppression, support groups, providing after-hours laboratory services for viral load blood draws, disclosure counseling, and revisions to the clinic flow process for child and adolescent clients.
CONCLUSIONS: Implementing focused, facility-based QI interventions can improve VLS in children and adolescents. Multiple touchpoints with parents/caregivers created an atmosphere of trust and good will while external monitoring of child ARV drug taking (such as home visits, working with social services for complex cases and utilizing community counselors) showed promise. Client and caregiver education using visual tools helped improve pill-taking autonomy, especially for adolescents. A similar mixed methods approach to analysis of other QI interventions could help determine QI collective impact.