Project team
- Collins Iwuji, University of Sussex (UK)
- Abraham Jacobus Herbst, Africa Health Research Institute (South Africa)
- Nothando Ngwenya, Africa Health Research Institute (South Africa)
- Rujeko Chimukuche, Africa Health Research Institute (South Africa)
- Andrew Boulle, University of Cape Town (South Africa)
- Natalia Hounsome, University of Sussex (UK)
- Henry Sunpath, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa (South Africa)
- Meg Osler, University of Cape Town (South Africa)
- Kathy Baisley, London School of Hygiene & Tropical Medicine (UK)
- Thandeka Khoza, Africa Health Research Institute (South Africa)
UN Sustainable Development Goals addressed
- Goal 1: Zero Poverty
- Goal 3: Good Health and Well-Being
- Goal 8: Decent Work and Economic Growth
Abstract
In our formative research, analysis of data manually entered in an electronic antiretroviral treatment (ART) database (TIER.net) showed poor viral load monitoring (VLM) and inadequate management of virological failure in HIV-positive patients on ART in KwaZulu-Natal, South Africa. ART interruption was high, with nearly half of patients falling out of care within five years. These factors are contributory to increasing HIV drug resistance (HIVDR) in this setting. HIVDR is associated with increased morbidity and mortality with the risk of transmitting drug-resistant HIV to sexual partners. We presented these findings to healthcare providers, policy makers and community representatives with brainstorming of health system challenges and potential interventions.
The proposed study aims to complement these findings by undertaking a review of the VLM process within the health system to identify gaps, with a view to developing a quality improvement package (QIP) to address the gaps. The stakeholders recommended such QIP would utilise the viral load champion model, a named individual who would be the focal point for ensuring proper administrative management of viral load tests and results through identification of those who need tests and triaging of results for action.
This QIP will be supported by technological enhancement of the routine clinic-based TIER.net which will allow automatic transfer of results from the National Health Service Laboratory to TIER.net and development of a dashboard system to support VLM. We will evaluate the effectiveness of these interventions compared to current care for improving VLM and virological suppression using an innovative effectiveness-implementation hybrid cluster-randomised design in 10 clinics. A within-trial health economics analysis will be undertaken using recommended methods to examine the cost-effectiveness of the intervention compared to current care. Finally, we will use a mixed-methods approach to undertake a process evaluation assessing acceptability, fidelity, adaptation and contexts in the implementation of the interventions.
Collins Iwuji, the project lead, said: “I am very excited about this project which aims to evaluate a quality improvement package to improve the care of HIV-positive individuals on antiretroviral therapy. We envisage that the project will result in improvement in viral load monitoring, prompt identification of virological failure and appropriate clinical management.”