Continuous quality improvement (CQI) Institutionalization to reach 95:95:95 HIV targets: a multicountry experience from the Global South

Peter Memiah,Sarah Nzyoka,Jackson Sebeza,Mope Shimabale,Patience Komba,Violet Makokha,Josephine Tlale,Adesina Tina

doi:10.1186/s12913-021-06731-7

Abstract

BackgroundScaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. This paper describes the experiences and outcomes related to implementing CQI processes to help reach these targets, with particular focus on clinical and programmatic settings in 6 countries from the global south.MethodsThe HIV program at the University of Maryland, Baltimore (UMB) implemented an adapted CQI model in Kenya, Tanzania, Botswana, Zambia, Nigeria and Rwanda that included the following steps: (1) analysing the problem to identify goals and objectives for improvement; (2) developing individual changes or ‘change packages’, (3) developing a monitoring system to measure improvements; and (4) implementing and measuring changes through continuous ‘plan-do-study-act’ (PDSA) cycles. We describe country-level experiences related to implementing this adaptive design, a collaborative learning and scale-up/sustainability model that addresses the 95:95:95 global HIV targets via a CQI learning network, and mechanisms for fostering communication and the sharing of ideas and results; we describe trends both before and after model implementation.ResultsOur selected country-level experiences based on implementing our CQI approach resulted in an increased partner testing acceptance rate from 21.7 to 48.2 % in Rwanda, which resulted in an increase in the HIV testing yield from 2.1 to 6.3 %. In Botswana, the overall linkage to treatment improved from 63 to 94 %, while in Kenya, the viral load testing uptake among paediatric and adolescent patients improved from 65 to 96 %, and the viral load suppression improved from 53 to 88 %.ConclusionsAdopting CQI processes is a useful approach for accelerating progress towards the attainment of the global 95:95:95 HIV targets. This paper also highlights the value of institutionalizing CQI processes and building the capacity of Ministry of Health (MoH) personnel in sub-Saharan Africa for the effective quality improvement of HIV programs and subsequent sustainability efforts.

Highlights

Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets
In 2014, the world embarked on an ambitious goal to end the HIV epidemic by 2030 by adopting the 95:95:95 targets, which are collectively known as the HIV fast-track approach [1]. These targets, developed by the Joint United Nations Program on HIV/AIDS (UNAIDS), seek to have 95 % of people infected with HIV diagnosed, 95 % of those diagnosed started on antiretroviral treatment (ART) and 95 % of those on treatment virally suppressed [2]
The type of support provided to Ministry of Health (MoH) staff varied between countries; in general, the support consisted of a stepwise approach where the following occurred: 1. A 1-day sensitization course for top-level managers and leaders engaged in health service provision at the national and subnational levels led to the following: 2. (a) A five-day CQI didactic training course for trainers of trainers (TOTs), known as ‘CQI coaches’, at the subnational level, followed by the TOTs cascading their training to (b) a 5-day training course for CQI implementers at the facility level

Summary

Introduction

Scaling up continuous quality improvement (CQI) processes could be key in achieving the 95:95:95 cascade and global HIV targets. In 2014, the world embarked on an ambitious goal to end the HIV epidemic by 2030 by adopting the 95:95:95 targets, which are collectively known as the HIV fast-track approach [1] These targets, developed by the Joint United Nations Program on HIV/AIDS (UNAIDS), seek to have 95 % of people infected with HIV diagnosed, 95 % of those diagnosed started on antiretroviral treatment (ART) and 95 % of those on treatment virally suppressed [2]. This fast-track approach is expected to avert nearly 28 million HIV infections and 21 million AIDS-related deaths by 2030, with a 15-fold return on HIV-related investments [2]. Its main objective is to quickly learn if a particular method produces the desired results and make necessary changes to continuously improve the processes and outcomes [14]

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Discussion

Conclusion