Retention of HIV-Positive Adolescents in Care: A Quality Improvement Intervention in Mid-Western Uganda.

Jonathan Izudi,Adeodata Kekitiinwa,Andrew Katawera,Benjamin Muwanika,Victor Tumukunde Spector,Mary Mugabekazi,John Mugenyi

doi:10.1155/2018/1524016

Abstract

Background Low retention of HIV-positive adolescents in care is a major problem across HIV programs. Approximately 70% of adolescents were nonretained in care at Katooke Health Center, Mid-Western Uganda. Consequently, a quality improvement (QI) project was started to increase retention from 29.3% in May 2016 to 90% in May 2017. Methods In May 2016, we analyzed data for retention, prioritized gaps with theme-matrix selection, analyzed root causes with fishbone diagram, developed site-specific improvement changes and prioritized with countermeasures matrix, and implemented improvement changes with Plan-Do-Study-Act (PDSA). Identified root causes were missing follow-up strategy, stigma and discrimination, difficult health facility access, and missing scheduled appointments. Interventions tested included generating list of adolescents who missed scheduled appointments, use of mobile phone technology, and linkage of adolescents to nearest health facilities (PDSA 1), Adolescent Only Clinic (PDSA 2), and monthly meetings to address care and treatment challenges (PDSA 3). Results Retention increased from 17 (29.3%) in May 2016 to 60 (96.7%) in August 2016 and was maintained above 90% until May 2017 (with exception of February and May 2017 recording 100% retention levels). Conclusion Context specific, integrated, adolescent-centered interventions implemented using QI significantly improved retention in Mid-Western Uganda.

Highlights

Besides the challenges of rapid physical, emotional, cognitive, and social changes, adolescents (10–19 years) have increased risk of poor health outcomes and acquisition of HIV (Human Immunodeficiency Virus) infection [1]
HIV associated morbidity and mortality and quality of life have remarkably improved with availability of life-saving antiretroviral therapy (ART) due to virologic suppression [2, 3]
Early entry and retention in HIV medical care increases the success of the test and treatment strategy, a policy guideline where all persons who test HIV positive are started on ART irrespective of their age, immune, and clinical status [1, 5]

Summary

Introduction

Besides the challenges of rapid physical, emotional, cognitive, and social changes, adolescents (10–19 years) have increased risk of poor health outcomes and acquisition of HIV (Human Immunodeficiency Virus) infection [1]. To prevent considerable HIV related morbidity and mortality, all HIV-positive adolescents must be put on antiretroviral therapy (ART) and should remain in care to achieve virologic suppression [4]. Early entry and retention in HIV medical care increases the success of the test and treatment strategy, a policy guideline where all persons who test HIV positive are started on ART irrespective of their age, immune, and clinical status [1, 5]. Interventions tested included generating list of adolescents who missed scheduled appointments, use of mobile phone technology, and linkage of adolescents to nearest health facilities (PDSA 1), Adolescent Only Clinic (PDSA 2), and monthly meetings to address care and treatment challenges (PDSA 3). Context specific, integrated, adolescent-centered interventions implemented using QI significantly improved retention in Mid-Western Uganda

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