Addressing the 3rd 90 Gap through Integrated Health Delivery Camps in 4 Health Facilities in Nwoya District, Uganda
In 2014, the Joint UN Program on HIV/AIDS set ambitious goals to eliminate the HIV/AIDS epidemic by 2020 through the 90-90-90 three-pronged approach. The Uganda Ministry of Health. together with implementing partners including ASSIST, adopted the approach. Nwoya, one of the 16 districts in Uganda under ASSIST support, prioritized the 3rd 90 target – viral load (VL) suppression for 90% of ART patients. A baseline assessment in May 2016 indicated that VL suppression was at 89% and yet only 41% of the eligible clients had received VL.
To initially close the VL backlog, the following changes in June and July 2016 were implemented: client chart color coding, client flow reorganization, and VL sample collection during both clinic and non-clinic days. However, these interventions increased VL access from only 41% to 57%, leaving a backlog of 1,202 tests. The District Quality Improvement Team proposed an integrated health camp approach to completely clear the backlog. With support from ASSIST, integrated camps were organized at the facility level and the following changes tested: client file audits, eligible patient list generation, linkage facilitator and peer-to-peer mobilization, and HIV testing and nutrition assessment at the camps. During the camps, 41% of the VL eligible clients were reached and samples collected. To completely clear the VL backlog, health facilities adopted the camp model and continued the mobilization of VL eligible clients. By September 2016, 92% of the eligible clients had received a VL test reducing the backlog to 113, which was later cleared by October 2016.