Improving viral load monitoring at health facilities providing HIV care: Tested changes and guidance from Uganda

UNAIDS’ 90-90-90 Strategy has set treatment targets to help bring to an end the AIDS epidemic by 2020. According to this strategy, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90% of all people receiving ART will have viral suppression. Uganda adopted this global strategy in 2014, and viral load is now the preferred measurement for monitoring response to ART in Uganda.

The change ideas shared in this change package are a compilation of actions taken by 34 health facility quality improvement (QI) teams located in east, east central, and western Uganda. ASSIST worked closely with the regional implementing partners STAR E and STAR EC (Strengthening TB and HIV Responses in the Eastern and East Central regions); RHITES SW (Regional Health Integration to Enhance Services) in the south western region; HIWA (HIV Health Initiatives in Workplace Activities); and Uganda Private Health Support (UPHS). ASSIST also identified ART centers and organized them into an improvement collaborative working towards better VL monitoring.

The resulting change ideas were further organized by the facilitators into five change concepts:

  1. Regular updating of client files and registers;
  2. Addressing information/knowledge gaps among health workers, clients, and their caregivers on VL monitoring;
  3. Identifying eligible clients for VL bleeding; 4) Improving efficiency of the facility to do viral load testing; and
  4. Follow-up of clients and results.

This change package is intended to provide guidance to individuals and QI teams wishing to improve VL testing access for ART clients. It provides a general idea of activities with examples of innovative changes that can be implemented in order to improve VL testing. Teams are encouraged to read through and adapt these changes to suit their clinic/facility settings to improve performance.

ASSIST publication: 
ASSIST publication
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