Quality improvement approaches to optimize care given to children and adolescents living with HIV in Lango sub-region of northern Uganda

BACKGROUND: Providing quality care for children and adolescents living with HIV(CALHIV) remains a global challenge and requires development of new healthcare delivery strategies. The USAID Regional Health Integration to Enhance Services-North, Lango (RHITES-N, Lango) project, through a health system strengthening intervention, used targeted quality improvement (QI) methods to accelerate care given to CALHIV.
DESCRIPTION: Between March and November 2021, RHITES-N, Lango invited 59 health facilities in the region to join a 'learning network' based on prescribed HIV care and treatment services. Clinic QI teams, consisting of nurses, counsellors, community linkages facilitators, data clerks, medical and clinical officers met to establish collective and individual performance targets, analyzed facilities' care systems using 'real-time' data feedback from an excel audit tool, were trained on best practices and implemented a set of simple tailored interventions to improve the proportion of CALHIV receiving comprehensive care. Some of the interventions included line-listing clients due for appointment and giving them reminders. Facility data was reviewed and summarized weekly.
LESSONS LEARNED: 6,257 CALHIV were audited out of a target of 6,142 (102%) by November 2021. The proportion of CALHIV who received all the services they were eligible for increased from 30% in March 2021 to 80% (average) in November 2021. In turn, several service delivery indicators improved. 97% of the CALHIV had been screened and linked to OVC services, 100% were optimized to the optimal regimen, 91% were initiated on TB prophylaxis treatment, and 80% had an up-to-date viral load test.
Improvement was observed across 59 facilities.The proportion of CALHIV receiving all services increased by 50% in eight months.
CONCLUSIONS:

• System improvement methods, standardized audit tools, use of real-time data, and opportunities for cross learning improve clinic processes and outcomes in a resource-constrained setting.
• The use of multiple stakeholders including health facilities and community members strengthens service integration and improves client care.
• A QI approach, using learning networks to teach simple data-driven methods for addressing system failures, with increased training, replicable best practices and resource inputs, can assist districts to quickly reach universal coverage targets.
• The use of the audit tool enabled the teams to identify and address performance gaps.

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