The utility of the Continuous Quality Improvement (CQI) methodology in identifying and addressing gaps in the HIV Care Continuum: the case of USAID strengthening the Care Continuum

BACKGROUND: In low prevalence and generalized epidemic contexts such as Ghana, effective and efficient case identification is critical in meeting the first 95% of the global 95-95-95 targets. However, structural and policy level challenges often inhibit utilization of all entry points for effective case identification. This abstract illuminates the power of the continuous quality improvement (CQI) methodology to test a change idea and convince reluctant policy actors to use blood banks as a feasible entry point for HIV testing and linkage to care in Ghana.
DESCRIPTION: As part of its CQI process in 2019, the USAID Strengthening the Care Continuum (Care Continuum) project implemented by JSI Research & Training Institute, Inc. collected retrospective baseline data from eight hospitals on blood donors in the Western Region (WR) of Ghana. The analysis revealed that about one percent (40 out of 3,152) voluntary donors and over two percent (299 of 11,743) replacement donors were reactive to HIV. This prevalence was close to the national average of two percent. However, due to stigma and fears of discouraging potential blood donors, these reactive donors missed the opportunity to know their HIV status and receive timely treatment. The Care Continuum project therefore used the largest hospital in WR, the Effia Nkwanta Regional Hospital (ENRH), to test an innovation by offering HIV testing services to blood donors as a test case. Two nurses from the blood bank received additional training on counseling to offer HIV tests to donors at the point of sample taking. Additional key stakeholder engagement included convincing hospital authorities that with effective counseling, HIV positive donor results could be disclosed without negative consequences.
LESSONS LEARNED: The change idea was successful and offering HIV testing services to donors did not lead to a reduction in persons donating blood. From April 2020 to June 2021, 3,634 donors were offered HIV testing services and eleven positive cases were identified and linked to care.
CONCLUSIONS:

• Harness the findings of this intervention for high-level policy engagement.
• Conduct more rigorous research studies in this area to inform policy and practice.
• Scale-up to other blood banks.

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