The effect of a targeted quality improvement intervention to improve access to antiretroviral therapy (ART) services for key populations in Zambia

Title

The effect of a targeted quality improvement intervention to improve access to antiretroviral therapy (ART) services for key populations in Zambia

Presenter

Edward Oladele

Authors

M. Nalwamba (1), S. Wenson (1), J. Kamanga (1), N. Phiri (2), M. Bateganya (3), F. Mwape (1), E. Oladele * (1)

Institutions

(1) FHI 360 Zambia, Lusaka, Zambia, (2) United States Agency for International Development, Lusaka, Zambia, (3) FHI 360, Durham, United States

BACKGROUND: The USAID Open Doors Project (ODP) is a five-year project aiming to increasing access to and use of comprehensive HIV prevention, care, and treatment services by key population individuals including female sex workers (FSWs), men who have sex with men (MSM) and transgender people. An ODP implementing partner, ZANERELA+, faced challenges in linking HIV-positive key populations to clinical HIV services, after joining the project in October 2020. A quality improvement (QI) intervention was implemented with a goal of 95% of newly diagnosed clients were linked.
DESCRIPTION: A QI team of two clinical officers and two medical doctors implemented QI activities over six weeks in collaboration with ZANERELA+. Starting December 1, 2020, the following interventions were implemented:

Engaged ZANERELA+ staff in a root cause analysis and driver diagram to identify specific issues
Developed job descriptions with defined responsibilities for health care providers and lay counselors
Developed and implemented weekly virtual and onsite mentorship on pre-ART counseling for program/clinical staff over six weeks
Demonstrated field-based HIV status probing skills for staff counselor
Established designated zones for client outreach

LESSONS LEARNED:

In the first quarter of fiscal year 2021 (Q1 FY21), the linkage rate for key population groups was 48% (FSW n=32 (50%), MSM n=5 (80%), transgender n=2 (0%)). Majority of unlinked clients were tested during community-based outreach (n=11) and were between the ages 20-29 (n=8). Linkage increased to 99.4% (FSW 99%, MSM 100%, transgender 100%) by March 2021, after the completion of Q1 interventions. Among previously unlinked FSWs, 92% (n=12) were initiated on care. All MSM (n=1) and transgender (n=2) clients were initiated, resulting in 100% linkage.
CONCLUSIONS: Average monthly linkage increased from 27% before the QI intervention to 98% after intervention activities were completed. We recommend that QI be extended to other subrecipients to improve service delivery and organizational capacity.

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