MOPED537
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Title
Implementing quality improvement in a large HIV clinic to improve the availability of pediatric viral load results for patient care in rural Zambézia, Mozambique
Presenter
C. William Wester
Authors
M. Melo1, C. De Schacht1, J. Langa2, R. Pinto2, A. Inácio3, W. Silva1, M. Stefanutto1, P. Gonzalez2, J.G. Cowan4, C.W. Wester5,6, S. Van Rompaey1
Institutions
1Friends in Global Health (FGH), Maputo, Mozambique, 2Friends in Global Health (FGH), Quelimane, Mozambique, 3Provincial Health Directorate Zambezia, Quelimane, Mozambique, 4Centers for Disease Control and Prevention (CDC), Maputo, Mozambique, 5Vanderbilt Institute of Global Health (VIGH), Nashville, United States, 6Vanderbilt University Medical Center (VUMC), Department of Medicine, Division of Infectious Diseases, Nashville, Mozambique

Background: In 2015, viral load (VL) testing became routine for children 2-5 years in Mozambique. Programmatic data from 11 supported districts in Zambézia showed that 9% of children on antiretroviral treatment (ART) for ≥6 months had a VL result registered between February 2015 - February 2016. Embedded within Quality Improvement (QI) activities, we designed a cascade including all steps leading up to VL results being communicated to caregiver, in an attempt to identify bottlenecks and devise tailored interventions to address them.
Methods: In the Namacurra main health facility, we collected patient-level data for 85, 22 and 43 HIV+ children (< 5 years old), who initiated ART between December 21, 2015-June 20, 2016, November 21, 2016-May 20, 2017 and June 21-December 20, 2017, respectively. Eligibility for VL, defined as having consistent ART pick-ups for the initial 6 months, was confirmed using Clinical Files (CF). Data on VL cascade such as VL requisitions, turn-around of samples and results, entry into the electronic patient tracking system (EPTS), entry into the CF, and communication to patient/caregiver were collected over three cycles.
Results:

Figure 1: Namacurra Health Facility Pediatric Viral Load Cascade
[Figure 1: Namacurra Health Facility Pediatric Viral Load Cascade ]

Initial bottlenecks included availability of CF and inconsistent ART pick-ups (impacting eligibility). Subsequent barriers included problems with result availability in the CF. QI activities such as clinical-mentoring and standard operating procedure for maintenance of CF improved outcomes: CF availability improved from 58% to 95%, VL requests registry from 7% to 37% and VL results registry in CF from 5% to 26%. Communication to the caregiver/patient was 21% in the third cycle.
Conclusions: Despite improvement in the availability of pediatric VL results, registration of VL requisitions remained suboptimal. This QI initiative identified key components in the pediatric cascade for improvement and inclusion in the QI/HIV action plans of this and other health facilities, that when implemented consistently can result in significant improvement in pediatric outcomes.

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