Abstract

CLOETE, Christie M. et al. Evaluation of a health system intervention to improve virological management in an antiretroviral programme at a municipal clinic in central Durban. South. Afr. j. HIV med. (Online) [online]. 2019, vol.20, n.1, pp.1-8. ISSN 2078-6751.  http://dx.doi.org/10.4102/sajhivmed.v20i1.985.

BACKGROUND: With the largest antiretroviral therapy (ART) programme globally, demand for effective HIV management is increasing in South Africa. While viral load (VL) testing is conducted, VL follow-up and management are sub-optimal OBJECTIVES: The objective of this study was to address gaps in the VL cascade to improve VL testing and management METHODS: Antiretroviral therapy records were sampled for an in-depth review. The study team then reviewed individual records, focusing on ART management, virological suppression and retention. Multifaceted interventions focused on virological control, including a clinical summary chart for ART care; streamlining laboratory results receipt and management; monitoring VL suppression, flagging virological failure and missed visits for follow-up; down-referral of stable patients eligible for the chronic club system; and training of personnel and patients RESULTS: Pre-intervention, 78% (94/120) of eligible patients had VL tests, versus 92% (145/158) post-intervention (p = 0.0009). Pre-intervention, 59% (71/120) of patients accessed their VL results, versus 86% (136/158) post-intervention (p < 0.0001). Post-intervention, 73% (19/26) of patients eligible for ART change were appropriately managed, versus 11% (4/36) pre-intervention (p < 0.0001). Only 27% had no regimen changes (7/26) post-intervention, versus 81% (29/36) pre-intervention (p < 0.0001 CONCLUSION: Service delivery was streamlined to facilitate HIV services by focusing on VL test monitoring, protocol training and accessibility of results, thereby improving clinical management

Keywords : HIV-1 infected; antiretroviral care or management; health strengthening systems interventions; virological suppression; retention in care.

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