A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa.
Acquired Immunodeficiency Syndrome
/ drug therapy
Adult
Anti-Retroviral Agents
/ therapeutic use
Epidemiological Monitoring
Female
Follow-Up Studies
HIV-1
/ genetics
Humans
Male
Middle Aged
Prevalence
Rural Health
Rural Population
South Africa
/ epidemiology
Sustained Virologic Response
Viral Load
/ drug effects
HIV
Monitoring
Rural health
South Africa
Viral load
Virologic suppression
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
11 Nov 2020
11 Nov 2020
Historique:
received:
04
03
2020
accepted:
03
11
2020
entrez:
12
11
2020
pubmed:
13
11
2020
medline:
20
11
2020
Statut:
epublish
Résumé
The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district. A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data. Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation. The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
Sections du résumé
BACKGROUND
BACKGROUND
The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district.
METHODS
METHODS
A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data.
RESULTS
RESULTS
Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p < 0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p < 0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation.
CONCLUSIONS
CONCLUSIONS
The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
Identifiants
pubmed: 33176715
doi: 10.1186/s12879-020-05576-5
pii: 10.1186/s12879-020-05576-5
pmc: PMC7659110
doi:
Substances chimiques
Anti-Retroviral Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
836Subventions
Organisme : NIH HHS
ID : R01AI098558
Pays : United States
Organisme : Center for AIDS Research, Emory University
ID : P30AI050409
Organisme : Research and Health Sciences IT division
ID : UL1RR025008
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