Lessons learned from a continuous quality improvement project on pediatric/adolescent viral load suppression in a state tertiary teaching hospital in Nigeria.
1
National Clinical Mentorship Programme, National AIDS & STIs Programme (NASCP), Abuja, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Viral load is important to monitor the outcomes of people on Antiretroviral Therapy (ART). The Continuous Quality Improvement team of the Ekiti State University Teaching Hospital, Nigeria, reviewed the pediatric/adolescent viral load suppression rate and saw rates of 82-85% over the quarter (November to February, 2024). This project was initiated to improve the suppression rate. Description: A mixed-methods approach was employed, comprising quantitative analysis of data extracted from the electronic medical records and qualitative insights through focus group discussions and interviews with healthcare workers, pediatric and adolescent clients, and caregivers. Data analysis was performed using Microsoft Excel. The root causes were: - Patient-related factors: low health literacy, scheduling difficulties due to school hours, and transportation problems for clinic appointments. - Caregiver(s) factors: limited health literacy, religious/socioeconomic status. - Household/environment factors: disclosure problems, changes in primary caregiver(s). - Institution/process factors: inefficient tracking systems, Human Resources. The Plan-Do-Study-Act was used to apply cross-cutting interventions to improve the rate from 84% to 90% from March to September 2024. Innovations applied were: - Client-focused counseling/clinical review by the paediatrician on every visit. - Participation in the caregiver’s forum for capacity building. - 30-day adherence calendar to send adherence reminders. - Case conferencing model to address social determinants of health. Lessons Learned: The case conferencing model was most effective as it addressed the social determinants of health. Here, patients/caregivers' other aspects of life were reviewed, including occupation, housing, and comorbidities. It involved collaborations between the OVC, social workers, and the clinical teams. It promoted service integration in the management of paediatric HIV. 90% of patients who passed through the model had a suppressed viral load by the end of six months.
CONCLUSIONS:
A holistic review of patients is ideal. Case conferencing model within the first three months of ART initiation improves viral load outcome.
Viral load is important to monitor the outcomes of people on Antiretroviral Therapy (ART). The Continuous Quality Improvement team of the Ekiti State University Teaching Hospital, Nigeria, reviewed the pediatric/adolescent viral load suppression rate and saw rates of 82-85% over the quarter (November to February, 2024). This project was initiated to improve the suppression rate. Description: A mixed-methods approach was employed, comprising quantitative analysis of data extracted from the electronic medical records and qualitative insights through focus group discussions and interviews with healthcare workers, pediatric and adolescent clients, and caregivers. Data analysis was performed using Microsoft Excel. The root causes were: - Patient-related factors: low health literacy, scheduling difficulties due to school hours, and transportation problems for clinic appointments. - Caregiver(s) factors: limited health literacy, religious/socioeconomic status. - Household/environment factors: disclosure problems, changes in primary caregiver(s). - Institution/process factors: inefficient tracking systems, Human Resources. The Plan-Do-Study-Act was used to apply cross-cutting interventions to improve the rate from 84% to 90% from March to September 2024. Innovations applied were: - Client-focused counseling/clinical review by the paediatrician on every visit. - Participation in the caregiver’s forum for capacity building. - 30-day adherence calendar to send adherence reminders. - Case conferencing model to address social determinants of health. Lessons Learned: The case conferencing model was most effective as it addressed the social determinants of health. Here, patients/caregivers' other aspects of life were reviewed, including occupation, housing, and comorbidities. It involved collaborations between the OVC, social workers, and the clinical teams. It promoted service integration in the management of paediatric HIV. 90% of patients who passed through the model had a suppressed viral load by the end of six months.
CONCLUSIONS:
A holistic review of patients is ideal. Case conferencing model within the first three months of ART initiation improves viral load outcome.
| eISSN: | 2654-1459 |
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