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PLoS One. 2017 Apr 18;12(4):e0175534. doi: 10.1371/journal.pone.0175534. eCollection 2017.

Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial.

Author information

1
Applied Analytics, Clinton Health Access Initiative, Lusaka, Zambia.
2
Applied Analytics, Clinton Health Access Initiative, Boston, Massachusetts, United States of America.
3
Demand-Driven Evaluations for Decisions, Clinton Health Access Initiative, Lusaka, Zambia.
4
Clinical Care and Diagnostic Services, Ministry of Health, Lusaka, Zambia.
5
Mother and Child Health, Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
6
Clinton Health Access Initiative, Lusaka, Zambia.
7
Health Financing, Clinton Health Access Initiative, Lusaka, Zambia.
8
Applied Analytics, Clinton Health Access Initiative, Kampala, Uganda.

Abstract

INTRODUCTION:

In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence.

METHODS:

Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention's impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services.

RESULTS:

The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2-48.5; P = 0.2).

CONCLUSION:

A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable intervention in Zambia's urban clinics.

PMID:
28419106
PMCID:
PMC5395211
DOI:
10.1371/journal.pone.0175534
[Indexed for MEDLINE]
Free PMC Article

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