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AIDS. 2017 Jul 1;31 Suppl 3:S243-S252. doi: 10.1097/QAD.0000000000001531.

Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge.

Author information

1
aDepartment of Global Health, University of Washington, Seattle, Washington, USA bDepartment of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya cInternational Training and Education Center for Health, University of Washington, Seattle, Washington, USA dVCT and HIV Prevention Unit/Youth Centre, Kenyatta National Hospital, Nairobi, Kenya eSchool of Medicine fDepartment of Epidemiology, University of Washington, Seattle, Washington, USA gResearch and Programs, Kenyatta National Hospital, Nairobi, Kenya hDepartment of Psychosocial and Community Health iDepartment of Pediatrics, University of Washington, Seattle, Washington, USA.

Abstract

OBJECTIVES:

To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA).

DESIGN:

CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya.

METHODS:

Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted.

RESULTS:

There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746).

CONCLUSION:

CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.

PMID:
28665882
PMCID:
PMC5497779
DOI:
10.1097/QAD.0000000000001531
[Indexed for MEDLINE]
Free PMC Article

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