A packaged intervention to improve viral load monitoring within a deeply rural health district of South Africa

• Type of Material: Article
• Authors: J. Brijkumar, University of Kwazulu Natal; B.A. Johnson, University of Rochester; Y. Zhao, Emory University; J. Edwards, Emory University; P. Moodley, University of Kwazulu Natal; K. Pathan, Emory University; S. Pillay, University of Kwazulu Natal; Kenneth Castro, Emory University; H. Sunpath, University of Kwazulu Natal; D.R. Kuritzkes, Harvard Medical School; M.Y.S. Moosa, University of Kwazulu Natal; Vincent Marconi, Emory University
• Language: English
• Date: 2020-11-11
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12879-020-05576-5
• Title of Journal or Parent Work: BMC INFECTIOUS DISEASES
• Volume: 20
• Issue: 1
• Start Page: 836
• End Page: 836
• Grant/Funding Information: The parent study was supported by the Emory University Centre for AIDS Research (CFAR) for salary support (V.C.M., P30AI050409) and NIH/NIAID for salary support and funding the parent study ADReSS (V.C.M. and D.R.K R01 AI098558).
• Keywords: Viral load; HIV; RISK; Infectious Diseases; Virologic suppression; ASSOCIATION; Life Sciences & Biomedicine; South Africa; Rural health; ANTIRETROVIRAL THERAPY; Science & Technology; VIRUS; Monitoring
• Research Categories: Health Sciences, Public Health; Biology, Virology

Abstract

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: 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: 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: 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.