Factors Influencing Effectiveness of the Viral Load Monitoring System in Hiv Programs: a Comparative Study of the Coptic Hope Center and Lea Toto Hiv Projects in Kenya

Abstract

In Kenya, there has been a recent scale-up of the M&E systems among the HIV programs in response to increasing donor demands to provide quality data for both programs and patient monitoring. There exist gaps in enhancing the existing monitoring systems to effectively generate reliable data that can be used for viral load monitoring. This study assessed factors associated with an effective viral load monitoring system in HIV programs, a comparative study of the Coptic Hope Center and the Lea Toto programs. The study adopted a cross-sectional study design with a representative sample of 36 respondents in each program. Both qualitative and quantitative data were collected on the various components of viral load monitoring system and a review of the existence of all components of viral load monitoring system was done. The findings revealed that the method used for viral load data collection has an influence on the effectiveness of the viral load monitoring system. The Coptic Hope Center had a well elaborate electronic medical record system, which was more efficient and relatively easy to use. Such a system generates accurate data while encouraging the use of data for decision-making. The Lea Toto program, on the other hand, used patient files and viral load registers, which were voluminous; a result of filling a questionnaire for every session a patient has with the service provider. Such a system was noted to contribute to inaccurate data while discouraging the use of data generated for decision making. The study further noted the absence of improvement plans on the monitoring gaps singled out by viral load data support supervision activities in both programs. This undermined the very benefit of data support supervision of helping build the capacity of staff collecting the viral load data and by extension, improving on the quality of the data collected. The study further observed that the different methods of disseminating the viral load data downwards affect utilization and hence the effectiveness of viral load monitoring system.

Though a majority of the staff in both programs mostly uses the viral load data for the viral load related decisions, a sizeable proportion of staff at the Lea Toto program does not always rely on the viral load data to make decisions due to limited involvement in the use of data for the decision-making process. The study recommends that programs should adopt a simplified electronic viral load monitoring system that makes it easier for the end users to navigate through different modules and allows service providers to generate accurate viral load reports at a point of care. Further supportive supervision of the viral load data, accompanied by an elaborate improvement plan, should be an integral part of the viral load monitoring system. Further, programs need to strengthen stakeholder involvement in decision-making, which may enhance demand for data. Finally, it is therefore important to ensure there is an effective protocol to ensure that inaccurate data is corrected in a timely manner.