Improving Utilization of HIV Viral Load Test Results Using a Quality Improvement Collaborative in Western Kenya

Abstract

Kenya has the world's fourth largest burden of HIV, with an estimated adult HIV prevalence of 4.8% and 1.6 million people living with HIV (Joint United Nations Programme on HIV/AIDS, 2019). In response, the Government of Kenya, with the support of its development partners, has scaled up HIV services and achieved 75% treatment coverage; 1.1 million people were accessing antiretroviral therapy (ART) by year end 2018 (Joint United Nations Programme on HIV/AIDS, 2019). The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that there has been a 55% drop in AIDS-related deaths and a 30% drop in new HIV infections in Kenya since 2010 (Joint United Nations Programme on HIV/AIDS, 2019). As Kenya strives to attain HIV epidemic control and to achieve the UNAIDS 90:90:90 goals, scaling up routine HIV viral load testing (VLT) is a priority for the Ministry of Health (MoH) and its National AIDS and Sexually Transmitted Infections Control Program (NASCOP), which have successfully expanded VLT coverage throughout the country (National AIDS and Sexually Transmitted Infections Control Program, 2016, 2019). As VLT coverage expands, MoH has also emphasized the importance of swift and accurate VLT result utilization. National guidelines recommend that people on ART with unsuppressed viral load (UVL) receive three enhanced adherence counseling (EAC) sessions at monthly intervals for 3 months followed by repeat VLT, with a switch to second-line ART if persistent UVL is found (Figure ​(Figure1).1). However, despite rollout of national policies, guidelines, and training, programmatic data suggest such VLT utilization has been suboptimal (National AIDS and Sexually Transmitted Infections Control Program, 2019).