Towards the third 90: improving viral load testing with a simple quality improvement program in health facilities in Malawi

Hubbard J, Kakwesa G, Nyirenda M, Mwambene J, Bardon A, Balakasi K, Dovel K, Kalua T, Hoffman RM

BACKGROUND: Viral load (VL) scale-up efforts have largely focused on laboratory systems, with less attention on facility-level strengthening of staff who facilitate VL testing. To address this gap we implemented a quality improvement (QI) program at 13 health facilities in central and southern Malawi.

METHODS: QI program tools focused on patient and provider VL knowledge and clarification of site-level roles and responsibilities, including the designation of a VL 'focal person' to oversee all VL activities. T-tests were used to compare differences in VL testing before (November 2016-April 2017) and after (May 2017-November 2017) the intervention.

RESULTS: The mean number of VL tests performed significantly increased after implementation of the QI program. Overall there was a 164% increase in the mean number of routine VL tests performed per month (p<0.001). Increased VL testing was sustained during the 6 months of follow-up.

CONCLUSIONS: A simple QI program focused on improving VL knowledge among patients and providers, and clarifying staff roles at a facility level increased VL testing over a 6-month period. Further investigation is needed on whether this program can be scaled in different settings across sub-Saharan Africa and on the duration of follow-up required for sustained improvements in VL testing.

December 5, 2019
Year of publication
Resource types
Reports and Fact sheets
quality improvement, viral load testing, 90-90-90 targets

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