A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia

Gillian Dougherty; Rodrigo Boccanera; Mary Adetinuke Boyd; Tracey Gantt; Siphiwe Chilungu Kasonka; Prisca Kasonde; Nila Kaetano; Caitlin Madevu-Matson; Phales Milimo; Mukuka Mwamba; Milembe Panya; Brenda Senyana; Fatima Tsiouris; Lauren Walker; Nancy Zyongwe; Alice Zulu; Miriam Rabkin

doi:10.1097/JNC.0000000000000268

A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia

J Assoc Nurses AIDS Care. 2021 Nov-Dec;32(6):701-712. doi: 10.1097/JNC.0000000000000268.

Authors

Gillian Dougherty¹, Rodrigo Boccanera, Mary Adetinuke Boyd, Tracey Gantt, Siphiwe Chilungu Kasonka, Prisca Kasonde, Nila Kaetano, Caitlin Madevu-Matson, Phales Milimo, Mukuka Mwamba, Milembe Panya, Brenda Senyana, Fatima Tsiouris, Lauren Walker, Nancy Zyongwe, Alice Zulu, Miriam Rabkin

Affiliation

¹ Gillian Dougherty, MPH, BSN, is the Senior Quality Improvement Technical Advisor, ICAP at Columbia University, Columbia University Mailman School of Public Health, New York, New York, USA. Rodrigo Boccanera, MPH, is a Project Officer, U.S. Health Resources and Services Administration (HRSA), Department of Health and Human Services, in Bethesda, Maryland, USA. Mary Adetinuke Boyd, MD, is the Deputy Director, U.S. Centers for Disease Control and Prevention (CDC), Lusaka, Zambia. Tracey Gantt, MSN, RN, APHN-BC, is a Project Officer, U.S. Health Resources and Services Administration (HRSA), Department of Health and Human Services, Bethesda, Maryland, USA. Siphiwe Chilungu Kasonka, MPH, is the Senior M&E Advisor, ICAP Zambia, Lusaka, Zambia. Prisca Kasonde, MD, MPH, is the Country Director, ICAP Zambia, Lusaka, Zambia. Nila Kaetano, BSN, is the QI Advisor, ICAP Zambia, Lusaka, Zambia. Caitlin Madevu-Matson, MSc, is the Informatics and Data Use Manager, ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA. Phales Milimo, MS, is the QI M&E Officer, ICAP Zambia, Lusaka, Zambia. Mukuka Mwamba, MSc, Dip Pharmacy, is the QI Project Director, ICAP Zambia, Lusaka, Zambia. Milembe Panya, MD, MPH, is the Regional Quality Improvement Advisor, ICAP Tanzania, Dar es Salaam, Tanzania. Brenda Senyana, MPH, is the M&E Advisor, ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA. Fatima Tsiouris, MSc, is the PMTCT Senior Technical Advisor, ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA. Lauren Walker, MPH, is the Senior Project Officer, ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA. Nancy Zyongwe, MD, is the QI Advisor, Zambian Ministry of Health (MOH), Lusaka, Zambia. Alice Zulu, MD, is the QI Advisor, ICAP Zambia, Lusaka, Zambia. Miriam Rabkin, MD, MPH, is the Director of Health Systems Strategies, ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA.

Abstract

HIV testing with rapid antiretroviral therapy (ART) initiation are life-saving interventions for adolescents living with HIV. However, in Zambia, HIV diagnosis and immediate ART initiation among adolescents living with HIV is lagging. In collaboration with the Zambian Ministry of Health, the U.S. Health Resources and Services Administration, the U.S. Centers for Disease Control and Prevention in Zambia, and ICAP at Columbia University designed and implemented a quality improvement collaborative (QIC) to improve adolescent immediate ART initiation at 25 health facilities in Lusaka. Over the 12-month implementation period, quality improvement teams tested and identified targeted intervention, that significantly improved ART initiation within 14 days of receiving positive test results, from 24% at baseline to more than 93% for the final 6 months of implementation. The quality improvement collaborative approach empowered health care workers to innovate addressing the root causes of suboptimal performance and produced a package of successful interventions that will be shared throughout Zambia.

Publication types

Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
HIV Infections* / diagnosis
HIV Infections* / drug therapy
Health Facilities
Humans
Quality Improvement*
Zambia

Grants and funding

PEPFAR/PEPFAR/United States