Page 170 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

Evaluation of a health system intervention to improve

virological management in an antiretroviral programme

at a municipal clinic in central Durban

Authors: Background: With the largest antiretroviral therapy (ART) programme globally, demand for
Christie M. Cloete 1 effective HIV management is increasing in South Africa. While viral load (VL) testing is
Jane Hampton 1
Terusha Chetty 1 conducted, VL follow-up and management are sub-optimal.
Thando Ngomane 2
Elizabeth Spooner Objectives: The objective of this study was to address gaps in the VL cascade to improve VL
3
Linda M.G. Zako 2 testing and management.
Shabashini Reddy 1
Tarylee Reddy 4 Methods: Antiretroviral therapy records were sampled for an in-depth review. The study team
Nozipho Luthuli 2 then reviewed individual records, focusing on ART management, virological suppression and
Hope Ngobese retention. Multifaceted interventions focused on virological control, including a clinical summary
2
Gita Ramjee 1
Anna Coutsoudis 3 chart for ART care; streamlining laboratory results receipt and management; monitoring VL
Photini Kiepiela 1 suppression, flagging virological failure and missed visits for follow-up; down-referral of stable
patients eligible for the chronic club system; and training of personnel and patients.
Affiliations
1 HIV Prevention Research Results: Pre-intervention, 78% (94/120) of eligible patients had VL tests, versus 92% (145/158)
Unit, South African Medical
Research Council, Durban, post-intervention (p = 0.0009). Pre-intervention, 59% (71/120) of patients accessed their VL
South Africa results, versus 86% (136/158) post-intervention (p < 0.0001). Post-intervention, 73% (19/26)
of patients eligible for ART change were appropriately managed, versus 11% (4/36)
2 eThekwini Health Unit, pre-intervention (p < 0.0001). Only 27% had no regimen changes (7/26) post-intervention,
eThekwini Municipality,
Durban, South Africa versus 81% (29/36) pre-intervention (p < 0.0001).
Conclusion: Service delivery was streamlined to facilitate HIV services by focusing on VL test
3 School of Clinical Medicine,
University of KwaZulu-Natal, monitoring, protocol training and accessibility of results, thereby improving clinical management.
Durban, South Africa
Keywords: HIV-1 infected; antiretroviral care or management; health strengthening systems
4 Department of Biostatistics, interventions; virological suppression; retention in care.
South African Medical
Research Council, Durban,
South Africa Introduction

Corresponding author: South Africa has the largest antiretroviral therapy (ART) programme in the world with over 4.1 million
Terusha Chetty, adults on treatment by the end of 2017. Despite expanded ART access, incident HIV infections are still
1
[email protected]
substantial with approximately 270 000 individuals infected with HIV in 2017. In 2014, UNAIDS
1
Dates: launched the 90–90–90 targets to progress towards elimination of HIV by 2020. The last ‘90’ of the
2
Received: 21 May 2019 UNAIDS strategy is to ensure that 90% of individuals receiving ART have achieved virologic
Accepted: 05 July 2019 2
Published: 26 Sept. 2019 suppression.
Plasma viral load (VL) is the main driver of new HIV infections. HIV replication is interrupted
3
by ART, thereby reducing VL, decreasing transmission risk and improving morbidity and
survival. Post-initiation, VL is indicative of ART response. In practical terms, to achieve the
4
5
UNAIDS 90–90–90 goals towards HIV elimination, 73% of people living with HIV would need
to be virologically suppressed to reduce the reproductive rate of infection to below 1. 2
In a study of South Africa’s ART ‘treatment cascade’ using data from the national health laboratory
service (NHLS), almost half of all South Africans infected with HIV were not linked to care.
6
The authors were not able to report the proportion of diagnosed people who were not linked to care.
Read online: However, among those linked to care and on treatment, only 73.7% had suppressed VLs. The overall
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Copyright: © 2019. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
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