Quality improvement intervention to increase adherence to ART prescription policy at HIV treatment clinics in Lusaka, Zambia: A cluster randomized trial

PLoS One. 2017 Apr 18;12(4):e0175534. doi: 10.1371/journal.pone.0175534. eCollection 2017.

Abstract

Introduction: In urban areas, crowded HIV treatment facilities with long patient wait times can deter patients from attending their clinical appointments and picking up their medications, ultimately disrupting patient care and compromising patient retention and adherence.

Methods: Formative research at eight facilities in Lusaka revealed that only 46% of stable HIV treatment patients were receiving a three-month refill supply of antiretroviral drugs, despite it being national policy for stable adult patients. We designed a quality improvement intervention to improve the operationalization of this policy. We conducted a cluster-randomized controlled trial in sixteen facilities in Lusaka with the primary objective of examining the intervention's impact on the proportion of stable patients receiving three-month refills. The secondary objective was examining whether the quality improvement intervention reduced facility congestion measured through two proxy indicators: daily volume of clinic visits and average clinic wait times for services.

Results: The mean change in the proportion of three-month refills among control facilities from baseline to endline was 10% (from 38% to 48%), compared to a 25% mean change (an increase from 44% to 69%) among intervention facilities. This represents a significant 15% mean difference (95% CI: 2%-29%; P = 0.03) in the change in proportion of patients receiving three-month refills. On average, control facilities had 15 more visits per day in the endline than in the baseline, while intervention facilities had 20 fewer visits per day in endline than in baseline, a mean difference of 35 fewer visits per day (P = 0.1). The change in the mean facility total wait time for intervention facilities dropped 19 minutes between baseline and endline when compared to control facilities (95% CI: -10.2-48.5; P = 0.2).

Conclusion: A more patient-centred service delivery schedule of three-month prescription refills for stable patients is viable. We encourage the expansion of this sustainable intervention in Zambia's urban clinics.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Ambulatory Care
  • Anti-HIV Agents / therapeutic use*
  • Drug Prescriptions / standards
  • Government Programs / legislation & jurisprudence
  • HIV Infections / drug therapy*
  • Health Facilities
  • Health Services Accessibility / standards
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Patient Compliance / statistics & numerical data*
  • Policy
  • Quality Improvement*
  • Time Factors
  • Zambia

Substances

  • Anti-HIV Agents

Grant support

This work was made possible through funding support from UKAid/DFID of the UK Government to the Clinton Health Access Initiative. The study sponsor (DFID) did not have any role in the study design; in the collection, analysis, and interpretation of data, in the writing of the report; or in the decision to submit the paper for publication. The views expressed in this article are the opinions of the authors and do not necessarily reflect the official policies of DFID or the UK Government.