Table 1.
Successful Change Ideas Tested by Health Facility Quality Improvement Teams
| Human resources systems and processes |
| Appoint rotating VL focal person to oversee results tracking and documentation |
| Implement task shifting to reduce clinical workload |
| Assign individual facility-based case managers to monitor UVL patients' care |
| Implement task shifting for home visits |
| Develop and use a working schedule for facility-based staff |
| VL test result management, data quality, and documentation |
| Use the national high VL register to generate a “line list” of clients with UVL to assist in longitudinal follow-up and assessment of timeliness of interventions |
| Develop and implement VL results management standard operating procedures (SOPs) |
| Utilize online NASCOP EID/VL system at the health facility to access and communicate VL test results before hard copies are available |
| Engage a facility-based VL focal person to communicate the online/electronic VL test results before hard copies are available |
| Store files for clients with UVL and/or on second-line ART regimens separately from other client files for easy access and follow-up |
| Conduct weekly reviews for data quality in the high VL register |
| Conduct monthly reviews for data quality in other relevant registers |
| Cross-reference client information across multiple sources and fill in any gaps to ensure proper follow-up action for all clients with UVL |
| Color-code client files using stickers to indicate the last EAC session completed |
| Review client contact information before every consultation and revise as needed |
| Workflow process modification |
| Develop and use a counseling summary tool to concisely convey findings from other EAC tools |
| Conduct and document pill count during all clinical consultations |
| Develop and use an EAC tool to standardize counseling sessions |
| Convene MDT meetings to review UVL clients and address barriers to adherence |
| Systematically retrieve client files a day before clinic appointment |
| Convene MDT meetings to review clients with repeat UVL before switching to second-line treatment |
| Schedule 30-day follow-up appointment for all clients after VL sample collection before providing ART |
| Provide convenient appointment and support group scheduling |
| Reduce the maximum number of prescheduled appointments per day |
| Offer peer-led psychosocial support groups tailored for specific patient populations |
| Client and family education and engagement |
| Introduce telephone-based appointment reminder system |
| Introduce and enroll eligible clients in family-centered care |
| Introduce treatment supporters to increase retention in care |
| Recruit and engage virally suppressed clients to provide health education from the peer perspective |
| Provide pill boxes and training on their use to help clients manage medications |
| HCW capacity building |
| Provide on-the-job mentorship on optimizing and standardizing EAC services for all adherence counselors |
| Train clinicians/nurses on proper coding/labeling of VL samples |
Note. ART = antiretroviral therapy; EAC = enhanced adherence counseling; EID = early infant diagnosis; HCW = health care worker; MDT = multidisciplinary team; NASCOP = National AIDS and Sexually Transmitted Infections Control Program; UVL = unsuppressed viral load; VL = viral load.