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Research article
Vincent Marconi
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8409-4689
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Background: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district.
Methods: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data.
Results: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p<0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p<0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation.
Conclusions: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
Keywords
HIV, viral load, South Africa, rural health, virologic suppression, monitoring
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CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 03 Nov, 2020
Editorial decision: Accept
On 01 Nov, 2020
Version 2
Posted 28 Oct, 2020
No comments provided
Editorial decision: Minor revision
On 28 Oct, 2020
Editor assigned
On 19 Oct, 2020
Submission checks complete
On 18 Oct, 2020
Editor invited
On 18 Oct, 2020
No comments provided
Editorial decision: Minor revision
On 05 Oct, 2020
Review #2 received
Received 21 Sep, 2020
Review #3 received
Received 04 Jul, 2020
Review #1 received
Received 04 Jul, 2020
Reviewer #3 agreed
On 22 Jun, 2020
Reviewer #2 agreed
On 19 Jun, 2020
Reviewer #1 agreed
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Editor assigned
On 05 Mar, 2020
First submitted
On 04 Mar, 2020
Submission checks complete
On 04 Mar, 2020
Editor invited
On 04 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Infectious Diseases.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Vincent Marconi
Corresponding Author
ORCiD: https://orcid.org/0000-0001-8409-4689
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Infectious Diseases.
No community comments so far
Submission checks complete
On 03 Nov, 2020
Editorial decision: Accept
On 01 Nov, 2020
Version 2
Posted 28 Oct, 2020
No comments provided
Editorial decision: Minor revision
On 28 Oct, 2020
Editor assigned
On 19 Oct, 2020
Submission checks complete
On 18 Oct, 2020
Editor invited
On 18 Oct, 2020
No comments provided
Editorial decision: Minor revision
On 05 Oct, 2020
Review #2 received
Received 21 Sep, 2020
Review #3 received
Received 04 Jul, 2020
Review #1 received
Received 04 Jul, 2020
Reviewer #3 agreed
On 22 Jun, 2020
Reviewer #2 agreed
On 19 Jun, 2020
Reviewer #1 agreed
On 07 Apr, 2020
Reviewers invited
Invitations sent on 07 Apr, 2020
Editor assigned
On 05 Mar, 2020
First submitted
On 04 Mar, 2020
Submission checks complete
On 04 Mar, 2020
Editor invited
On 04 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Infectious Diseases.
Background: The KwaZulu-Natal (KZN) province of South Africa has the highest prevalence of HIV infection in the world. Viral load (VL) testing is a crucial tool for clinical and programmatic monitoring. Within uMkhanyakude district, VL suppression rates were 91% among patients with VL data; however, VL performance rates averaged only 38·7%. The objective of this study was to determine if enhanced clinic processes and community outreach could improve VL monitoring within this district.
Methods: A packaged intervention was implemented at three rural clinics in the setting of the KZN HIV AIDS Drug Resistance Surveillance Study. This included file hygiene, outreach, a VL register and documentation revisions. Chart audits were used to assess fidelity. Outcome measures included percentage VL performed and suppressed. Each rural clinic was matched with a peri-urban clinic for comparison before and after the start of each phase of the intervention. Monthly sample proportions were modelled using quasi-likelihood regression methods for over-dispersed binomial data.
Results: Mkuze and Jozini clinics increased VL performance overall from 33·9% and 35·3% to 75·8% and 72·4%, respectively which was significantly greater than the increases in the comparison clinics (RR 1·86 and 1·68, p<0·01). VL suppression rates similarly increased overall by 39·3% and 36·2% (RR 1·84 and 1·70, p<0·01). The Chart Intervention phase showed significant increases in fidelity 16 months after implementation.
Conclusions: The packaged intervention improved VL performance and suppression rates overall but was significant in Mkuze and Jozini. Larger sustained efforts will be needed to have a similar impact throughout the province.
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
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