Factors affecting quality of care for virologically non-suppressed HIV positive patients in Jinja, Buikwe and Iganga Districts, Uganda, 2016

Introduction : viral load (VL) testing improves monitoring of patients’ response to HIV therapy. According to the World Health Organization (WHO), more than 70% of non-suppressed clients should re-suppress after 6 months intensified adherence support (IAS). However, only 50% re-suppressed on 2nd time testing at 6 months of follow up. We established whether virologically non-suppressed patients underwent IAS for 6months, identified structural and process issues affecting service delivery for non-suppressed clients, estimated outcomes at end of 6 months period of IAS, and assessed patient and provider perspectives on what else is needed for effective provision of IAS. Methods : we used the Donabedian model of quality of health care that evaluates structures, processes and outcomes of health care for data collection. We extracted data from clients’ files, ART card and, CD4 and VL daily activity register. We interviewed clients who had received their 1st VL results between Aug 2014 and Dec 2015 (427) at 10 health facilities. We interviewed ART clinic in-charges, expert clients and laboratory staff (33). In-addition, we used checklists and observation guide to obtain additional data. Primary outcome variable was % virological suppression at 6months and secondary outcomes were % that underwent IAS, % that submitted 6months follow up sample and % of eligible clients switched to 2nd line ART.