Background: Early infant diagnosis (EID) and rapid antiretroviral therapy (ART) initiation are life-saving interventions for HIV-infected infants. In Zambia, EID testing coverage for HIV-exposed infants is suboptimal and the time to initiate ART upon receipt of positive test results often exceeds the national standard of 2 weeks, despite rollout of national guidelines.
Methods: In collaboration with MOH, HRSA and CDC Zambia, ICAP at Columbia University designed and implemented a QIC to improve reporting of EID test results and same-day ART initiation among HIV-infected infants at 25 health facilities (HF) in Lusaka between February 2017 and May 2018. Key indicators were collected at baseline and throughout QIC implementation, which included training on QI methods and EID guidelines for 76 health care workers followed by monthly QI coaching visits and quarterly learning session workshops. Each HF team identified contextually appropriate interventions; used QI methods and tools to conduct rapid tests of change; and analyzed progress using run charts. QI teams presented their performance and shared best practices at quarterly learning sessions.
Results: Over the 15-month implementation period, QI teams tested and identified successful interventions focused on: health worker training through mentoring and supervision, data quality, caregiver education, workflow processes and community engagement. These interventions improved return of positive results to caregivers from 48% at baseline to 85% during the QIC; ART initiation for HIV-infected infants from 46% to 82%; and swift ART initiation (e.g., within 2 weeks of diagnosis) from 25% to 62%. Improvement was rapid but not always sustained. For example, it took on average 1.4 months (median 1, range 0-7) for HF to reach a 90% target of initiating ART within two weeks of diagnosis and this was sustained for an average of 2.9 months (median 2, range 0-9).
Conclusions: The QIC approach improved EID coverage and ART initiation by helping facilities generate local innovations to ensure rapid return of results to caregivers and timely ART initiation. Ongoing effort is required to ensure that improvements are sustained over time. In addition to building QI capacity and improving outcomes, the QIC resulted in a “change package” of successful initiatives that will be disseminated within Zambia.

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