Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone
Improving inpatient provider-initiated HIV testing and counseling in Sierra Leone
复制标题
DOI：
10.1371/journal.pone.0236358
复制
发表时间：
2020-07-24
期刊：
影响因子：
3.7
通讯作者：
Rabkin, Miriam
中科院分区：
文献类型：
--
作者：
Kassa, Getachew;Dougherty, Gillian;Rabkin, Miriam
背景/背景 2017 年，只有 47% 的艾滋病毒呈阳性的塞拉利昂人知道自己的状况，这使得扩大艾滋病毒检测成为当务之急。国家指南支持提供者发起的艾滋病毒检测和咨询 (PITC)，以提高检测覆盖率，但塞拉利昂很少提供 PITC。为此，实施了质量改进合作组织（QIC），以提高成年住院患者的 PITC 覆盖率。方法 2017 年 10 月至 2018 年 8 月期间，10 家医院接受了干预；没有控制设施。每家医院的目标是将 PITC 覆盖率提高到≥ 95% 的合格患者。工作人员接受了 PITC 和 QIC 方法以及一套 PITC 最佳实践和工具的培训。然后，他们努力确定其他适合具体情况的干预措施，对变革进行快速测试，并使用共享指标和时间序列数据跟踪绩效。支持性监督增强了 QI 技能，季度会议促进了创新的传播，同时促进了友好竞争。结果基线 PITC 覆盖率为 4%。医院团队使用 QI 方法测试了各种干预措施，包括员工培训；数据审查会议；加强工作流程和监督；患者教育和宣传活动 9 家医院达到并维持了 95% 的目标，所有医院都出现了快速和持久的改善，这种改善的持续时间中位数为六个月。在 5,238 名艾滋病毒检测患者中，311 名 (6%) 被发现艾滋病毒呈阳性并被转诊接受治疗。项目期间发生了 HIV 快速检测试剂盒缺货的情况，在某些情况下限制了 PITC 服务。结论 该干预措施导致住院 PITC 覆盖率迅速持续改善，并对数百名 HIV 感染者进行了诊断。塞拉利昂卫生和卫生部计划在全国范围内采取举措，并密切关注检测试剂盒缺货问题。
Background/settingOnly 47% of HIV-positive Sierra Leoneans knew their status in 2017, making expanded HIV testing a priority. National guidelines endorse provider-initiated HIV testing and counselling (PITC) to increase testing coverage, but PITC is rarely provided in Sierra Leone. In response, a Quality Improvement Collaborative (QIC) was implemented to improve PITC coverage amongst adult inpatients.MethodsTen hospitals received the intervention between October 2017 and August 2018; there were no control facilites. Each hospital aimed to improve PITC coverage to >= 95% of eligible patients. Staff received training on PITC and QIC methods and a package of PITC best practices and tools. They then worked to identify additional contextually-appropriate interventions, conducted rapid tests of change, and tracked performance using shared indicators and time-series data. Supportive supervision bolstered QI skills, and quarterly meetings enabled diffusion of innovations while spurring friendly competition.ResultsBaseline PITC coverage was 4%. The hospital teams tested diverse interventions using QI methods, including staff training; data review meetings; enhanced workflow processes and supervision; and patient education and sensitization activities Nine hospitals reached and sustained the 95% target, and all saw rapid and durable improvement, which was sustained for a median of six months. Of the 5,238 patients tested for HIV, 311 (6%) were found to be HIV-positive and were referred for treatment. HIV rapid test kit stockouts occurred during the project period, limiting PITC services in some cases.ConclusionsThe intervention led to swift and sustained improvement in inpatient PITC coverage and to the diagnosis of hundreds of people living with HIV. Sierra Leone's Ministry of Health and Sanitation plans to take the initiative to national scale, with close attention to the issue of test kit stockouts.