A Quality Improvement Collaborative for Adolescents Living With HIV to Improve Immediate Antiretroviral Therapy Initiation at 25 Health Facilities in Lusaka, Zambia.
Gillian Dougherty, Rodrigo Boccanera, Mary Adetinuke Boyd and 14 others
PMID 35137703WHAT IT FOUND
At 25 Zambian health facilities, newly diagnosed adolescents were started on ART within 14 days more often during a quality improvement collaborative, rising from 24% to more than 93%.
Key findings
01ART initiation within 14 days of a positive HIV test increased from 24% at baseline to more than 93% in the final 6 months.
02Same-day ART initiation increased from 27% at baseline to more than 92% in the final 6 months.
03The authors state that causation was not demonstrated, and there was no control group for comparison with non-participating facilities.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
There was no control group, so results at these 25 facilities cannot be compared with non-participating facilities or generalized to other settings. Many locally adapted interventions were tested together, so the contribution of any single component cannot be separated. The authors state that causation was not demonstrated, only that the increase could be postulated as correlated with the interventions. Small monthly counts of newly diagnosed adolescents could produce large percentage swings, so facilities with fewer than 5 identified adolescents may look worse even if one delay occurred. The comparison used aggregate monthly means, not adolescent-level outcome data.
Declared interests
The authors report no real or perceived vested interests that could be construed as a conflict of interest. The publication types list U.S. government PHS research support.
The easy way to misread this
Do not read the rise from 24% to more than 93% as proof that the QIC caused the improvement or that any one change idea worked. The study had no control group, and facilities tested many locally adapted interventions together.