Improving Quality of Care at the Core of Health System Strengthening
By The Task Force for Global Health
In 2013, the 90-90-90 goals were set to help end the global AIDS epidemic – by 2020, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression (UNAIDS).
Once a patient has tested positive for HIV, they need to start antiretroviral therapy to stop the virus from progressing and to prevent further transmission. This requires attending regular viral load monitoring at a clinic or health facility to see how well the therapy is suppressing the virus.
For already low-resource clinics, ensuring that HIV patients are receiving quality care and monitoring can often stretch clinical resources, including staff, very thin. This results in a road-block to reaching the 90-90-90 goals because process gaps — like long wait times and miscommunication between labs and clinics — can prevent them from providing the necessary treatment and monitoring that HIV patients require.
However, there is a potential solution: The Laboratory African Regional Collaborative (LARC). Spearheaded by the Centers for Disease Control and Prevention (CDC), LARC is a continuous quality improvement collaborative that helps health facilities improve their business processes from the laboratory to the clinic, fix identified gaps in services provided, and ultimately provide continuously better quality care for more HIV patients throughout their treatment.
Using Continuous Quality Improvement tools and methodologies tailored by our Public Health Informatics Institute (PHII) and implemented by in-country clinical partners with the support of our PHII team, health facilities go through a collaborative training session that helps the facility identify and understand the problems they’re having, solve them, and inspire continuous improvement of services provided to patients.
Phase one of LARC focused on a few facilities in multiple countries — Kenya, Malawi, Swaziland, Mozambique, Tanzania and Uganda — starting in 2016, and now phase two has focused on one country, Kenya, to see if the initiative could be scaled-up throughout to multiple facilities in a health system.
In 2016, the CDC reached out to PHII because they wanted to do a process improvement around the lab-clinic interface for PEPFAR (United States President’s Emergency Plan for AIDS Relief) countries, and it seemed like the perfect fit for PHII because of the skill sets that LARC required. The principles of LARC are a reflection of who PHII is and their mission, says LARC principal investigator, Jimica Tchamako, MPH, director of PHII’s Requirements Lab. “We go in, we understand a population, we understand a culture, we do robust analysis, we do robust refining of the existing state to develop a future state, we put core indicators in place to help us measure as we move along, and we do hands on implementation, working closely with our clients in a very collaborative manner to be able to ultimately get to the goal or objective.”
The LARC curricula are like tools in a toolbox, and “during implementation, we pull from that toolbox based on what [the client’s] needs are to be able to develop a tailored approach that helps them improve their processes,” adds Tchamako.
But this isn’t just a tool for improving HIV treatment, it could also be applied to any disease treatment and a health facilities’ general processes to strengthen their systems and provide better quality health services.
For many of these clinics, they know there are gaps that are preventing them from reaching their target number of patients treated, so they are eager to figure out the problems. “When you’re going through the implementation sessions with them, you’re walking with them, you are in their everyday life, and you are seeing and hearing their needs and their patients’ needs. It is like a full-body experience,” says Tchamako. “These sessions are pulling them away from their already busy work schedules, but you can see they’re excited because they know it is going to help them provide better care to the people in their communities.”
Now that phase two pilot of the initiative was completed in July, the next steps for PHII are “to continue to be a champion for the work that has been done,” says Tchamako. Whether it’s completing the publications on the project that they are working on now, sharing about the successes of the initiative via the LARC website (www.LARCcqi.org) that they developed, developing out the formal magazine, or continuing to infuse the LARC curricula in new work and opportunities, PHII will be focusing on advocating for this initiative and making it widely available to other practitioners.
“Ultimately, I believe LARC is going to take off because the people who needed to hear the outcomes of what we did in Kenya were at a final dissemination meeting held in July,” says Tchamako, “and so I’m looking forward to the continued investments that will be made in scaling LARC up to other countries because if we look at approaches to health system strengthening, LARC is at the core.”
Watch this video to learn more about Kenya’s journey with LARC.