Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge

• DOI: 10.1097/qad.0000000000001531
• Publication Date: 2017-06-29T18:03:15Z
• Authors: Anjuli D. Wagner; Cyrus Mugo; Shay Bluemer-Miroite; Peter M. Mutiti; Dalton C. Wamalwa; David Bukusi; Jillian Neary; Irene N. Njuguna; Gabrielle O’Malley; Grace C. John-Ste...; Jennifer A. Slyker; Pamela K. Kohler
• Keywords: Male; Health Knowledge, Attitudes, Practice; Adolescent; HIV Infections; Diagnostic Services; Kenya; Quality Improvement; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Humans; Supplement Article; Female; Health Services Research; 10. No inequality

To determine whether continuous quality improvement (CQI) improves quality of HIV testing services for adolescents and young adults (AYA).CQI was introduced at two HIV testing settings: Youth Centre and Voluntary Counseling and Testing (VCT) Center, at a national referral hospital in Nairobi, Kenya.Primary outcomes were AYA satisfaction with HIV testing services, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted.There were 172 AYA (Youth Centre = 109, VCT = 63) during 6 baseline weeks and 702 (Youth Centre = 454, VCT = 248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at Youth Centre: 18 vs. 63% [adjusted risk difference (aRD) 0.42,95% confidence interval (CI) 0.21 to 0.63], and a trend at VCT: 38 vs. 72% (aRD 0.30, 95% CI -0.04 to 0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46 vs. 61% (aRD 0.39, 95% CI 0.02-0.76), but not Youth Centre (P = 0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs. 4.3; aRD 0.78, 95% CI -0.11 to 1.67), but not at Youth Centre (P = 0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (P = 0.384, P = 0.755). HCW satisfaction remained high during intervention and baseline (P = 0.746).CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.