Improving the Proportion of HIV-positive Pregnant and Breastfeeding Women Receiving Viral Load Testing – Nine Councils

Review of data from the six months prior to the workshop revealed that all councils had viral load testing coverage of less than 95 percent, which is the national target for viral load. The councils with the lowest viral load testing coverage were Mpwapwa DC, Kinondoni MC, and Dar CC, with rates of 62%, 74%, and 76%, respectively. Causes contributing to low HIV viral load coverage among HIV-positive pregnant and breastfeeding women (PBFW) included inadequate skilled healthcare workers due to staff rotation and high workload, inadequate Mother-Child Cohort Register documentation, inadequate monthly data review before submission to the council level, inadequate provision of health education to HIV-positive PBFW in the community, and inadequate eligibility follow-up for HIV-positive PBFW strategies at health facilities. Additionally, delay of HVL results from the hub to health facilities was identified as a contributing factor. Implemented solutions aimed to strengthen documentation in the Mother-Child Cohort Register, enhance identification of eligible mothers for HVL testing, and strengthen adherence counselling sessions. MC Cohort Register orientation was conducted among Council Health Management Team members, and focused on MC-Cohort documentation with healthcare workers during monthly supportive supervision visits. Data cleaning exercises were also conducted. HVL algorithm job aids were distributed to healthcare workers, and adherence counselling sessions were followed up on clients' adherence education topics and schedules. CHMT observed healthcare workers providing adherence counselling sessions and provided feedback for improvement. Following the implementation of these change ideas, improvement trends were observed in three councils: Kongwa DC, Dar CC, and Bahi DC, with viral load testing coverage rates increasing to 94%, 86%, and 77%, respectively. However, six councils still require improvement, with viral load testing coverage rates ranging from 68% to 92%. To sustain improvement in the three councils showing positive trends, work with Council Health Management Teams will continue to tweak strategies designed to attain improvement in performance.