Improving the Risk of Treatment Failure in Antiretroviral Treatment: Support Group Attendance in the Post-COVID-19 Pandemic in Western Cape, South Africa — A Quality Improvement Approach

This study aimed to improve the attendance of people living with HIV (PLHIV) in the Risk of Treatment Failure (ROTF) support group via quality improvement initiatives at Delft Community Health Center, Western Cape, in South Africa.

A quality improvement approach (QI) was employed. The “five whys framework” was used to identify the root cause of low attendance of PLHIV in the ROTF support group. Plan–do–study–act (PDSA) cycles were conducted, and measures were set to monitor project outcomes. The project started with a baseline analysis with stakeholders to identify root causes and drivers of change. We implemented the required changes with continuous engagement of QI teams and PLHIV members.

The number of PLHIV attendees in the ROTF support group increased with the implementation of the QI intervention, from non-attendance at baseline to improved attendance over subsequent months. One month after the QI intervention started in April 2023, 30% of the participants (3) attended the ROTF support group, and the number increased to five (100%) in the next month. It increased to thirteen in June 2023 (100%), and 19 attended the ROTF support group meeting in the final session. Three ROTF support group members attained the required VL suppression levels and graduated from the program.

This QI project shows that structured, low-cost QI approaches can substantially improve attendance of people living with HIV in ROTF adherence support groups. Using the five whys framework to identify root causes and iterative PDSA cycles to address them led to improvements in participation, increasing from non-attendance at baseline to improved attendance within three months. Enhanced engagement was accompanied by meaningful clinical gains, including viral load suppression and graduation of three participants from the programme. These findings highlight the effectiveness of simple QI methods in strengthening adherence support and improving outcomes in resource-constrained primary healthcare settings when patient engagement, frontline involvement, and leadership support are prioritized. As a limitation, the study's small sample size and short study period make it difficult to ascertain clinical outcomes. Continuous quality improvement, scaled up with a larger sample size, could help to better ascertain clinical outcomes.

This study highlights the use of quality improvement approaches that improved PLHIV attendance in the ROTF adherence support group. Health and health outcomes can improve even in resource-constrained settings by optimally allocating available resources and adapting and adopting simple measures. The attendance of PLHIV in the ROTF adherence support group improved with the use of QI practices. Training in QI concepts and principles, as well as project implementation, is recommended to ensure QI sustainability through a robust methodology, skilled support structures, prioritization, and leadership involvement.