Understand success and challenges in adaptation and implementation of Quality Improvement Collaboratives to help End the HIV Epidemic in Namibia and Zimbabwe
Creators: name: Jok, Christie
name: Hirschhorn, Lisa Ruth
name: Persaud, Udita
name: Agins, Bruce
name: Murungu, Joseph
name: Basenero, Apollo
name: Neidel, Julie
name: Khabo, Bobbie
name: Mabuko, Japhet
name: Ikeda, Dan
name: Schaefer, Willemijn
Publisher: name: DigitalHub. Galter Health Sciences Library & Learning Center
Year: 2021
Subjects: subject: HIV
subject: health care quality
subject: improvement collaboratives
subject: Namibia
subject: Zimbabwe
subject: epidemic
subject: HIV
subject: Quality of Health Care
subject: Intersectoral Collaboration
subject: Epidemics
subject: Namibia
subject: Zimbabwe

description: Background: Improving HIV health care quality remains an unfulfilled goal necessary to both reduce mortality for people living with HIV and reach epidemic control. Although a common strategy, improvement collaboratives (ICs) are variably effective in improving quality and better understanding of their implementation and adaptation to local contexts is needed. We applied implementation science methods to study how Ministry of health-led ICs supported by UCSF-HEALTHQUAL were implemented in Namibia and Zimbabwe to support and accelerate improvement in the HIV care cascade including rapid uptake of ART and viral load suppression.  Methods:  We applied two implementation research frameworks, EPIS [Exploration, Preparation, Implementation, and Sustainment] and CFIR [Consolidated Framework for Implementation Research] to guide data collection and analysis for a retrospective mixed methods case study of the ICs. We conducted nine key informant interviews, field observations, and document review to identified implementation strategies contextual factors and implementation outcomes. Results were synthesized using content analysis and organized by EPIS stage. Results:  Many implementation strategies for both countries were similar across the exploration, preparation and implementation stages, including alignment with national priorities and guidelines, leveraging existing relationships with stakeholders, QI capacity-building, and adaptations of IC components and data collection tools. Important contextual factors of both ICs were: national leadership, donor funding and country resources, baseline national and local QI knowledge, capacity and culture, existing implementation partnerships, data system integrity, and geography. All sites in both countries completed QI projects. Active peer-to-peer learning occurred; and improvement was demonstrated in many of the targeted measures.  Implementation challenges encountered included data validity and quality, finite resources and staff turnover. Limited information was available for sustainment improvement, but both countries have scaled ICs, indicating longer term capacity in QI.  Conclusions: Successful implementation of ICs involved adaptation to local context and other strategies which leveraged facilitating factors and addressed barriers with strong adoption and fidelity. Other key lessons included early stakeholder engagement, national leadership engagement, alignment with national priorities, and attention to developing QI capacity. These results can inform future efforts to accelerate improvement of HIV care and treatment through ICs in the region and improving quality more broadly.