Supporting Quality Data Systems:？？lessons Learned From Early Implementation of Routine Viral Load Monitoring At A Large Clinic in Lilongwe, Malawi - Supporting Quality Data Systems:？？lessons Learned From Early Implementation of Routine Viral Load Monitoring At A Large Clinic in Lilongwe, Malawi - Open Access Pub

Successful viral load programs rely on the presence of data systems and high quality of patient data. Using a cohort of 49 patients at Partners in Hope, a large, urban HIV clinic in Malawi, we performed a quality improvement assessment of a new viral load program with a focus on accuracy of data collected from patients as well as adherence to Malawi HIV Guidelines in regard to response to elevated viral loads (≥1,000 copies/mL). Data were obtained from three parallel medical record systems to investigate the proportion of patients with a repeat viral load and whether the three data systems agreed in regard to sociodemographic and clinical data. Fewer than 30% of patients had a repeat viral load within six months, as recommended in the Malawi HIV Guidelines. There were significant problems with data agreement across the three parallel databases used for care. Date of birth was consistent for 55.1% (N=27) of patients, while a different date of birth was noted in all three sources for 10.2% of patients (N=5). Viral load data from all three sources agreed for only 2.0% of patients (N=1). For 65.3% (N=32), the viral load from the laboratory did not match the recorded viral load in the electronic or paper record. Scale-up of viral load monitoring must be accompanied by the development of data systems that support workflow from sample collection to lab and back to provider. Education of providers and strategies for data collection with minimal errors can facilitate scale-up of high quality programs. DOI10.14302/issn.2324-7339.jcrhap-17-1468 In 2016, the World Health Organization (WHO) recommended viral load monitoring as part of routine care in all settings1. Viral load monitoring was introduced in Malawi in 2011, and in the 2016 Malawi HIV Guidelines viral load is recommended as part of routine care, with an initial viral load six months after antiretroviral therapy (ART) initiation, a second viral load 24 months after initiation, and subsequent viral loads every 24 months1, 2. Those with a viral load ≥1,000 copies/mL require adherence counseling and repeat viral load in three months, with switch to second line if viral load remains elevated. Of the sub-Saharan African nations South Africa is generally accepted to have the most developed healthcare infrastructure. Viral load programs have shown promising results, demonstrating that routine viral load monitoring can be cost-effective3. Extrapolation of this data to Malawi is difficult given drastically different infrastructure, limited equipment, challenging transportation of samples to central laboratories,