Quality Improvement Team In+Care - Improving Viral Load Suppression A Quality Improvement Project AIDS Activities Office Quality Improvement Team Carlos Castillo, RN Roselen Villalba, RN Lynn Nagel, BSEd, CQI Coordinator Stephen D Sabo, AA, Data Coordinator Length of study: February 2012 – January 2013 Focus on clients in the AAO Adherence Program

Background Information/Rationale for QI Project Clients missing doses of medication can lead to resistance Lowering of one’s viral load shows responding to treatment and following medication regiment Clients in the adherence education program will show a increase in viral load suppression. Overall in 2007, 64% of AAO clients had a suppressed viral load. In 2011, the percentage was 74.

Performance Measure In+Care 4: Percentage of clients with HIV infection whose last viral load in the measurement year is less than 200 copies

In Care -Baseline Data VL Suppression – Below 200 All AAO clients Year 2011 – 528/711 = 74% Clients in Adherence program Year 2011 – 118/194 = 60% Clients in adherence program November 1, 2011 – January 31, 2012 = 84 clients were enrolled in the adherence program. 56% (47/84) had a viral load of <200 Clients are referred to adherence program by physicians

Cause Diagram

PDSA – Plan/Do (First Quarter) Create flow diagram and review adherence process Create cause diagram and review with team Classification of clients in program, long term / short term Frequent adherence appointments will be scheduled as needed Frequent follow up phone calls Review list of clients on adherence & remove those that no longer need to be in program, lost to follow-up, moved, etc and removed these clients from active list Run monthly reports with VL’s for adherence nurses to monitor Interventions specific to individual clients needs that are in the Adherence Program Will help pay co-pays for clients Provide transportation assistance – bus passes or taxi vouchers

PSDA - Study/Results (First Quarter) All AAO clients Overall there was an increase in the number of clients with a viral load <200 to 77% (510/727) – April 30, 2012 For 2011 74%(528/711) of clients had a viral load <200 Incentives and perseverance on part of the adherence nurses have shown an increase in the number of clients with a viral load <200.

PSDA - Study/Results (First Quarter) Clients in Adherence Program – Feb 1 – April 30, 2012 92 clients were enrolled in the adherence program. 62% (57/92) had a viral load of <200 10 clients received transportation vouchers. 60% (6/10) had a viral load of <200 23 clients received co-pay assistance. 61% (14/23) had a viral load of <200 2 clients received both transportation & co-pay assistance. 0% (0/2) had a viral load of <200 57 clients did not receive any incentives. 61% (35/57) had a viral load of <200

PSDA - Study/Results (First Quarter) Months in Program VL <200 New – 2 months 23% (21/92) 3 months – 5 months 24% (22/92) > 6 months 15% (14/92) VL > 200 New – 2 months 20% (18/92) 3 months – 5 months 11% (10/92) > 6 months 8% (7/92)

PDSA – Act (Second Quarter) Next step: continue with paying co-pays, transportation needs, frequent visits & phone calls Design a bulletin board for visual reinforcement in the clinic on the importance of medication adherence Closely monitor “long term” clients for any adherence issues Compare 3 month data with 6 month data looking for trends