1. Abstract no. TUPDE0106
Increasing linkage to HIV care for newly diagnosed HIV infected persons through Quality Improvement approach in urban slums in Kenya
Author: Kegoli S1, Njoroge A1, Motoko J, Muriithi C, Mutisya I2
 Affiliations: 1Eastern Deanery AIDS Relief Program, Nairobi, Kenya ;2 Division of Global HIV/AIDS,U.S Centers for Disease Control and Prevention, Nairobi, Kenya

2. Increasing linkage to HIV care for newly diagnosed HIV infected persons through Quality Improvement approach in urban slums in Kenya
Introduction :
Effective linkage from HIV testing to HIV care ensures that persons living with HIV/AIDS receive the services they need to improve their health and enhance their quality of life.
Despite Scale-up of HIV testing coverage only 60% of HIV-positive clients were tested were linked to care and treatment in Kenya.
Eastern deanery aids relief program (EDARP) utilizing the Kenya HIV Quality Improvement Framework (KHQIF) to improve linkages care /treatment in its 14 facilities in Nairobi.
Gaps were identified in HIV linkages to care with an aim to improving linkages from 60% to above 90%
Routine clinical data was between October 2011 and September 2015

3. CQI strategies
Patient escort : Patient who test HIV positive from VCT are escorted to the clinician after testing to ensure successful linkages.
Linkage register : Linkage registers were developed after noting those clients not linked on the same date are hard to track. .
Trainings/linkage register/ QI teams (multiple strategies) : Teams were taken through the following strategies to improve linkages .
Results
PDSA cycle 1 (patient escort) - Patient escorts by counselors which led to increased linkage from 60% to 80.8% by June-2012 
PDSA cycle 2 (linkage register + patient escort) - Introduced linkage registers for counselors to track intra-facility linkages This was in addition to patient escorts, telephone calls and home visits for patients not linked on the testing day. Linkages improved linkages from 74.2% to 91.8% by Mar-2013.
PDSA cycle 3 (linkage register, patient escort, Trainings, peer-peer support&trainings) linkages had improved and were sustained at 98% by Sept-2015. 

4. Results/Lessons learned
Table: Trends of improved linkages to care of newly diagnosed HIV infected persons between Oct-2012 and Sept-2015

5. Conclusion
Successful Linkages to HIV care and treatment services may be achieved through adoption of multiple strategies that are feasible and affordable