1. 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

2. 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.

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

4. 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

7. Cause Diagram

8. 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

9. 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 %(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.

10. 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

11. 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)

12. 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