A modified HIV continuum of care: A six-year evaluation of a viral load cascade at a hospital-based clinic in Kingston, Jamaica.

To achieve the goal of HIV viral suppression, provision of medication alone is not sufficient. Concomitant frameworks to evaluate HIV care delivery programmes are needed. This study examined the care continuum at a hospital-based HIV clinic in Kingston, Jamaica using a modified HIV continuum of care, with an increased focus on viral load indicators (viral load samples taken, results returned and viral suppression). A statistical analysis of patient flow through the care continuum to identify gaps in programme delivery was performed. Key programmatic areas for process improvement and the utility of this approach for viral load suppression interpretation were identified. Between 2010 and 2015, more than 1600 patients had been registered for care and more than 1000 had accessed antiretroviral therapy at this location. Consistent trends in programme performance were seen from 2010 to 2012. Although declines in the proportion of viral load samples taken and results returned occurred because of laboratory failures in 2013, the trend of increasing numbers and proportions of virally suppressed patients continued. Statistical analysis indicated that improvements in laboratory quality (fraction of viral load samples returned with accurate test results) could increase viral load suppression among patients at the clinic by up to 17%. Refining care delivery processes can significantly improve HIV viral load suppression rates. Expanding monitoring frameworks to include all of the essential processes that affect final outcome indicators can provide valuable insight into trends of outcome indicators and programme performance.