Background Continuous Quality Improvement (CQI) is a quality management process that encourages all health care team members to continuously ask critical questions especially using CQI initiative that employs a Plan-Do-Study-Act (PDSA) cycle to test a proposed change or initiative. Granular Site Management (GSM) was established to enhance identification of innovations or best practices and scale across facilities and ensuring resources application efficiency. The aim of the study was thus to improve key indicators in HIV program treatment cascade in Western Nigeria.

Methods The CQI implementation was in four selected (secondary & tertiary) facilities where a cumulative 6000 patients living with HIV (PLHIV) in care. The major drivers of poor performance on key program indicators were identified with underlying causes, in-depth analysis & review of performance done then using CQI approach to implement change strategies for improvement, monitor and periodically evaluate change ideas for improved outcomes.

Results A total of four facilities were included in this study. Escort service was implemented for all newly identified HIV positive patients which made linkage to care improve from 50% to 95% within a space of six months. Task shifting & sharing, improved health education for clients, introduction of biometrics capturing for all clients and creation of additional hub for sample logging to viral load reference laboratory all helped to improve viral load uptake & suppression from < 30% & < 80% to 79% & > 80% respectively. Other CQI initiatives also greatly improved the positivity rate, total number of positives placed on treatment and retention in care.

Conclusion This CQI initiative using GSM approach has been used to achieve peer learning and cross fertilization of change ideas among facilities thus encouraging them to innovate and have a problem solving approach to achieve programmatic best practices thus ensuring program & resources application efficiency.

Disclosure No significant relationships.