A framework to improve electronic viral load result distribution to lower facilities : a case study of Kayunga Hospital, Uganda

Abstract

This study was conducted to investigate the challenges that lead to long viral load results turnaround time at the lower facilities in Kayunga District. The study objectives were: to determine the requirements for a framework, structured system designed to improve the distribution of electronic viral load results to low level health facilities, and to design that framework to support improved data flow and accessibility, and to evaluate how well the framework, system developed to improve the efficiency and reliability of electronic viral load results distribution, enhance the delivery of these results to the intended facilities. The study used a mixed–methods approach, which combines qualitative and quantitative methods to gain a comprehensive understanding of the issues. Qualitative research helped to explore the experiences and perceptions of healthcare providers and patients. It used methods like interviews to gather in-depth insights into the challenges in electronic viral load result distribution, while Quantitative research provided statistical analysis and trends. It employed surveys and statistical analysis to identify patterns and trends in viral load data. The study used a case study and survey research as a research strategy to conduct an in-depth analysis of a specific healthcare facility to understand the challenges and context of electronic viral load results distribution, questionnaires to collect data from a large sample of healthcare providers and patients, providing a broader understanding of the issue. A sample size of 279 respondents was used from a population of 882 respondents. Data was collected using the questionnaire and interview guide. The response rate of 100% was obtained from which key findings suggested a positive response and provided valuable insights for health facilities to identify critical areas for improvement in the testing processes. From the study, it was learned that to determine the requirements for the framework, we had to first address the identified challenges that lead to long TAT to identify the requirements. It was also learnt that to design the framework, we had to first identify the design choices to fulfil the identified requirements for framework design. Therefore, it was concluded that to overcome the challenges, there is a need to enhance standard operating procedures governing sample handling and processing to address the issue of the longtime taken to process samples and reduce delays in testing processes. This requirement can be achieved if the Ministry of Health (MOH) strengthens primary healthcare delivery systems by introducing data quality policies and practices for the institution, and also ensures that standard operating procedures are integrated into automatic processes at all health facility levels. The study recommendations include the need for continuous improvement activities such as continuing medical education, quality improvement projects, root cause analysis, and monthly staff rotations. For results that are misplaced, developing a root cause analysis, phone call follow-ups, and increasing the frequency of reviewing hub riders from monthly to twice a month.