Abstract
INTRODUCTION: Engaging communities in the design, implementation and monitoring of health services is critical for delivering high-quality, person-centred services that keep people living with HIV engaged in care. The USAID-funded Integrated HIV/AIDS Project in Haut-Katanga (IHAP-HK) integrated an electronic client feedback tool into continuous quality improvement (CQI) processes. We aimed to demonstrate this system's impact on identifying and improving critical quality-of-care gaps. METHODS: Through stakeholder and empathy mapping, IHAP-HK co-designed a service quality monitoring system-comprising anonymous exit interviews and ongoing monitoring through CQI cycles-with people living with HIV, facility-based providers and other community stakeholders. IHAP-HK trained 30 peer educators to administer oral, 10- to 15-minute exit interviews with people living with HIV following clinic appointments, and record responses via the KoboToolbox application. IHAP-HK shared client feedback with facility CQI teams and peer educators; identified quality-of-care gaps; discussed remediation steps for inclusion in facility-level improvement plans; and monitored implementation of identified actions. IHAP-HK tested this system at eight high-volume facilities in Haut-Katanga province from May 2021 through September 2022. RESULTS: Findings from 4917 interviews highlighted wait time, stigma, service confidentiality and viral load (VL) turnaround time as key issues. Solutions implemented included: (1) using peer educators to conduct preparatory tasks (pre-packaging and distributing refills; pulling client files) or escort clients to consultation rooms; (2) limiting personnel in consultation rooms during client appointments; (3) improving facility access cards; and (4) informing clients of VL results via telephone or home visits. Due to these actions, between initial (May 2021) and final interviews (September 2022), client satisfaction with wait times improved (76% to 100% reporting excellent or acceptable wait times); reported cases of stigma decreased (5% to 0%); service confidentiality improved (71% to 99%); and VL turnaround time decreased (45% to 2% informed of VL results 3 months after sample collection). CONCLUSIONS: Our results showed the feasibility and effectiveness of using an electronic client feedback tool embedded in CQI processes to collect client perspectives to improve service quality and advance client-responsive care in the Democratic Republic of Congo. IHAP-HK recommends further testing and expansion of this system to advance person-centred health services.