Strengthening HIV Rapid Testing Accuracy Through Continuous Quality Improvements in Isoka District, Zambia

Authored By: Silvester Mpanga

Background

Accurate HIV rapid testing is vital for diagnosis and treatment. Variability in testing performance during the 2023 External Quality Assessment provided by the Zambia National Quality Assurance (ZANEQAS) and patient complaints in Isoka District prompted a Continuous Quality Improvement (CQI) initiative integrating External Quality Assessment (EQA) Proficiency Testing (PT) and Rapid Testing Continuous Quality Improvement (RTCQI) approaches. The main objective was to enhance the accuracy and reliability of HIV rapid testing and improve patient trust and clinical outcomes.

Methods

Using the Plan-Do-Study-Act framework, baseline EQA PT data informed interventions. Key activities included targeted training, competency assessments, real-time performance monitoring, technical support, and Corrective and Preventive Actions (CAPAs). Facilities participated in quarterly EQA PT cycles and received routine supervisory visits. Quality control systems were strengthened, and processes refined based on feedback.

Results

Testing accuracy improved from 42.9% in 2023 to 95.2% in 2024 and 90.5% in 2025 across participating facilities. The district target is set at 100% across all HIV Testing Sites. Performance gap was at 57.1% (baseline) and currently at 9.5%. Contributing factors included; improved adherence to national testing algorithms, better documentation, and timely corrective action. Provider confidence and patient satisfaction increased, supporting early treatment initiation and reduced service complaints.

Conclusion

This CQI initiative demonstrates that integrating EQA and RTCQI effectively improves HIV rapid testing quality. Success was driven by regular mentorship, data use, and stakeholder involvement. Sustained progress will require continued staff training, institutionalized QI practices, and expanded implementation across more facilities.

Author's Career Title: Quality Officer

Author's Education: Diploma in Biomedical Science