Optimised electronic patient records to improve clinical monitoring of people living with HIV (MONART trial) intervention: a qualitative process evaluation

BACKGROUND: Viral load monitoring systems enable early detection of antiretroviral therapy failure, allowing for timely interventions. Systemic gaps and infrequent viral load monitoring contribute to delayed identification of antiretroviral treatment failure, increased risk of drug resistance, and poorer health outcomes for people living with HIV. METHODS: We conducted qualitative research to assess the delivery and quality of the MONART Trial intervention, which utilised a VL champion model comprising an upgraded TIER.net platform and a quality improvement process. The upgraded TIER.net platform involved technological enhancements to the public electronic ART database. We conducted fourteen in-depth interviews with viral load champions to evaluate competency and experience, sixteen interviews with patients to understand their user experiences and acceptability of the intervention. The analysis was guided by the Consolidated Framework for Implementation Research (CFIR) and the Normalisation Process Theory (NPT) to understand the delivery and quality of implementation. RESULTS: Our findings showed that ongoing support and continuous training on the upgraded TIER.net systems enabled healthcare workers to better engage and understand the electronic ART database which freed up time. Healthcare workers reported that the upgraded TIER.net reduced workloads while patients' acknowledged improvements in service delivery, notably the reduced waiting times at public health facilities. CONCLUSION: Our study highlighted both the structural and behavioural dimensions of implementing the MONART intervention. The analysis enabled us to better understand the factors influencing the implementation process. Our findings underscored the importance of tailored training and patient-centred approaches for the effective integration of interventions within embedded health systems.