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Assessing the Quality of HIV Care in Health Care Facilities in Kinshasa, Democratic Republic of Congo: Compliance with National Guidelines

Rams Mpale1,2*, Bilal Selman3

Context: The Democratic Republic of Congo (DRC) has more than 400,000 people living with HIV on antiretroviral treatment (ART). This burden of patients on ART on a health system with limited resources and resilience has an impact on the quality of HIV care delivery. The general objective of this study is to assess the quality of care for people living with HIV in health care facilities in Kinshasa, and specifically to measure the level of compliance of HIV care provision with national guidelines.

Methodology: This is a retrospective, quantitative cohort study using secondary data collected from March 4 to 12, 2024 in three health care establishments (ESS) offering HIV care services in Kinshasa. The study used as a framework a single object of care evaluation, the “procedures”, among the three of the Avedis Donabedian model, that is to say “structures – procedures – results”. The medical records of a cohort of 110 patients aged 18 years and older who initiated ART during the period from November 1, 2021 to January 31, 2022 and followed for at least 2 years of treatment were evaluated. Data was collected through android mobile phones using a form developed in the KoBo Collect application and analyzed using SPSS Windows version 25.0 software. The performance of each ESS was determined based on the level of compliance (compliance score) of its HIV care provision with national guidelines.

Results: The majority of patients on ART are female (67.3%) and the average age is 40.95 ± 7.93 years. Compliance of HIV care provision with national guidelines is 31.1%. It is 71.3% before ART initiation and 14.4% during clinical and biological monitoring. Compared to each health establishment (ESS), it is 39.6% at CS Libondi having less than 1000 patients on ART, 31.3% at CH Kingasani having between 1000 and 2000 patients on ART and 30.2 % at CH Kinkenda having more than 2000 patients on ART.

Conclusion: Generally speaking, compliance with national HIV/AIDS treatment guidelines by healthcare providers in ESS in Kinshasa is poor. It is good before initiation of ART and poor during clinical and biological monitoring of patients on ART, and it varies depending on the number of patients on ART followed in the ESS. HIV care therefore requires urgent actions to improve the quality of its procedures.