Adolescents living with HIV (ALHIV) in high ALHIV-burden, resource-limited settings like Nigeria have significantly inferior outcomes from antiretroviral therapy (ART). This study reports on analysis, innovations, processes and outcomes of several continuous quality improvement (CQI) initiatives by the Institute of Human Virology Nigerian (IHVN) to identify gaps in achieving adolescent viral suppression among Nigerian ALHIVs - including suboptimal or complete lack of HIV status disclosure, higher rates of loss to follow up, poor ART adherence and increased need for psychosocial support. These CQI initiatives referred to as "small tests of change" to improve poor performing areas help to bridge identified gaps and follow four major steps per CQI requirements including – problem statement; root cause analysis; developing solutions and making an aims statement; and implementation of improvement changes which involves a plan-do-studyact (PDSA) cycle. The PDSA cycle represents a series of tests that forms the basis of a monitoring cycle to track innovations, outcomes and document change. It involves developing a strategy to test the change (Plan), executing the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act). Strengthening adolescent viral suppression within IHVN supported sites in Abuja Nigeria ensures that ALHIVs are not left behind in the UNAIDS 90-90-90 targets.
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