Background: While the UNAIDS 95-95-95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return-to-care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county-level rural health facility in eastern Uganda.

Methods: Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root-cause analysis using a fishbone diagram, and developed and ranked improvement changes using the impact-effort matrix. The improvement changes were implemented using Plan-Do-Study-Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements.

Results: Before the implementation of CQI initiatives (August 2022-January 2023), the average return-to-care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return-to-care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024.

Conclusion: The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies.

Keywords: Adolescent; Continuous quality improvement; Paediatrics; Patient-centred care.

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

背景： 尽管联合国艾滋病规划署（UNAIDS）的95-95-95目标在成人中已经实现，但儿童和青少年的目标仍然不理想。本研究旨在提高乌干达东部县级农村卫生设施中错过门诊预约的感染艾滋病毒的儿童和青少年（CALHIV）的回访率。

方法： 2023年1月至2024年1月期间，我们进行了一项持续质量改进（CQI）研究。通过入门会议和培训成立了CQI委员会，并通过数据分析确定了护理质量差距。我们通过对这些差距进行排名来优先解决一个缺口，使用鱼骨图进行了根本原因分析，并利用影响-努力矩阵制定了并按重要性排序改善措施。改善措施的实施采用计划-执行-学习-行动（Plan-Do-Study-Act）循环的方式。这些措施包括：(1) 对错过预约的CALHIV进行名单登记，并通过电话跟进；(2) 每周数据分析以协调未出现的情况；(3) 赋予社区卫生工作者（CHWs）责任，追踪并让CALHIV重新接受治疗。我们跟踪并绘制了CALHIV随时间回访的比例图，以便评估改善情况。

结果： 在实施CQI措施前（2022年8月至2023年1月），平均回访率为35%（基线）。自2023年2月开始实施CQI后，从2月到5月2023年的引入名单登记阶段，平均回访率提高至59%，6月到9月的每周数据分析实施阶段增加到了69%，10月至2024年1月的社区卫生工作者参与阶段进一步提升到88%。最终，在2024年1月达到了最高的100%。

结论： CQI方法改善了错过预约的CALHIV的回访，使他们能够获得最佳治疗和更好的健康结果。这些发现应作为更大规模随机研究的初步数据。

关键词： 青少年；持续质量改进；儿科；以患者为中心的护理。