Objectives Determine whether continuous quality improvement (CQI) improves quality of HIV testing services (HTS) for adolescents and young adults (AYA). Design CQI was introduced at 2 HIV testing settings: Youth Centre (YC) and Voluntary Counseling and Testing (VCT) at a national referral hospital in Nairobi, Kenya. Methods Primary outcomes were AYA satisfaction with HTS, intent to return, and accurate HIV prevention and transmission knowledge. Healthcare worker (HCW) satisfaction assessed staff morale. T-tests and interrupted time series analysis using Prais-Winsten regression and generalized estimating equations accounting for temporal trends and autocorrelation were conducted. Results There were 172 AYA (YC=109; VCT=63) during 6 baseline weeks and 702 (YC=454; VCT=248) during 24 intervention weeks. CQI was associated with an immediate increase in the proportion of AYA with accurate knowledge of HIV transmission at YC: 18% vs 63%, adjusted risk difference (aRD)=0.42 (95%CI: 0.21–0.63), and a trend at VCT: 38% vs 72%, aRD=0.30 (95%CI: −0.04–0.63). CQI was associated with an increase in the proportion of AYA with accurate HIV prevention knowledge in VCT: 46% vs 61%, aRD=0.39 (95%CI: 0.02–0.76), but not YC (p=0.759). In VCT, CQI showed a trend towards increased intent to retest (4.0 vs 4.3; aRD: 0.78 [95%CI: −0.11–1.67]) but not at YC (p=0.19). CQI was not associated with changes in AYA satisfaction, which was high during baseline and intervention at both clinics (p=0.384, p=0.755). HCW satisfaction remained high during intervention and baseline (p=0.746). Conclusions CQI improved AYA knowledge and did not negatively impact HCW satisfaction. Quality improvement interventions may be useful to improve adolescent-friendly service delivery.

This evaluation suggests that it is both possible and valuable to include patients as partners in quality improvement efforts, especially when resources must be prioritized for the highest impact efforts. Patient engagement in the improvement process is particularly powerful when addressing illnesses that may be stigmatized such as HIV.