Several factors are associated with HIV patient enrollment, retention in ART care and treatment outcomes. These factors can broadly be categorized into patient and health facility factors. To improve the quality of HIV care services at health units, there is need to account for the modifiable and fixed characteristics of the health units. This study investigated the relationship between characteristics of the facility and the changes in quality of care indicators in the context of an intervention to improve services delivered in the facilities.

The study found very few significant associations between characteristics of the participating facilities examined in this study and their performance in the improvement intervention. The variation in improvements seen in clinics may be due more to other characteristics of the facilities not measured, such as the types of patients they serve. Based on our findings, we recommend that facilities working to improve performance in service delivery focus on changing factors identified as causes of deficits in quality independent of considerations of the immutable characteristics of their facility. Any future study on this topic should take into account patient factors because patients with certain characteristics associated with HIV treatment indicators might be unevenly distributed among the facilities.

A final version of this study will be avaible soon.

26 facilities in the Northern Region of Uganda are participating in the collaborative improvement effort implementing the ART Framework. This study aims to understand how best practices to improve HIV/AIDS care are modified and adapted as they are spread across and implemented at these various sites, which are free to choose which changes they wish to apply and to modify those changes to suit their needs. This study will identify best practices that are being spread throughout the facilities and gather details of the implementation of specific changes. Tentatively, the following three practices will be studied: 1) giving 2-3 months supply of ARVs to adherent patients to improve retention, 2) pre-packaging medicines to reduce waiting time and ultimately improve coverage and clinic efficiency, and 3) using a screening tool for detecting tuberculosis in HIV/AIDS patients to improve clinical outcomes. The study will look at best practices that are implemented by five or more of the 26 participating facilities in order to understand how that change is modified across different sites.

Quality improvement is becoming an important component of health care world over and there is growing recognition in the literature of the contribution patients can make to improving health outcomes (Coulter 2007, Groene 2005). Given the increasing prevalence of chronic illnesses, there is a need to have patients play an active role in their health care. This study will examine the extent to which selected interventions successfully engaged clients and providers together in quality improvement activities (problem identification, problem analysis, solution identification, and testing and implementing changes) in HIV/AIDS care clinics (in comparison to control clinics) in Uganda, and what health care providers’ and clients perceptions are on clients’ active participation in the process.

This pre/post qualitative evaluation will include six intervention and six control sites. HCI coaches will provide feedback to the intervention sites and present to them a selection of interventions to increase client involvement. Sites will be invited to select the interventions that best suit their facility’s needs and resources.

This presentation was given by Herbert Kisamba, QI Advisor for HCI Uganda, at the 28th International Conference of the International Society for Quality in Health Care, Ltd. (ISQua), which took place in Hong Kong, China from September 14-17, 2011. The conference theme was, “Patient Safety: Sustaining the Global Momentum.”

This short report describes the assistance that the USAID Health Care Improvement Project (HCI) is providing the Uganda Ministry of Health (MOH) to change the way care is provided to people living with chronic conditions. HCI is promoting the use of the Chronic Care Model, an evidence-based set of principles for improving chronic condition care that has been endorsed by the World Health Organization. HCI is working with clients, providers and managers in Buikwe District and the central MOH to train patients and providers from 14 clinics about the principles of good chronic care and help form quality improvement teams in each facility to change their systems to be more responsive to the needs of patients with chronic conditions.

This short report summarizes the ways in which the USAID Health Care Improvement Project (HCI) is working with local groups and partners to apply quality improvement (QI) methods within the Community Health System in order to strengthen the impact of CHWs and other service providers at the community level, while at the same time increasing sustainability of programmatic impacts. Currently carrying out activities in more than 30 countries globally, HCI seeks to develop the capacity of health systems to apply modern QI approaches to make essential services better meet the needs of underserved populations; improve efficiency and outcomes; reduce costs from poor quality; and improve health worker capacity, engagement, and performance.