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HIV-family planning integration

  • Nicaragua | Antiretroviral Therapy (ART) Improvement Collaborative | Collaborative Profile
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  • Feasibility of Proposed Quality Criteria for Monitoring and Improving HIV Services | Publications

    At the request of the Office of the Global AIDS Coordinator (OGAC), the United States Agency for International Development (USAID) and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (Global Fund), the USAID Health Care Improvement Project (HCI) developed an approach to yield meaningful information about the quality of HIV services for users at multiple levels of the health system. The approach proposes 16 quality criteria (QC) that were assessed through 25 existing indicators. The indicators were based on measures previously required or recommended by funders and other stakeholders, such as the Global Fund, PEPFAR, and the World Health Organization. This report presents the findings from a field test of the approach in five countries in three world regions: Africa, Eurasia, and Southeast Asia.

    As a result of its findings, the report offers three recommendations:
     
    1.) Increase facilities’ ability to use indicator data by requiring denominators that reflect the number of patients who visit a facility;
    2.) Encourage monthly monitoring and the use of data to make decisions to manage and improve care processes; and
    3.) Improve the use and reporting of quality criteria data by: (a) supporting countries in using up-to date, centralized record systems to record patient status, (b) establishing systems to track and ensure attendance, (c) linking different service areas, and (d) supporting countries in building capacity to use their data to make decisions and improve the quality of their services.
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  • Spread of PMTCT and ART Better Care Practices through collaborative learning in Tanzania | Publications

    This evaluation takes place in the context of the “Partnership for Quality Improvement” (PQI) initiative in Tanzania. The partnership was initiated in 2007 by the Tanzania National AIDS Control Program (NACP) and PEPFAR to improve the quality of ART/PMTCT services in Tanzania through the implementation of a harmonized approach to modern quality improvement.   At the time of this report, the Health Care Improvement Project (HCI) and PharmAccess International (PAI) are providing technical leadership to facilitate shared learning among ART/PMTCT collaboratives managed by implementing partners (FHI, CHAI. EGPAF, AIDS Relief etc.) and regional health management teams in Tanga, Morogoro, Mtwara and Lindi. 

    Within the partnership, learning developed within one partner’s collaborative should lead to rapid uptake of effective changes by other teams, leading to desired level of results for all teams. Sharing this learning should not be limited just within that region or that implementing partner, but spread to other regions supported by other partners as well. This ability to build on learning within regions, within partners, across regions and across partners is important for efficient achievement of better care and better outcomes for people affected by HIV and AIDS. 
     
    Research questions/objectives:
    This evaluation seeks to study the mechanisms and results of the spread of better care practices in the Partnership for Quality Improvement. Identifying facilitating and hindering factors for shared learning and spread will help determine how learning among peers and spread of better care practices can be strengthened within the PQI context. The specific objectives of this evaluation are:
     
    1.    To describe the various steps involved in the change process including the origin of ideas, their testing and implementation and their subsequent spread to other teams.
    2.    To determine the various internal and external factors influencing the change process and identify means to augment the effects of favorable factors and remove barriers.
    3.    To explore the role of the higher levels of the health system and collaboratives in catalyzing the spread of best practices and their scale up.
     
    The lessons learnt from this evaluation will provide guidance to quality improvement programs in other countries for strengthening learning among peers and improving spread within a collaborative approach or in other quality improvement efforts.
     
    Methodology:
    This is a cross-sectional evaluation which involves both quantitative and qualitative methods of data collection. All sites in the 3 regions (Tanga, Morogoro and Mtwara) whose collaboratives have been operative for more than 6 months were included in this evaluation (total of 29 facilities). Data was collected by interviewing the quality improvement focal person of facility teams and through focus group discussions with QI team members. 
     
    Results:
    Results of the evaluation showed that the improvement collaborative is indeed facilitating sharing of ideas. Across the three regions, the great majority of ideas are “borrowed “from other teams, managers and coaches; with Tanga and Morogoro borrowing almost 70% of ideas, while in Mtwara 40% of the ideas had been borrowed. This indicates that ideas gained from participating in the collaborative are the main sources of adopted changes. The HCI/Tanzania project team composed a list of 16 effective changes (as of January 2010. Of these 16 effective change ideas teams had tried an average 12.6 changes per facility. Four of these 16 changes were tried by all facilities: issuing a 2 month supply for clients living far away; reorganizing patient charts for easy retrieval, establishing a mother-child register to link children to their HIV+ mother; and issuing Co-trimoxazole in the Reproductive Health Clinics.
     
    Learning sessions and coaching were the primary mechanisms for being exposed to or sharing changes with other teams, but other meetings, site visits, and phone calls were also used. Teams desired detailed information about “how to carry out” the changes they are being exposed to. Not all changes were found to be equally spreadable – spread of ‘better care practices” depended upon how straight-forward their implementation is and whether teams possessed the authority or resources to implement the activity. Staff engagement and staff resistance were cited as important factors impacting the implementation of a change. Implementation also depended upon external technical support, facility leadership and capacity for change. At present, the sharing across collaboratives has been mainly dependent on the role of the HCI/PAI team to create the linkages across collaboratives and regions. Additional mechanisms for sharing learning across a network of regions are needed, as well as mechanisms for sharing learning within a region that build on existing structures and opportunities.

     

    Click here for the full report

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  • Strategies Used by Facilities to Integrate FP into HIV Care: What works and what doesn’t | Publications

    Presentation made on November 16, 2009 by Dr. Ibrahim Kirunda, Quality Improvement Advisor for the HCI Project, at the International Conference on Family Planning, in Kampala, Uganda.

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  • Uganda ART Collaborative | Collaborative Profile
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  • Resources for HIV/AIDS Prevention and Sexual and Reproductive Health | Publications

    This resource is designed to help you in your efforts to integrate provision of sexual and reproductive health services with activities for preventing and treating HIV/AIDS.

    Here you will find a selected collection of documents and other materials which reflect field experience and the latest thinking of the health community on integration of HIV and sexual and reproductive health services.

    Topics include the key technical approaches to integration:

    • • ABC 
    • • Community-Based Approaches to Integration
    • • Contraception for HIV-Positive Women
    • • Dual Protection
    • • Family Planning and Antiretrovirals
    • • Family Planning and Mother-to-Child-Transmission
    • • Family Planning and Voluntary Counseling and Testing
    • • Family Planning and Home-Based Care
    • • Family Planning and Orphans and Vulnerable Children
    • • Microbicides
    • • STIs
       

    The site is designed to identify a full range of resources upon which to develop policies, guidelines, or practices. There are links to the following types of materials:

    • Documents: Includes Books and book chapters, Technical reports, Journal articles, Laws, bills, and court decisions, Papers presented at conferences, Theses and dissertations, Limited-distribution unpublished reports, Training manuals.
    • News: Includes any news article, feature article, editorial, commentary, or and press release from an online news source or journal.
    • Photos: Includes photos illustrating the realities of urban and rural life in developing countries, as well as global efforts to improve and save lives. Primarily taken by public health professionals in the field, photos are intended for non-profit, documentary use and are available upon request.
    • Communication Materials: Includes audio materials, calendars, CD-ROMs, videos and DVDs, films, flipcharts, kits, novelty items, pamphlets, posters, and some training materials.
    • Q&As: Includes any brief presentation of information in a question and answer format (for example, Dr. Shelton's Pearls, Healthwize, Q&As from Population Reports).

     

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