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HIV-TB
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Tanzania | Morogoro ART/PMTCT Improvement Collaborative
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Collaborative Profile
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Uganda| Private Sector Collaborative
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Collaborative Profile
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Russia| HIV/AIDS Treatment, Care and Support: Support for Regional Spread Collaborative: Improvement of Access to Basic HIV/AIDS Care and ART Collaborative
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Collaborative Profile
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Adaptability of better care practices to improve HIV/AIDS care as they spread across sites in Uganda
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Publications
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.
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Vietnam| TB/HIV Collaborative-Thai Binh Province
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Collaborative Profile
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Améliorer la documentation et le maintien des patients dans le programme de prise en charge du VIH en Côte d’Ivoire
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Publications
En 2008, à la demande du Ministère de la santé, avec l’appui financier du PEPFAR, le Projet d’Amélioration des Soins de Santé de l’USAID (HCI) a été invité à assister le Programme National de Prise en Charge des personnes vivant avec le VIH (PNPEC) pour conduire une évaluation nationale de la qualité des soins dans le domaine du VIH en Côte d’Ivoire. HCI et les partenaires de mise en œuvre ont conduit une évaluation nationale de la qualité des soins et services offerts aux PVVIH. Sur la base de l’évaluation, un comité technique dirigé par le PNPEC avec l’appui technique d’URC a développé un paquet de changement pour améliorer la documentation, le suivi et la rétention des patients. Ce rapport décrit les résultats du collaboratif d’amélioration d’ARV/PTME.
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Nicaragua | Antiretroviral Therapy (ART) Improvement Collaborative
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Collaborative Profile
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Quality Improvement of HIV and AIDS programs: experiences from South Africa (2007 - 2010)
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Publications
This presentation was given by Dr. Donna Jacobs, HCI Country Director for South Africa, 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."
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Feasibility of Using Quality Criteria to Monitor and Improve the Quality of HIV Services
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Publications
This short report describes assistance that the USAID Health Care Improvement Project (HCI) is providing to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and to the Office of the Global AIDS Coordinator (OGAC) to develop an approach that can be used to harmonize global reporting and improve the quality of HIV services and health outcomes. This study details HCI’s approach that employs 16 quality criteria for 5 HIV service delivery areas: testing and counseling, care and treatment, PMTCT, TB/HIV, and harm reduction. Field tests were conducted in five selected countries: 3 in Africa, 1 in Eurasia and 1 in Southeast Asia.
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Improving the Quality of Care
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Community Resource
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Grace Children's Hospital - TB Screening
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Improvement Report
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A QI Team Approach to Scale Up Provision of TB Isoniazid Preventive Therapy (IPT) at Outapi ART Clinic
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Improvement Report
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Sequential Validity of Quality Improvement Team Self-assessments in Tanzania
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Publications
Emerging evidence indicates that collaborative improvement is a cost-effective way to improve health care quality in diverse cultures. Such improvement generally relies on data from quality improvement (QI) teams’ own assessment of their facility’s performance and results. The validity of self-assessment data is important to both the teams themselves and to the collaborative as a whole: These data provide QI teams with the information they need to identify quality problems and to learn whether their actions actually improved quality.This report presents the results of an investigation of sequential validity of self-assessment by service providers in an improvement collaborative in the Mtwara Region of Tanzania. Study objectives were to determine the validity of self-assessments by the QI teams and whether validity improved during the first year of the collaborative.The study was carried out in nine health care facilities participating in an improvement collaborative in Mtwara Region of Tanzania, during its first 10 months of activity. The collaborative is addressing HIV/AIDS care, particularly as it relates to antiretroviral therapy (ART) and the prevention of mother-to-child transmission of HIV (PMTCT).The research team defined eight activities in the self-assessment process that can influence the validity of the information that results: 1) writing the records, 2) storing and retrieving records, 3) selecting records from which to abstract data, 4) abstracting data from the selected records, 5) summarizing the abstractions, 6) the agreement of computer and written records, 7) the quality and use of computer records, and 8) communicating the summary data (results related to improving the quality of care) to other members of the QI team and the clinical staff. The team then developed and tested forms and procedures for measuring the validity of the information each activity produced.The study found significant upward trends in measurement scores occurred for the tasks of writing the record, selecting the sample, the use of computer results, and communicating results. No significant change in validity occurred in storing and retrieving records, abstracting or summarizing selected records, or agreement of written records with computer records. However, some of these activities started high and remained high throughout the study: For retrieving records, validity was close to 100% in the first and last two measurements for most cases; for abstracting records, a small increase occurred in validity during the study for all three indicators but was significant for only one of them; and for summarizing abstracts, errors were zero or close to it throughout the study. Changes in validity were roughly the same for all three indicators.Over the course of the study, validity either improved or started and remained high for most self-assessment activities; none decreased. The communication activity, which differs from the others in that it does not contribute directly to the validity of the performance scores reported by the QI teams, had a very low end-of-study score across all sites, suggesting limited use of data for QI activities. With few exceptions, this study shows that self-assessment as part of Mtwara improvement collaborative provided valid data and improved as the collaborative matured. This finding—coupled with the result that some steps in the self-assessment process, such as storing and retrieving records and communicating results, are not always done well—suggests the need to address these activities early in a collaborative. The finding that the validity of abstracted data between QI teams and the gold standard set by the expert reviewers was not statistically different is especially encouraging.
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TB HIV Training Manual for Community Health Workers
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Community Resource
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A comprehensive approach for Quality Improvement of TB laboratory service in resource-limited settings
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Improvement Report
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Improving TB assessment among HIV/AIDS patients attending Mengo Hospital, an urban hospital in Uganda
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Improvement Report
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Investigation of the Sequential Validity of QI Team Self-Assessments in a Health Facility HIV Improvement Collaborative in Tanzania
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Publications
This is a study of the validity of the QI Teams’ self-assessment of their own performance as part of the ART/PMTCT improvement collaborative in Mtwara region, considering all the steps in the self-assessment process. Data collection began in August 2009 with baseline data collection by new QI teams as part of their QI work. Four rounds of data collection evaluated improvements in: completeness of case recording, record storage and retrieval, sample selection for abstraction, abstraction, summary, and communication of findings. The study found that validity of self-assessment data generally improved over the life of the collaborative.
This study has been submitted for publication in a peer-reviewed journal, and will be availble when published.
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Health Care Improvement Project: Provincial Glimpses
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Publications
This short booklet describes some of the results and lessons learned from HIV/AIDS and TB care improvement efforts in five provinces of South Africa.
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A Portfolio of Health Care Improvement Success Stories, 2001-2008
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Publications
The United States Agency for International Development (USAID) funded Quality Assurance Project (QAP) and its follow on, the USAID Health Care Improvement (HCI) Project under URC have, since 2001, been engaged in work that is crucial for health system strengthening with respect to HIV and AIDS programmes and TB. These diseases require ongoing intervention, monitoring and treatment, and when they present on a mass scale, as they do in South Africa, necessitate measures that are not easy to institute. Indeed, an entire infrastructure has to be put in place wherever affected people require treatment, and especially so in rural areas, where rates of infection are high but medical facilities are scarce.
USAID’s QAP and HCI Projects intervened to answer this need, creating small but effective infrastructures at crucial nodes to support South Africa’s health systems, and to bolster the health of the population in general with basic health care programmes. This publication is a compilation of success stories written over an eight-year period to document developments supported by QAP and the HCI Project.
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A Rapid Evaluation of the Uganda MoH Training Program on the Use of HIV Patient Monitoring Tools
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Publications
Due to the chronic nature of HIV/AIDS, accurate, up-to-date patient records are vital to ensuring that HIV/AIDS patients receive quality care. Recognizing this, the Uganda Ministry of Health (MoH) hasdeveloped a set of patient monitoring tools—registers and cards—to aid health workers in recording encounters with HIV/AIDS patients, tracking services provided, ensuring that needed services are provided, and provide data to the district level. The MoH has developed a training course to help health workers use these tools accurately and completely. Such training was conducted for 23 health facilities in Mbale Region in August 2009. The USAID Health Care Improvement Project (HCI) conducted a rapid evaluation of that training session and some of its outcomes to determine whether it improved health workers’ performance in using the tools.
Data were collected in 10 of the 23 facilities through a retrospective record review and interviews with facility in-charges and medical superintendents. Three patient monitoring tools were reviewed at each facility: cards for recording either pre-antiretroviral therapy (ART) or ART care and two registers for recording pre-ART and ART care. Pre-training performance was based on the quality of patient recordkeeping (that is, how well they were completed) in June and July 2009 and post-training performance on the same tools the following September and October.
The evaluation found that the training was well implemented, on schedule, and gave all participants a training manual and a copy of the patient monitoring tools. The knowledge test given to trainees at the start of the training and at its conclusion was also given twice, four days apart, to a comparison group of similar persons who did not attend the training. The training group’s performance increased 10.0 percentage points over the four days while that of the comparison group increased 5.9 percentage points. The 4.1 percentage point difference was not statistically significant.
The evaluation concluded that the training was not, on its own, sufficient to ensure adequate use of the patient monitoring tools. In addition to training, the MoH can improve patient monitoring by ensuring adequate stocks of these tools at facilities, assigning a facility staff member to be responsible for data management, and assigning a facility staff member to supervise record and data management functions.
