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HIV laboratory services

  • Nicaragua | HIV Counseling and Testing Collaborative for People with STIs | Collaborative Profile
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  • Comparison of Coaching Strategies for Improvement Collaboratives in Ugandan HIV/AIDS Health Centres | Publications

     

    HCI has been implementing centrally organized collaborative improvement, with coaching provided by technical experts outside the MOH hierarchy, in 113 sites in Uganda to improve health care for patients with HIV/AIDS since 2006. In 2008, HCI introduced a district-based coaching strategy using MOH district management structures, as an alternative to centrally organized coaching, to facilitate sustainability of the approach and encourage its institutionalization and greater country ownership in the Ugandan health system.This study’s goal was to measure the relative efficiency and effectiveness of the two strategies in achieving improvements in process indicators.
     
    The study found that there were mostly very small improvements in quality indicators for both district and central strategy sites but these were generally not associated quality improvement team performance (QITP). There were some differences in QITP in four of 13 team indicators but no difference in improvements between district and central strategy sites. The district strategy was about 1/5th the cost of the Central strategy cost and therefore significantly more efficient. We therefore recommend the MOH use the district rather than the central strategy for more widespread interventions.
     
    HCI is preparing a manuscript for journal submission.

     

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  • Effets du collaboratif d’amélioration sur les indicateurs PTME et ARV en Côte d’Ivoire : Etude Comparative | Publications

    La Côte d’Ivoire a une prévalence élevée du VIH, avec 4,7 % de la population infectée par le virus. Cependant en 2008, une évaluation nationale de la prévention de la transmission mère-enfant du VIH (PTME) et les services de thérapie antirétrovirale (ARV) ont montré un écart important dans la qualité des soins tant dans le secteur privé que public. Pour mesurer les effets du collaboratif quant à la réduction des écarts, le Projet d’Amélioration des soins de santé de l’USAID (HCI) en Côte d’Ivoire, a comparé les résultats obtenus dans les sites de démonstration et ceux obtenus sur de nouveaux sites qui allaient rejoindre le projet. Ce rapport décrit le collaboratif d’amélioration qui a été mis en place par HCI en 2009 pour améliorer les soins et services ARV/PTME offerts aux PVVIH (Personne Vivant avec le VIH).

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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 | 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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  • Amélioration de la Qualité des Soins et Services en Côte d'Ivoire | Publications

     

    Apres plus d’une décennie de soin et de traitement d’ARV, il semble très important pour le PNPEC de se concentrer sur la qualité des interventions. Pour répondre à ce besoin, le PNPEC à fait appel au support technique d’URC pour mettre en œuvre un processus d’amélioration de la qualité avec le soutien financier du PEPFAR. Les résultats de cet effort national à travers le Projet d’Amélioration des Soins de Santé de l'USAID (HCI) conduit par URC.  
     
    Ce rapport décrit les objectifs de quatre projets d’amélioration dirigés par HCI en Cote d’Ivoire :
    1.    ARV-PTME : Améliorer la qualité de la prise en charge des PVVIH par le traitement antirétroviral et celle des services de prévention de la transmission mère-enfant du VIH.
    2.    OEV : Améliorer la qualité des services offerts aux OEV et leurs familles à travers le développement des normes et bonnes pratiques.
    3.    Prévention : Développer la norme Nationale pour les programmes d’éducation par les pairs dans le domaine du VIH/sida.
    4.    Laboratoire : Renforcer les capacités techniques des laboratoires impliqués dans le programme d’accréditation selon le schéma OMS-AFRO.

     

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  • 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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  • Toward “real time” HIV/STI diagnosis in the HIV/AIDS Program of Mexico City | Improvement Report
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  • Facilitating Active Lab Sample Transport (FAST) System Using Public Mini-Buses – Report of a Pilot Program in Swaziland | Improvement Report
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  • A comprehensive approach for Quality Improvement of TB laboratory service in resource-limited settings | Improvement Report
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  • Lessons in providing quality assurance for HIV rapid testing in Malawi | Improvement Report
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  • Effects of participating in collaborative improvement on the quality of HIV/AIDS care in facilities in Cote d’Ivoire: a comparison of intervention and control sites | Publications

     

    Collaborative improvement is one approach being used in many countries to improve prevention of mother to child transmission (PMTCT) and treatment with anti-retroviral therapy (ART) services. Collaborative improvement is consists of a network of teams engaging in a structured effort to learn from one another. A recent study analyzing the experiences of 27 collaboratives in 12 countries has shown collaborative improvement’s potential in achieving significant improvements in the level of the quality of care and the sustainability of such results.  However, this is one of the first studies in developing countries that examines the effect of collaborative improvement in comparison to a control group.
     
    The Ministry of Health of Cote d’Ivoire and the USAID Health Care Improvement Project (HCI) launched a collaborative improvement initiative in December 2008, in collaboration with implementing partners. The collaborative operated in two phases: the initial demonstration phase, which began in January 2009, and the extension (spread) phase, initiated in August 2010.  This collaborative provided an opportunity to: 1) examine whether there is a significant difference in the level of the quality of care between sites that have participated in an improvement collaborative versus those sites that will be in the extension phase and have therefore not yet participated in the collaborative activities; and  2) identify the factors contributing to this difference (if any) in the quality of care provided in the intervention and control sites.
     
    Methodology
    This study uses a modified quasi experimental design, in which the intervention group includes those sites participating in the demonstration phase of the ART/PMTCT collaborative, and the control group is composed of spread sites which had not yet been exposed to the collaborative activities but were planned to be included in the spread phase. Data were collected from 36 of the original 41demonstration (intervention) sites, and 42 spread (control) sites.
     
    Results
    Intervention sites saw significantly more improvement in quality of care indicators than control sites for completeness of documentation for PMTCT and ART, and for testing of children born to HIV+ mothers. Complete documentation for PMTCT at intervention sites rose from 22% at baseline to 83% after the collaborative, whereas at control sites during the same period there was only an 8% increase (from 0% to 8%); Complete documentation for ART at intervention sites rose from 22% at baseline to 87% after the collaborative, control sites had a higher baseline at 46% but this indicator barely showed any improvement at the end of the year (49%). Testing of children born to HIV+ mothers also increased at intervention sites. Results related to loss to follow-up for intervention sites do show initial improvement but some of the gains were lost towards the end of the study period. However, control sites experienced significant increases in loss to follow-up over time.  Data availability was significantly lower in control sites than in intervention sites.
    QI competency and implementation were significantly higher in the intervention group, as were having a standardized process that would allow maintaining gains, mechanisms for orienting new staff, and systems for ensuring resource availability. Few differences in resource availability were noted. Control sites had a higher percentage of clinically trained providers. Intervention sites were likely to have generated change ideas themselves or borrowed these ideas from other participating sites rather than control sites, which, if they implemented the change, were mostly likely to have received the idea from their implementing partner.
    Regression analyses, holding other independent variables fixed (resources and clinical competence), showed a strong association between being involved in the collaborative and results related to documentation and testing of children born to HIV+ mothers.
     
    Conclusions and Recommendations
    This study has shown that facilities involved in collaborative improvement are able to achieve significant improvement over their own baseline results in comparison to sites that have not participated in a collaborative. Regression analysis indicates a strong association between being involved in the collaborative and improved documentation and increased testing of children born to HIV+ mothers. Time series charts also indicate potential impact on loss to follow-up, although the results were not as well maintained over time. This study is one of the first of its kind in a developing country to demonstrate the effects of participating in collaborative improvement on results achieved in comparison to a control group.

     

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  • Improving the Quality of HIV and AIDS Care and Related Services in Cote d'Ivoire | Publications

    This short report describes assistance that the USAID Health Care Improvement Project is providing to the National Program for HIV Care and Treatment (PNPEC) of the Ministry of Health, implementing partners, the National Program for Orphans and Vulnerable Children (PN-OEV) and the Ministry of the Family, Women and Social Affairs (MFFAS) in Cote d'Ivoire to apply improvement methods to improve the quality of antiretroviral therapy services, PMTCT, OVC programs, and peer prevention of HIV.  The report also highlights results from 41 sites that have been engaged in an improvement collaborative on ART and PMTCT since 2008.

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  • Laboratory Collaborative Uganda | Collaborative Profile
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  • Uganda ART Collaborative | Collaborative Profile
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  • National Quality Center | Publications

    The National Quality Center (NQC) is a web resource funded by the U.S. Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) whose mission is to provide technical support for grantees of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 to improve the quality of HIV care throughout the United States.  Managed by the New York State Department of Health AIDS Institute, NQC offers state-of-the-art resources for HIV/AIDS care quality improvement and training, including online tutorials on topics such as training HIV providers in quality management, collecting performance data, choosing quality measures, QI tools, statistical methods, and cultural competence and tools developed and applied by HIV/AIDS providers.

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