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Collaborative Evaluation Series: Russia Site Visit Report

Gutmann M | Catsambas TT | McLaughlin S
Organization: USAID Health Care Improvement Project/URC

This report presents the methodology, findings, and conclusions of an evaluation of the HIV/AIDS Treatment, Care, and Support (TCS) Collaborative in Russia. The evaluation included individual and group discussions with about 25 actors in the health care systems addressed by the collaborative; document review of plans, memos, reports, indicator data, job aids, and other types of documents; and observations of clinics (not patient consults) and health ministry offices, a learning session for representatives of facility teams participating in the collaborative, and a training session on voluntary counseling and testing. The collaborative started in June 2004 (involving one district of St. Petersburg and limited regions in three oblasts), and the evaluation took place in March–June of 2007. Findings reveal broad-based successes and point to areas where additional strides could be made to improve the quality of care for PLWHA in Russia. Within TCS, the collaborative addressed four topic areas: access to care and patient retention, coordination of care, patient management and adherence to treatment, and coordinated HIV and TB detection and treatment. All four topics were addressed by all sites, which were not facilities but rather larger administrative systems of care involving polyclinics, AIDS centers, and other specialty providers. Briefly, findings reveal significant achievements in each topic (the text provides details, including run charts showing the speed of achievements, and an appendix provides data on 30 indicators defined by the project, USAID, or PEPFAR). Other important accomplishments were: re-organizing the referral systems and communication channels between facilities, creating case management positions and integrating them into existing systems, creating a TB specialist position at one oblast’s AIDS centers, enhancing the role of polyclinics in the medical follow-up of HIV-infected patients, expanding screening for TB among HIV patients at the polyclinic level, and initiating isoniazid preventive therapy among HIV-infected patients.