Adherence to treatment | USAID Health Care Improvement Portal
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Adherence to treatment

  • Tanzania | Morogoro ART/PMTCT Improvement Collaborative | Collaborative Profile
  • Tanzania | Mtwara ART/PMTCT Collaborative | Collaborative Profile
  • Tanzania | Lindi ART/PMTCT Collaborative | Collaborative Profile
  • Russia| Improvement of Social Support for HIV-infected mothers and their newly born children (St. Petersburg) | Collaborative Profile
  • Russia| HIV/AIDS Treatment, Care and Support: Support for Regional Spread Collaborative: Improvement of Access to Basic HIV/AIDS Care and ART Collaborative | Collaborative Profile
  • Adaptability of better care practices to improve HIV/AIDS care as they spread across sites in Uganda | 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.


  • Cote d’Ivoire| HIV Care and Treatment-ART and PMTCT Spread Collaborative | Collaborative Profile
  • Tanzania | Tanga Region ART/PMTCT Improvement Collaborative | Collaborative Profile
  • 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.  

  • Nicaragua | Antiretroviral Therapy (ART) Improvement Collaborative | Collaborative Profile
  • How to Investigate Adherence to Antiretroviral Therapy: An Indicator-Based Approach | Publications

    The International Network for Rational Use of Drugs (INRUD) has published a set of tools to help HIV program managers accurately assess the level of patient adherence to antiretroviral therapy.  The tools can be used as a facility level or across multiple facilities to identify sites which are performing below average, in order to examine the causes of low adherence.

    The INRUD website offers the following downloadable files:

    1. The manual: “Adherence Indicator Survey Manual”
    2. The data collection forms for country-level customization (password “INRUD”); printing for data collection; and for double data entry: "Questionnaires"
    3. The form which will automatically consolidate the data: "Consolidated"
    4. The training slides to train the data collectors: "Team Leader Role;" "Dispensing Records;" "Exit Interviews;" and "Facility Form"
    5. The report template: "Adherence Survey Report Template"
  • Quality Improvement of HIV and AIDS programs: experiences from South Africa (2007 - 2010) | 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."

  • Initiation of Highly Active Antiretroviral Therapy for HIV-infected patients at the Primary Health Care level in South Africa | 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."



  • Feasibility of Using Quality Criteria to Monitor and Improve the Quality of HIV Services | 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.  

  • Improving Care for People with Chronic Conditions in East Africa | Publications

    Until recently, malaria and other acute infectious diseases were the leading causes of mortality and morbidity in East Africa, and the health systems in the region were generally designed to manage acute conditions. Now with the advent of the HIV pandemic and increasing prevalence of non-communicable diseases, health systems are struggling to manage people with chronic conditions. Helping health systems change from the acute care model to one which has structures and processes in place to help people living with chronic conditions manage their condition at home will require transformation at many levels.  HCI is working with the Ministries of Health in Uganda and Tanzania to make these changes.   This flyer describes current efforts supported by HCI to promote 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.

  • Improving adherence of HIV/AIDS patients to ARVs in Tororo General Hospital, Eastern Uganda | Improvement Report
  • Improving the quality of care for adolescents living with HIV/AIDS by introducing Psychosocial Support services at Beatrice Road Infectious Disease Hospital (BRIDH) Opportunistic Infections and Antiretroviral Therapy (OI/ART) Clinic in Harare, Zimbabwe | Improvement Report
  • Chronic Care Design Meeting: Transforming Health Systems and Improving Quality Care for Chronic Conditions in Africa | Publications


    As patients throughout Africa are living longer with chronic conditions such as HIV, hypertension and diabetes, health systems must adapt to meet their needs. Chronic conditions are defined as those with which patients live for many months or years. This report details the discussions and conclusions of a Chronic Care Design workshop held in Uganda to explore how to improve care for these conditions, focusing on HIV, in Africa. Officials from the Ministry of Health of Uganda, the United States Agency for International Development (USAID), USAID Health Care Improvement Project (HCI), and experts in HIV and chronic care, participated in this three-day workshop held at Speke Resort, in Munyonyo, Kampala, Uganda from May 26-28, 2010.
    As Uganda has been a leader in HIV care for African nations—exhibited in its implementation of programs such as the Ministry of Health Quality of Care Initiative in HIV and AIDS—its health system is optimal for analyzing the current and future ability to respond to chronic care conditions.
    During the three-day meeting, about 50 participants engaged in group work, discussions, and presentations in order to understand the current Ugandan chronic care system and how it can be improved and adapted to better care for patients with long-term illnesses and medical conditions.

    Conclusions from the workshop and success stories from Uganda were presented on May 31, 2010, the first day of a four-day international conference on “Transforming Health Systems and Improving Quality Care for Chronic Conditions in Africa,” held in Kampala. More than 250 participants from 10 African countries (Cote d’Ivoire, Nigeria, Ethiopia, Rwanda, Kenya, Tanzania, Namibia, Malawi, South Africa and Uganda) gathered at the Imperial Royale Hotel in Kampala, Uganda and listened to highlights from the chronic care design meeting and learned how to redesign a health system to meet chronic care conditions in their home countries.

  • 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.
    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.
    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.


  • A Portfolio of Health Care Improvement Success Stories, 2001-2008 | 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.