A review of how the quality of HIV clinical services has been evaluated or improved

Abstract

To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improving quality of HIV clinical services. We extracted country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were programme evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or programme, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programmes develop their HIV care quality improvement frameworks.

Building a tuberculosis-free world: The Lancet Commission on tuberculosis

“…By leveraging a four-step continuous cycle of improvement (plan-do-check-act), these programmes have driven substantive change by developing local solutions to improve the quality of HIV care. Improvements have been shown across different facets of care, including treatment adherence, 136 reducing mother-to-child transmission of HIV, 137 paediatric services, 138 enhancing adherence to treatment guidelines, 139 and strengthening the clinical capacity of front-line providers. 140 Similar approaches can be used to improve the quality of care for patients with tuberculosis, while also enabling increased accountability at all levels of national tuberculosis programmes (case studies in the appendix pp 22-24 provide examples from the public and private sector, at facility and regional level, of how quality improvement approaches have been deployed to improve tuberculosis outcomes).…”

Structure and quality of outpatient care for people living with an HIV infection

“…An initial step in this process is to define what good quality of HIV care is (Hung & Pradel, 2014). Since the role of non-HIV comorbidity is increasing, researchers and health-care providers need to go beyond HIV-related morbidity in the evaluation of health outcomes (Chu et al, 2011).…”