Assessing the quality of HIV/AIDS services at military health facilities in Zambia

Kim, Young Mi; Banda, Joseph; Hiner, Cyndi; Tholandi, Maya; Bazant, Eva; Sarkar, Supriya; Andrade, Adriana; Makwala, C

doi:10.1177/0956462412472811

Cited by 7 publications

(11 citation statements)

References 5 publications

(5 reference statements)

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“…Notably, scores on three of the nine ART standards increased significantly at intervention sites, whereas decreasing at comparison sites: checking for signs of opportunistic infections, assessing adverse reactions, and nutrition counseling. For PMTCT, providers made greater progress at intervention than comparison sites on the following three important areas of weakness identified at baseline [15]: S148 AIDS 2015, Vol 29 (Suppl 2) There was less improvement in providers' performance on the eight general ANC standards listed in Table 2; scores rose by almost 7 percentage points in the intervention group, whereas declining by about the same amount in the comparison group. In multivariate models of ART, PMTCT, and ANC provider performance, the difference between the study groups was not significant.…”

Section: Provider Performancementioning

confidence: 93%

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities

Kols

Kim

Bazant

et al. 2015

Aids

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Section: Provider Performancementioning

confidence: 93%

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities

Kols

Kim

Bazant

et al. 2015

Aids

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“…These checklists were based on SBM-R assessment tools, which measure service quality as the percentage of essential items present at facilities or the percentage of essential tasks performed by providers. For a detailed description of the methods used to collect the observational data, see the articles published by Kim et al [ 11 , 12 , 22 ]. Where possible, this paper triangulates the provider interview findings with these previously published observation data.…”

Section: Methodsmentioning

confidence: 99%

“…We conducted an evaluation study on an SBM-R intervention that was implemented in ZDF facilities to strengthen HIV-related services. Provider performance in ART and PMTCT at these sites [ 11 , 12 ] has been documented. However, providers’ perspectives on the quality of care have not yet been described.…”

Section: Introductionmentioning

confidence: 99%

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia

Bazant

Sarkar

Banda³

et al. 2014

Hum Resour Health

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BackgroundHuman resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers’ work environment and perceived quality of HIV-related care were assessed to complement data of provider performance.MethodsThe intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups.ResultsIn the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group’s improvement and the comparison group’s decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item “provider lacks confidence in some clinical skills” declined in the intervention group but increased in the comparison group (P = –0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care.ConclusionsThe performance and quality improvement intervention implemented at Zambian Defence Forces’ health facilities was associated with improvements in providers’ perceptions of work environment consistent with the intervention’s focus on commodities, skills acquisition, and receipt of constructive feedback.

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“…22 QI has been applied to increase maternal HIV status documentation in the U.S., 23 cotrimoxazole prophylaxis among adult HIV patients in Uganda, Mozambique, Namibia, and Haiti, 24 uptake of early infant diagnosis of HIV in rural Mozambique, 25 and decrease turn-around time for HEI screening test results in Tanzania. 26 QI has proven feasible to apply to PMTCT programs in South Africa 27–29 and Zambia, 30 though previous PMTCT-focused QI interventions in sub-Saharan Africa have lacked a comparison group 27,28 or were non-randomized. 30 None have evaluated QI to improve PMTCT services in the era of Option B+, though one other randomized QI intervention is ongoing in Nigeria.…”

Section: Introductionmentioning

confidence: 99%

“…26 QI has proven feasible to apply to PMTCT programs in South Africa 27–29 and Zambia, 30 though previous PMTCT-focused QI interventions in sub-Saharan Africa have lacked a comparison group 27,28 or were non-randomized. 30 None have evaluated QI to improve PMTCT services in the era of Option B+, though one other randomized QI intervention is ongoing in Nigeria. 31 …”

Section: Introductionmentioning

confidence: 99%

Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial

Rustagi

Gimbel

Nduati

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Prior studies of systems engineering applications to PMTCT lacked comparison groups or randomization. METHODS Thirty-six health facilities in Côte d’Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6–8 weeks. We compared the change between baseline (January 2013–January 2014) and post-intervention (January–March 2015) periods using t-tests. All analyses were intent-to-treat. RESULTS ARV coverage increased 3-fold (+13.3 percentage points [95% CI: 0.5, 26.0] in intervention vs. +4.1 [−12.6, 20.7] in control facilities) and HEI screening increased 17-fold (+11.6 [−2.6, 25.7] in intervention vs. +0.7 [−12.9, 14.4] in control facilities). In pre-specified sub-group analyses, ARV coverage increased significantly in Kenya (+20.9 [−3.1, 44.9] in intervention vs. −21.2 [−52.7, 10.4] in controls; p=0.02). HEI screening increased significantly in Mozambique (+23.1 [10.3, 35.8] in intervention vs. +3.7 [−13.1, 20.6] in controls; p=0.04). HIV testing did not differ significantly between arms. CONCLUSIONS In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared to controls, which were significant in pre-specified sub-groups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV.

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Assessing the quality of HIV/AIDS services at military health facilities in Zambia

Cited by 7 publications

References 5 publications

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia

Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial

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