Improving HIV outcomes in resource-limited countries: the importance of quality indicators

Ahonkhai, Aimalohi A.; Bassett, Ingrid V.; Ferris, Timothy G.; Freedberg, Kenneth A.

doi:10.1186/1472-6963-12-427

Cited by 14 publications

(26 citation statements)

References 71 publications

(101 reference statements)

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“…46,47 Adding costs of NCD screening and treatment to already overstretched health services must be weighed against the burden inflicted by NCDs, including the direct costs associated with management of advanced disease and indirect costs such as time costs (e.g., lost wages) for those affected. 48 Additionally, integrating NCD services with existing HIV infrastructure could decrease overall costs by taking advantage of efficiencies of scope.…”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

HIV, Tuberculosis, and Noncommunicable Diseases

Hyle

Naidoo

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.

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Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

HIV, Tuberculosis, and Noncommunicable Diseases

Hyle

Naidoo

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…A preliminary list of QoC indicators for expert vetting was identified through literature review that focused on those comprehensive, evidence-based care processes shown to increase the likelihood of achieving the best clinical outcomes of HIV patients. The review included eight clinical guidelines [19][20][21][22][23][24][25][26] and seven sets of indicators previously proposed for HIV health-care evaluation 7,9,[27][28][29][30][31] . The list of QoC indicators was divided into two groups: processes and clinical outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…Multilateral organizations (e.g., The Joint United Nations Program on HIV/AIDS, and the Global Fund to fight AIDS, Tuberculosis, and Malaria) have proposed indicators to evaluate national HIV programs at the health systems-level. However, these indicators do not focus on processes for care continuum and do not reflect the multidisciplinary care that HIV patients require 7 . The HQSS commission and other studies identified that there is a lack of information regarding the quality of health-care processes and their impact on health outcomes, such as viral suppression, in most low-and middle-income countries, except for African countries [6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…However, these indicators do not focus on processes for care continuum and do not reflect the multidisciplinary care that HIV patients require 7 . The HQSS commission and other studies identified that there is a lack of information regarding the quality of health-care processes and their impact on health outcomes, such as viral suppression, in most low-and middle-income countries, except for African countries [6][7][8][9] . Existing evidence supports the following factors associated with viral suppression among HIVpositive individuals on antiretroviral treatment (ART) [10][11][12][13] : older age; male sex; no history of injected drug use; low baseline viral load; and the type, adherence to, and longer duration of ART.…”

Section: Introductionmentioning

confidence: 99%

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Quality of health care and viral suppression among human immunodeficiency virus patients

Luna-Mireles

Doubova

Pérez‐Cuevas

2020

RIC

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Background: In Mexico, the quality of health care for human immunodeficiency virus (HIV) patients is unknown. The study objectives were to develop quality of care (QoC) indicators for outpatient care of HIV patients, evaluate the quality of the processes of care (QPC) and outcomes, and analyze the association between the QPC and viral suppression among HIV patients. Methods: The study used a mixed-methods approach: (1) Development of QoC indicators through RAND/UCLA method; (2) cross-sectional study of QoC evaluation; and (3) multiple Poisson regressions to measure the association between the QPC and viral suppression. The study included 439 HIV patients, ≥ 19 years of age, with at least one outpatient consultation during 2017 at a public hospital in the State of Mexico. Results: We developed 21 QoC indicators to evaluate HIV care. Based on these indicators, the QoC gaps that emerged were related to clinical history (24% of patient records included sexual history information), routine adherence assessment (no records demonstrated regular recording of antiretroviral treatment adherence), and screening and referral (50% were screened for depression, and 42% for tuberculosis; 1.2% of patients with abnormal body mass index were referred to a dietitian). On average, HIV patients received 63% of recommended QPC; 77.7% achieved viral suppression. Receiving over 75% of recommended QPC was associated with a higher probability of viral suppression (adjusted prevalence ratio 1.13, 95% confidence interval 1.03-1.24). Conclusions: Evaluation of the QoC for HIV patients is essential to identify and address gaps in health-care quality to increase the probability of viral suppression.

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“…9 For example, in the 2007 framework for health system strengthening in resource-limited countries, the World Health Organization (WHO) recognized quality of care as a key element to improve health outcomes and efficiency. 10,11 As further demonstration of their emphasis on quality, the WHO has continuously developed quality assurance and improvement guidances for a variety of HIV-related services over the years.…”

Section: Quality Of Hiv Carementioning

confidence: 99%

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

Hung

Pradel

2014

Int J STD AIDS

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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.

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Improving HIV outcomes in resource-limited countries: the importance of quality indicators

Cited by 14 publications

References 71 publications

HIV, Tuberculosis, and Noncommunicable Diseases

HIV, Tuberculosis, and Noncommunicable Diseases

Quality of health care and viral suppression among human immunodeficiency virus patients

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

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