Improving HIV service delivery in detention centers and ART facility in Odessa, Ukraine

Abstract

Background: Under USAID funded RESPOND project, a collaborative Quality Improvement (QI) effort was initiated in March 2013 with two detention centers and an Anti-retroviral treatment (ART) site in Odessa; their respective aims were to improve the HIV continuum of care among the rural population and to increase the coverage of detainees with HIV Testing and Counseling (HTC) services and enrolment in care. Before the improvement effort, in 2012, only 3.0% of detainees received HIV counseling, of which 19.2% were tested for HIV. Furthermore, there was no reliable mechanism to link released HIV-positive detainees with ART services.Methods & Materials: The three sites applied a Plan-Do-Study-Act QI Model to test changes; this model included teamwork and coordination with the Odessa AIDS Center; monthly selfmonitoring against improvement indicators, QI coaching visits, and sharing results during quarterly learning sessions. After 12 months of implementation, a data review and qualitative assessment survey were conducted.Results: Over one year, the two detention centers increased the coverage of HIV counseling services for detainees from 44% to nearly 70% . The coverage of HIV testing increased on average from 32% to 70%. The percentage of detainees that tested positive who were enrolled in care with the AIDS Center increased from 0% to 40% after introduction of health system changes.The ART Center increased the proportion of HIV patients enrolled into care within 30 days after the confirmatory HIV test from 55% to 70% . The percentage of patients that underwent regular checkups increased from 42% (June 2013-October 2013) to 80% Conclusion:The key results of the project were the following: for the Odessa ART Center -1) increased timely enrolment of HIV positive individuals in care, and 2) improved attendance of HIV positive patients at regular check-ups; and 3) increased coverage with HTC services. These results indicated that more people were diagnosed with HIV at an earlier stage and more of them were enrolled in care in a timely manner and benefitted from the known efficacy of ART.