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World AIDS Day, 2003

AIDS ribbon

QAP is working to create sustainable systems of service delivery for HIV/AIDS care and support and improve the quality and impact of HIV/AIDS programs in developing countries. Field activities and research in several countries are aimed at increasing quality and use of HIV/AIDS services and preventive practices, including voluntary counseling and testing (VCT), prevention of mother-to-child transmission of HIV (PMTCT), and improving related provider knowledge, skills, and performance. QAP is also addressing the quality of laboratory and diagnostic services and human resource issues related to appropriate staffing and scale-up of HIV/AIDS services.

  • In Rwanda, URC is helping the national AIDS commission, TRAC, to implement a collaborative approach to scaling up VCT, PMTCT, and anti-retroviral (ARV) therapy. The aims of the collaborative improvement effort are to develop highly effective strategies and solutions for the rapid spread of best practices in HIV/AIDS care; demonstrate significant results in the quality and outcomes of HIV/AIDS care within 12-18 months; develop continuous communication between implementation sites and between professional groups to share experiences in improving HIV/AIDS care; and increase the motivation and satisfaction of health workers and the community through improved results and shared learning. The collaborative improvement initiative was launched in 20 sites in April 2003, with at least one site in each of the country's 11 provinces. The teams are now engaged in implementing rapid cycle improvements in the areas of demand creation (e.g., for pregnant women and for partner testing), logistics of HIV testing, roles for staff and volunteers, strategies to ensure adherence with PMTCT and ARV, re-supply of patient medication, patient and infant follow-up, patient self-care strategies, and counseling and support.
  • To address the obstacle that stigma poses for HIV programs, URC has begun operations research on the impact of HIV/AIDS stigma among healthcare workers on the quality of care provided in PMTCT services. Stigma studies are being carried out in Rwanda, Tanzania, and Haiti to assess HIV knowledge, attitudes and practices of health providers, as a first step towards designing interventions to reduce stigma. Other operations research studies are planned to prospectively document patient adherence to antiretroviral therapy and to evaluate outcomes of patients currently receiving antiretroviral therapy in Rwanda.
  • For UNICEF and WHO, URC conducted a review of programmatic experience with prevention of mother-to-child transmission of HIV and infant feeding. The review, which will be published in early 2004, contributed to the revision of WHO-UNICEF guidelines on infant feeding. The HIV and infant feeding study represents the first systematic effort to collect and analyze a wide range of program experiences and research on infant feeding and the prevention of mother-to-child-transmission of HIV (PMTCT). The analysis drew on questions generated during a recent international colloquium on HIV and infant feeding, with additional input from a number of key informants. Results were clustered around seven broad issues: general universal findings, exclusive breastfeeding, exclusive replacement feeding, informed choice, male involvement, stigma and abuse faced by mothers perceived as having HIV, and formula use.
  • QAP Partner Initiatives, Inc. conducted an analysis of the human resource requirements needed to scale-up PMTCT and ARV programs in Zambia. The study also documented the quality of PMTCT and ARV services currently being provided in both public and private sector programs in Zambia. The study was conducted to assist the Government of Zambia to determine what it staffing needs will be to scale up voluntary counseling and testing (VCT), prevention of mother-to-child transmission of HIV (PMTCT), and antiretroviral (ARV) therapy as planned under its Global Fund application. Cost figures for alternative assumptions about scale-up are included in the analysis.
  • In Jamaica, URC is providing technical support to the Ministry of Health's pilot HIV/AIDS program to improve the quality of PMTCT and care and support services. An operations research study is now following up HIV-positive mother and infant pairs to assess sero-conversion among the children.
  • In South Africa, URC is helping the Departments of Health in Mpumalanga and KwaZulu-Natal Provinces to improve the quality of PMTCT, VCT, STI, and TB services.

For more information on QAP's work to fight the spread of HIV/AIDS, contact Dr. David Nicholas.

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.