QAP is committed to creating sustainable systems of service delivery for HIV/AIDS Care and Support, including treatment of sexually transmitted infections and opportunistic infections in developing countries. QAP HIV/AIDS activities 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 Uganda, QAP is a key partner in the Ministry of Health’s Quality of Care (QoC) Initiative, which is developing a sustainable quality improvement system for HIV/AIDS service delivery at national scale. As part of the QoC Initiative, QAP is supporting a national antiretroviral treatment improvement collaborative that is piloting more effective procedures for ensuring high quality antiretroviral treatment for patients with HIV/AIDS. The collaborative has also introduced monitoring of a small number of quality indicators to track teams’ progress. The collaborative is being implemented at 57 sites in 51 of the 56 districts in the country.
- Healthcare workers in Tanzania are being trained to effectively use HIV and infant feeding job aids to counsel prenatal and postpartum women to make informed decisions about infant feeding options and to safely practice the method selected. Funded by USAID and the President’s Emergency Plan for AIDS Relief (PEPFAR), development of the tools took place under QAP-supported operations research conducted in 2004 in close collaboration with the University of Bergen, Norway and the Kilimanjaro Christian Medical Centre. The integrated package of job aids was developed from generic materials produced by WHO and UNICEF and reflects updated international guidelines on HIV and infant feeding. QAP also provided assistance to the Ministries of Health of Zimbabwe and Uganda to adapt the Tanzanian materials for use in those countries. (Download HIV and infant feeding job aids.)
- QAP is working with the National Department of Health and Provincial Departments of Health and over 100 facilities in five provinces of South Africa to operationalize national protocols on C&T, PMTCT, HIV-TB integration, and antiretroviral treatment and counseling. Our technical assistance aims to increase the uptake of services related to VCT, PMTCT, HIV-TB integration, antiretroviral therapy, and palliative care and support activities for persons living with HIV/AIDS. Local QAP staff provide training and mentoring in quality improvement methods and support facility staff in making changes in care processes to improve adherence with guidelines, reduce missed opportunities, and reinforce the continuum of care for HIV patients on ART. QAP is also working with community-based organizations in the Eastern Cape and Mpumalanga Provinces to provide home-based palliative care and adherence support. Read about results in South Africa health facilities.
- In Tanzania, QAP is supporting the Ministry of Health (MOH) to improve the quality of pediatric AIDS care and services through a pediatric hospital improvement collaborative that involves 19 hospitals in seven of the country’s 25 mainland regions. Through learning sessions, training, and coaching, hospitals participating in the collaborative have introduced emergency treatment assessment and triage systems and a new process for screening hospitalized children for HIV infection and channeling infected children to HIV care and treatment.
- In Lesotho, QAP is providing support to the National Tuberculosis Program (NTP) of the Ministry of Health and Social Welfare to apply lessons from South Africa’s HIV/AIDS and TB quality improvement activities to develop integrated service delivery models and algorithms for health facilities and providers. QAP is also supporting clinical training in TB-HIV as well as strengthening support systems in the NTP and other service delivery partners.
- QAP is also working with the NTP in Swaziland to develop policies and integrated service delivery models for HIV/AIDS and TB services. QAP assisted the NTP to update TB treatment guidelines for HIV-infected persons and is supporting clinical training in the management of TB-HIV co-infection.
- In Russia, QAP is collaborating with national and regional health authorities to scale up a model system of comprehensive treatment, care, and support for people living with HIV in Orenburg Oblast and in St. Petersburg City. QAP works with providers of both ART and basic care and social services to strengthen access and patient retention, care coordination, case management, adherence, and HIV-TB integration. Particular progress has been made to date in expanding the availability of palliative care and treatment for opportunistic infections and in addressing TB-HIV co-infection. In 2006, QAP launched a new initiative with local health authorities in St. Petersburg, Orenburg Oblast, Togliatti in Samara Oblast, and Engels in Saratov Oblast to improve the quality of family planning services and counseling for people living with HIV/AIDS.
- QAP is assisting the Ministry of Health of Nicaragua to design quality services to identify, treat, and follow up people infected with HIV and to develop a network of laboratory services to support HIV testing. QAP is working with local health authorities in eight of the country’s 17 local health systems (SILAIS) to integrate voluntary counseling and testing for HIV into existing family planning services, strengthen capacity of personnel to process HIV lab tests, and introduce counseling and testing of pregnant women to prevent vertical transmission of HIV. QAP has also facilitated discussions among hospital personnel to reduce stigma and discrimination towards persons infected HIV and to create multi-disciplinary teams to support HIV counseling and testing.
- In Vietnam, QAP is working closely with the National Tuberculosis Program (NTP), the Vietnam Administration of HIV/AIDS Control (VACC), and other stakeholders to implement a collaborative improvement model to increase TB-HIV cross-referrals in Thai Binh Province. The collaborative activities will aim to increase uptake of HIV counseling and testing among TB patients as well as TB screening among HIV patients. In addition, the program will develop linkages to refer co-infected patients for ARV treatment. Other elements of the program include strengthening of health worker skills, improved linkages with laboratories, and better functioning recording and reporting systems for TB-HIV co-infected patients.
- From 2003-2006, QAP supported the Ministry of Health and the National Treatment and Research AIDS Center (TRAC) to implement a national PMTCT/VCT Improvement Collaborative involving 37 sites in all 12 provinces of the country. The PMTCT/VCT collaborative demonstrated marked gains in the rate of HIV testing of prenatal care clients and their partners and in the proportion of HIV-positive pregnant women receiving Nevirapine at delivery. Important progress was also made in increasing follow-up of children born to HIV-positive mothers; through monthly appointments for mother-child pairs and home visits, the percentage of children tested at 15-18 months increased from less than 10% to over 80%. In 2004, QAP initiated a second AIDS improvement collaborative in Rwanda to improve the management and service quality of antiretroviral therapy in 16 sites. Teams in the ART collaborative improved monitoring of HIV-infected patients not yet eligible for ART. QAP also implemented a demonstration of HIV/AIDS case management at the community level through three local NGOs, which provided important counseling, nutritional and adherence support to over 6000 patients at relatively low cost.
- QAP's partner Initiatives Inc. conducted studies of the human resource requirements needed to scale-up PMTCT and ARV programs in Zambia and Rwanda. The studies also documented the quality of PMTCT and ARV services being provided now in both countries. (See Zambia and Rwanda reports in the list below of QAP HIV/AIDS publications.)
- The XV International AIDS Conference (IAC) held in Bangkok, Thailand, July 11-16, 2004, generated a number of abstracts related to HIV and infant feeding. At the request of the USAID MTCT Partners Working Group, QAP and the LINKAGES Project selected approximately eighty-five of these abstracts, developed for both oral presentations and poster sessions, and organized them under 17 key themes related to HIV and infant feeding. Several major findings and key issues that emerge from these abstracts have been highlighted by the editors to inform policy development, programming, and future research. Given the subjective nature of the selection of these abstracts and their assignment to one thematic category or another, the editors strongly encourage the reader to visit the IAC website at http://www.aids2004.org, where all conference abstracts are available for review. Download "Selected Abstacts on HIV and Infant Feeding."
- HIV/AIDS is a major contributor to morbidity and mortality among children, particularly in Africa. In order to preserve the lives of children who are suffering, the current focus on adults with HIV/AIDS must widen to include children and families, and health interventions that have not traditionally included HIV, such as IMCI, should be expanded to include HIV/AIDS as an important component. To respond to the expressed need for current evidence and experiences in providing services for children infected and affected by HIV/AIDS, QAP compiled and categorized by theme, abstracts from the Bangkok 2004 AIDS conference to provide a quick resource to those developing and implementing programs in pediatric HIV/AIDS care and support, especially in the developing world. Download "Selected Abstracts on Pediatric HIV/AIDS."
Related QAP Publications: