RESUMO
BACKGROUND: Continuous quality improvement (CQI) is essential for HIV and tuberculosis (TB) services. Similarly, a thorough understanding of the requirements and impact of CQI is critical to its successful institutionalisation. However, this is currently lacking. OBJECTIVES: The objective of this study is to describe the CQI implementation process and examine its effect on HIV and TB service delivery at selected primary healthcare facilities in two South African districts. METHOD: We used a separate sample, pre- and post-test, quasi-experimental study design based on data collected from the clinical audit of patient cohorts seen in 2014 and 2015 respectively. Quality was measured based on the extent to which prescribed services were provided. Tailored CQI interventions were implemented based on service delivery gaps identified by the 2014 CQI audit. Data were summarised and analysed using a combination of univariate and multivariate analysis. RESULTS: The services identified as low quality were related to opportunistic infections management and laboratory practices. Compliance to prescribed service items in antiretroviral treatment initiation and monitoring, pharmacy and laboratory management, exceeded 70% across study sites. Over 80% of low quality service delivery items were optimised in less than six months with targeted quality improvement support. CONCLUSION: The observed improvements signal the effectiveness of the CQI approach, its capacity to rapidly improve under-performance, its high replicability and the need to provide quality maintenance support to sustain or improve healthcare facilities performing well. The study strongly underscores the need to improve the management of opportunistic infections and complications, particularly TB.
RESUMO
INTRODUCTION: The provision of antiretroviral treatment (ART) for HIV infection is a key strategy in addressing the high burden of HIV/AIDS in South Africa and improving the quality and length of life for those infected. Information produced from routine monitoring is essential for evidence-based decision-making within ART programmes. An evaluation of the ART programme data system in Eastern Cape, South Africa was conducted to determine the causes of irregular reporting and to make recommendations to improve data quality. METHODS: Data audits and semi-structured interviews were performed in facilities that initiate and provide ART. Thirty-two facilities in three sub-districts were audited. RESULTS: The number of adults receiving ART was over-reported by 36.6% (P < 0.05) on the District Health Information System. The interviews of nurses and administrators revealed various factors that contributed to the inaccuracy of the data including training, staffing levels, use of registers, data verification processes, and standardization with programme partners. CONCLUSIONS: Recommendations to address the inaccuracy of ART programme data include improving knowledge translation during training of ART programme staff, ensuring the implementation of established data verification policies and procedures, rethinking the design of the programme to reduce the burden on health facilities and personnel, and standardizing information management procedures amongst the various governmental and non-governmental stakeholders. The challenges with reporting in the Eastern Cape may be shared by other South African provinces as well as other low-middle income countries that require high quality data to inform well-designed and well-implemented interventions in the fight against HIV/AIDS.