Health-care worker engagement in HIV-related quality improvement in Dar es Salaam, Tanzania.

OBJECTIVE: To assess health-care worker (HCW) awareness, interest and engagement in quality improvement (QI) in HIV care sites in Tanzania. DESIGN: Cross-sectional survey distributed in May 2009. SETTING: Sixteen urban HIV care sites in Dar es Salaam, Tanzania, 1 year after the introduction of a quality management program. PARTICIPANTS: Two hundred seventy-nine HCWs (direct care, clinical support staff and management). MAIN OUTCOME MEASURES: HCW perceptions of care delivered, rates of engagement, knowledge and interest in QI. HCW-identified barriers to and facilitators of the delivery of quality HIV care. RESULTS: Two hundred seventy-nine (73%) of 382 HCWs responded to the survey. Most (86%) felt able to meet clients' needs. HCW-identified facilitators of quality included: teamwork (88%), staff communication (79%), positive work environment (75%) and trainings (84%). Perceived barriers included: problems in patients' lives (73%) and too few staff or too high patient volumes (52%). Many HCWs knew about specific QI activities (52%) or had been asked for input on QI (63%), but fewer (40.5%) had participated in activities and only 20.1% were currently QI team members. Managers were more likely to report QI involvement than direct care or clinical support staff (P < 0.01). No difference in QI involvement was seen based on patient load or site type. CONCLUSIONS: HCWs can provide important insights into barriers and facilitators of providing quality care and can be effectively engaged in QI activities. HCW participation in efforts to improve services will ensure that HIV/AIDS quality of care is achieved and maintained as countries strive for universal antiretroviral access.

Utility of antenatal HIV surveillance data to evaluate prevention of mother-to-child HIV transmission programs in resource-limited settings.

Prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT) programs are expanding in resource-limited countries and are increasingly implemented in antenatal clinics (ANC) in which HIV sentinel surveillance is conducted. ANC sentinel surveillance data can be used to evaluate the first visit of a pregnant woman to PMTCT programs. We analyzed data from Kenya and Ethiopia, where information on PMTCT test acceptance was collected on the 2005 ANC sentinel surveillance forms. For Zimbabwe, we compared the 2005 ANC sentinel surveillance data to the PMTCT program data. ANC surveillance data allowed us to calculate the number of HIV-positive women not participating in the PMTCT program. The percentage of HIV-positive women missed by the PMTCT program was 17% in Kenya, 57% Ethiopia, and 59% Zimbabwe. The HIV prevalence among women participating in PMTCT differed from women who did not. ANC sentinel surveillance can be used to evaluate and improve the first encounter in PMTCT programs. Countries should collect PMTCT-related program data through ANC surveillance to strengthen the PMTCT program.

Perceived sufficiency and usefulness of IEC materials and methods related to HIV/AIDS among high school youth in Addis Ababa, Ethiopia.

This study was conducted to assess the perceived sufficiency and usefulness of HIV/AIDS information, education and communication (IEC) messages and materials as well as to identify preferences for IEC sources and methods. Data were collected using a self-administered questionnaire and focus group discussions. A total of 901 students in Addis Ababa, Ethiopia, participated in the study. Over three quarters of the respondents believed in the usefulness of IEC. IEC materials were perceived to be useful in increasing knowledge about HIV/AIDS by 456 (51%), to influence attitude by 357 (40%) and to acquire safer sexual practices by 382 (42%) of the respondents. None of the information sources and messages available for high school students highly satisfied the sufficiency indicators. Even though no single information source was highly preferred, radio and television ranked top. Life skills training was the most desired intervention by the students. IEC on HIV/AIDS was able to acquaint students with the disease rather than equipping them with knowledge and skill needed in their daily life. Therefore, appropriate and mutually reinforcing IEC messages with emphasis on life skill training are recommended.

Stress, motivation and professional satisfaction among health care workers in HIV/AIDS care and treatment centers in urban Tanzania: a cross-sectional study.

BACKGROUND: Shortages of health care workers (HCWs) represents a serious challenge to ensuring effective HIV care in resource-limited settings (RLS). Stress, motivation, and job satisfaction have been linked with HCW retention and are important in addressing HCW shortages. In this cross-sectional study HCW stress, motivation and perceived ability to meet patient needs were assessed in PEPFAR-supported urban HIV care and treatment clinics (CTCs) in Tanzania. METHODS: A self-administered questionnaire measuring motivation, stress, and perceived ability to and meet patient needs was given to HCWs at 16 CTCs. Scales measuring HCW satisfaction, motivation, and stress were developed using principle components analysis. Hierarchical linear models were used to explore the association of HCW and site characteristics with reported satisfaction, stress, motivation, and ability to meet patients' needs. RESULTS: Seventy-three percent (279) of HCWs completed the questionnaire. Most (73%) HCWs reported minimal/no work-related stress, with 48% reporting good/excellent motivation, but 41% also reporting feeling emotionally drained. Almost all (98%) reported feeling able to help their patients, with 68% reporting work as rewarding. Most reported receipt of training and supervision, with good availability of resources. In the multivariate model, direct clinical providers reported lower motivation than management (p < 0.05) and HCWs at medium-sized sites reported higher motivation than HCWs at larger sites (p < 0.05). HCWs at small and medium sites were more likely to feel able to help patients than those from larger sites (p < 0.05 and p < 0.001 respectively). CONCLUSION: Despite significant patient loads, HCWs in these PEPFAR-supported CTCs reported high levels of motivation, job satisfaction, ability to meet patients' needs, low levels of stress but significant emotional toll. Understanding the relationship between support systems such as strong supervision and training and these outcomes is critical in designing interventions to improve motivation, reduce stress and increase retention of HCWs.