Ability and willingness to pay for family planning services in low resource settings: evidence from an operational research.

Objective: This paper establishes levels and patterns of ability and willingness to pay (AWTP) for contraceptives, and associated factors. Study design: A three-stage cluster and stratified sampling was applied in selection of enumeration areas, households and individuals in a baseline survey for a 5-year Family planning programme. Multivariable linear and modified Poisson regressions are used to establish factors associated with AWTP. Results: Ability to pay was higher among men (84%) than women (52%). A high proportion of women (96%) and men (82%) were able to pay at least Ug Shs 1000 ($0.27) for FP services while 93% of women and 83% of men who had never used FP services will in future be able to pay for FP services costed at least Shs 2000 ($0.55). The factors independently associated with AWTP were lower age group (<25 years), residence in urban areas, attainment of higher education level, and higher wealth quintiles. Conclusion: AWTP for FP services varied by different measures. Setting the cost of FP services at Shs 1000 ($0.27) will attract almost all women (96%) and most of men (82%). Key determinants of low AWTP include residence in poor regions, being from rural areas and lack of/low education.Implications statement: Private providers should institute price discrimination for FP services by region, gender and socioeconomic levels. More economic empowerment for disadvantaged populations is needed if the country is to realise higher contraceptive uptake. More support for total market approach for FP services needed.

Cost Control of Mining Personnel Based on Wireless Communication Network from the Perspective of Operations Research.

The sublevel caving method without sill pillar is used to improve the cost of mining. The analysis is performed according to unique geographical environment and the current mining technology of the mine. The wireless communication network is used to budget and control the work cost of mining. Simulation operation about unit explosive dosage, fan-shaped deep hole interval, hole bottom distance, and collapse step distance is performed. Experiments have shown that budget and control of the cost of mining workers with wireless communication technology can manage mining data and guide the design of mining data.

Rules of incidental operation risk propagation in metro networks under fully automatic operations mode.

The frequent interruptions of network operation due to any incident suggest the necessity to study the rules of operational risk propagation in metro networks, especially under fully automatic operations mode. In this study, risk indicator computation models were developed by analyzing risk propagation processes within transfer stations and metro networks. Moreover, indicator variance rules for a transfer station and different structural networks were discussed and verified through simulation. After reviewing the simulation results, it was concluded that under the impacts of both sudden incident and peak passenger flow, the more the passengers coming from platform inlets, the longer the non-incidental line platform total train operation delay and the higher the crowding degree. However, train headway has little influence on non-incidental line platform risk development. With respect to incident risk propagation in a metro network, the propagation speed varies with network structure, wherein an annular-radial network is the fastest, a radial is moderately fast, and a grid-type network is the slowest. The conclusions are supposed to be supports for metro operation safety planning and network design.

Needs-led human resource planning for Sierra Leone in support of oral health.

BACKGROUND: In Sierra Leone (SL), a low-income country in West Africa, dental care is very limited, largely private, and with services focused in the capital Freetown. There is no formal dental education. Ten dentists supported by a similar number of dental care professionals (DCPs) serve a population of over 7.5 million people. The objective of this research was to estimate needs-led requirements for dental care and human resources for oral health to inform capacity building, based on a national survey of oral health in SL. METHODS: A dedicated operational research (OR) decision tool was constructed in Microsoft Excel to support this project. First, total treatment needs were estimated from our national epidemiological survey data for three key ages (6, 12 and 15 years), collected using the 'International Caries Classification and Management System (ICCMS)' tool. Second, oral health needs were extrapolated to whole population levels for each year-group, based on census demographic data. Third, full time equivalent (FTE) workforce capacity needs were estimated for mid-level providers in the form of Dental Therapists (DTs) and non-dental personnel based on current oral disease management approaches and clinical timings for treatment procedures. Fourth, informed by an expert panel, three oral disease management scenarios were explored for the national population: (1) Conventional care (CC): comprising oral health promotion (including prevention), restorations and tooth extraction; (2) Surgical and Preventive care (S5&6P and S6P): comprising oral health promotion (inc. prevention) and tooth extraction (D5 and D6 together, & at D6 level only); and (3) Prevention only (P): consisting of oral health promotion (inc. prevention). Fifth, the findings were extrapolated to the whole population based on demography, assuming similar levels of treatment need. RESULTS: To meet the needs of a single year-group of childrens' needs, an average of 163 DTs (range: 133-188) would be required to deliver Conventional care (CC); 39 DTs (range: 30-45) to deliver basic Surgical and Preventive care (S6P); 54 DTs for more extended Surgical and Preventive care (S5&6P) (range 38-68); and 27 DTs (range: 25-32) to deliver Prevention only (P). When scaled up to the total population, an estimated 6,147 DTs (range: 5,565-6,870) would be required to deliver Conventional care (CC); 1,413 DTs (range: 1255-1438 DTs) to deliver basic Surgical and Preventive care (S6P); 2,000 DTs (range 1590-2236) for more extended Surgical and Preventive care (S5&6P) (range 1590-2236); and 1,028 DTs to deliver Prevention only (P) (range: 1016-1046). Furthermore, if oral health promotion activities, including individualised prevention, could be delivered by non-dental personnel, then the remaining surgical care could be delivered by 385 DTs (range: 251-488) for the S6P scenario which was deemed as the minimum basic baseline service involving extracting all teeth with extensive caries into dentine. More realistically, 972 DTs (range: 586-1179) would be needed for the S5&6P scenario in which all teeth with distinctive and extensive caries into dentine are extracted. CONCLUSION: The study demonstrates the huge dental workforce needs required to deliver even minimal oral health care to the Sierra Leone population. The gap between the current workforce and the oral health needs of the population is stark and requires urgent action. The study also demonstrates the potential for contemporary epidemiological tools to predict dental treatment needs and inform workforce capacity building in a low-income country, exploring a range of solutions involving mid-level providers and non-dental personnel.

Adecuación de los modelos de evaluación en recursos humanos para el desempeño laboral / Evaluation models adequacy in human resources for job performance / Adequação dos modelos de avaliação de recursos humanos para o desempenho no trabalho

Cada vez se presta más atención a la gestión de los recursos humanos para lograr la mejora del desempeño organizacional, evaluar el desempeño laboral es fundamental para que cualquier organización conozca los resultados del trabajo de cada uno de sus empleados. Si bien cada empresa u organización realiza su evaluación de desempeño, muchas lo hacen con herramientas descontextualizadas o con limitaciones de evaluación. En consecuencia este artículo tiene como propósito, crear un instrumento de evaluación de desempeño laboral para cargos comerciales que contemple las dimensiones esenciales del desempeño en las organizaciones, mediante la adecuación del modelo Harvard de las 4C de Beer, utilizando el tipo de investigación exploratoria de enfoque cuantitativo. En la primera fase (Cualitativa) se adecuaron los cuatro tópicos del modelo de evaluación de gestión de recursos humanos a la evaluación individual del desempeño, en el segundo momento (fase cuantitativa) se utilizaron los índices y coeficientes estadísticos más apropiados para validar el instrumento de evaluación propuesto, obteniendo un resultado favorable para la validación del instrumento.

Constantly more attention is paid to the management of human resources in order to achieve the improvement of organizational performance, evaluating job performance is essential for any organization to find out the performance results of every employee. Although each company or organization develops performance's evaluation, many of them does it with decontextualized tools or with evaluation limitations. Consequently, this article has the purpose to create an instrument for evaluation job performance for commercial positions that considers the essential dimensions of performance in organizations, by adapting the Harvard model of the 4C of Beer, using the type of exploratory research of quantitative approach. In the first phase (Qualitative) the four topics of the human resources management evaluation model were adapted to the individual evaluation of performance, in the second stage (quantitative phase) the most appropriate indexes and statistical coefficients were used to validate the instrument of proposed evaluation, getting a favorable result for the validation of the instrument.

Cada vez se presta mais atenção na gestão de recursos humanos para alcançar a melhora do desempenho organizacional, avaliar a performance laboral é fundamental para que qualquer organização conheça o resultado do trabalho de cada um dos seus empregados. Se bem, cada empresa ou organização realiza a sua própria avaliação de desempenho ou performance. Muitas fazem com ferramentas descontextualizadas ou com limitações de avaliação. Em consequência, esse articulo tem como proposito, criar um instrumento de avaliação de performance laboral para cargos comerciais que comtemple as dimensões essenciais do desempenho nas organizações, mediante a adequação do modelo Harvard 4C de Beer, utilizando o tipo de investigação exploratória de enfoque quantitativo. Na primeira fase (qualitativa) se adequarão os quatro tópicos do modelo de avaliação de gestão de recursos humanos até a avaliação individual de desempenho, no segundo momento (fase quantitativa) se utilizarão os índices e coeficientes estatísticos mais apropriados para validar o instrumento de avaliação proposto.

Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India.

OBJECTIVES: Cost-efficient active case finding (ACF) approaches are needed for their large-scale adoption in national tuberculosis (TB) programmes. Our aim was to assess if community health workers' (CHW) knowledge about families' health status can improve the cost efficiency of the ACF programme without adversely affecting the delivery of other health services for which they are responsible. DESIGN: Quasi-experimental design. INTERVENTIONS: We evaluated an ACF programme in the Samastipur district in Bihar, India, between July 2017 and June 2018. CHWs called Accredited Social Health Activists generated referrals of individuals at risk of TB and conducted symptom-based screening to identify patients with presumptive TB. They also helped them undergo testing and provided treatment support for confirmed TB cases. PRIMARY AND SECONDARY OUTCOME MEASURES: We compared the notification rate from the intervention region with that from a control region in the same district with similar characteristics. We analysed operational data to calculate the cost per TB case diagnosed. We used routine programmatic data from the public health system to estimate the impact on other services provided by CHWs. FINDINGS: CHWs identified 9895 patients with presumptive TB. Of these, 5864 patients were tested for TB, and 1236 were confirmed as TB cases. Annual public case notification rate increased sharply in the intervention region from 45.8 to 105.8 per 100 000 population, whereas it decreased from 50.7 to 45.3 in the control region. There was no practically or statistically significant impact on other output indicators of the CHWs, such as institutional deliveries (-0.04%). The overall cost of the intervention was about US$134 per diagnosed case. Main cost drivers were human resources, and commodities (drugs and diagnostics), which contributed 37.4% and 32.5% of the cost, respectively. CONCLUSIONS: ACF programmes that use existing CHWs in the health system are feasible, cost efficient and do not adversely affect other healthcare services delivered by CHWs.

Implementation, Outputs, and Cost of a National Operational Research Training in Rwanda.

Background: Training and mentorship in research skills are essential to developing a critical mass of researchers in low- and middle-income countries (LMICs). However, reporting on the details of such training programs, especially regarding the cost of the training, is limited. Objectives: This paper describes a year-long operational research training and mentorship course in Rwanda, implemented between 2013 and 2017. Approach: We describe motivations for the design of the Intermediate Operational Research Training Course (IORT) across four iterations. We also report outputs, evaluate trainee experiences, and estimate training and mentorship costs. Findings: Of the 132 applicants to the course, 55 (41.7%) were selected, and 53 (96.4%) completed the training. The ratio of female-to-male trainees in the course increased from 1:8 in 2013 to 1:3 in 2017. Trainees developed and co-first-authored 28 research manuscripts, 96.4% (n = 27) of which are published in peer-reviewed journals. For the 15 trainees who completed the post-course evaluation, 93.3% and 86.7% reported improvement in their research and analytical skills, respectively. The median cost per trainee to complete the course was US$908 (Range: US$739-US$1,253) and per research project was US$2,708 (US$1,748-US$6,741). The median annual training delivery and mentorship cost was US$47,170 (US$30,563-US$63,849) for a course with a Rwanda-based senior mentor, junior mentor, and training coordinator. The total essential cost for a year-long IORT course with 16 trainees co-leading eight research projects and mentored by two senior and four junior mentors was US$101,254 (US$73,486-US$157,569). Conclusion: We attribute the high course completion rates, publication rates, and skills acquisition to the learning-by-doing approach and intensive hands-on mentorship provided in the course. IORT was costly and funded through institutional resources and international partnerships. We encourage funders to prioritize comprehensive research capacity-building initiatives that provide intensive mentorship as these are likely to improve the pool of skilled researchers in LMICs.

Incorporating operational research in programmes funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria in four sub-Saharan African countries.

BACKGROUND: The current study builds upon a previous situation analysis of the extent to which grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) are being utilized to support operational research and implementation research (OR/IR) activities in recipient countries. The objective of this follow-up study was to identify approaches and pathways to implement an OR component into grants to the Global Fund, in four sub-Saharan African countries. Special focus was given to the Structured Operational Research and Training IniTiative (SORT IT). METHODS: The conceptual framework was based on an analysis to identify elements supporting and blocking the integration of OR, called force field analysis, and a behavioural change assessment covering aspects such as opportunity, motivation, capability and triggers to do the integration. Data were collected through online surveys and stakeholder interviews both via telephone/online conference tools and in person in four countries with a high burden of malaria and tuberculosis. These countries were Ghana, Sierra Leone, the United Republic of Tanzania and Zimbabwe. The stakeholders included programme managers, implementation partners, representatives from international organisations, academic and governmental research institutions and other individuals involved in the countries' needs assessment and National Strategic Plan development. RESULTS: We identified opportunities to integrate OR into the countries' programmes during the funding process, the country's needs assessment being the most important one, including the need of OR-related capacity. Both the force field analysis and the behavioural change assessment showed that the necessary elements to integrate OR were present in the countries. Motivation, capability and efficiency were found to be a managerial value omnipresent across stakeholders. However, those elements were influenced by the tendency to favour tangible assets over any abstract ones, such as increasing organisational capacity in OR. CONCLUSIONS: In each of the countries assessed, there is potential to integrating OR into the programmes supported by the Global Fund. However, given the relative lack of OR-related capacity and skills encountered, a capacity strengthening tool, such as SORT IT, would be of benefit helping to identify and carry forward OR activities sustainably.

Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review.

INTRODUCTION: Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies. METHODS: We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC). RESULTS: A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC. CONCLUSION: Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.

Nikshay Poshan Yojana (NPY) for tuberculosis patients: Early implementation challenges in Delhi, India.

BACKGROUND: Nutrition support is one of the essential factors for envisioning Tuberculosis (TB) elimination in India by 2025. In this regard, Government of India introduced Nikshay Poshan Yojana (NPY) through Direct Benefit Transfer (DBT) as monthly financial assistance towards nutrition for TB patients in April, 2018. Assessment of early implementation challenges of the scheme is essential. OBJECTIVE: (a) To determine the number (proportion) of TB patients who received the benefits (b) to explore the challenges encountered by the health care providers in delivering the NPY through DBT (c) to explore the ways the incentives were utilised by the patients. MATERIAL AND METHODS: It was a cross-sectional study conducted among patients registered for TB treatment at Ladosarai and Mehrauli DOTS centre between July-September, 2018.Health providers engaged in implementation of NPY at the study sites were also interviewed. The data were collected through structured questionnaires, double entered and analyzed in Epi Data. RESULTS: Out of 119 patients registered, we interviewed 57 (47.9%) patients. Of which, 30 (52.6%) had received NPY for 2 months in the fourth and fifth month of treatment. The health providers reported increased workload, lack of training and complex reporting formats as main hurdles in implementation of the scheme. While, the patients cited non-availability of bank accounts and unlinked bank account with Aadhar card as difficulties to receive NPY through DBT. CONCLUSION: Nearly half of the interviewed TB patients received nutritional incentives of NPY through DBT for 2 months. Non-availability of bank accounts and unlinked bank accounts were some challenges faced by both health providers and patient. It is recommended to address these implementation on time in order to reap the benefit of scheme in improving nutritional status of TB patients. Further studies are needed to determine the effect of nutrition support on TB patients.

Leading a Digital Transformation in the Pharmaceutical Industry: Reimagining the Way We Work in Global Drug Development.

We are experiencing seminal times in computing that seem to define a fourth industrial revolution. This may fundamentally change the way we live, work, and relate to one another. Embracing data and digital information is a top priority for most industries these days, and Life Sciences is no exception. The pharmaceutical industry in particular is fundamentally a data-driven business. Inspired by a desire to "Go Big on Data," we developed a strategic roadmap defining a digital transformation to reimagine the way we work in Novartis Global Drug Development, leveraging data science to generate and inject actionable insights into our best practices. We launched a program called Nerve Live, and built a state-of-the-art data and analytics platform to harness past and present operational data, providing access to decades of drug development "experience" buried across multiple sources. The platform enabled the systematic application of machine learning and predictive analytics to generate "intelligence": new insights across multiple functional areas. To action the insights and create "value," we crafted skillfully designed end-user applications for domain experts to plan, track, predict, compare and monitor domain activities, optimize costs, and maximize quality. Today, the Nerve Live program enables insights-driven decision making at scale, unlocking productivity, and providing transparency across the Novartis Global Drug Development organization and beyond. We identified three main drivers making the Nerve Live program successful and enabling the associated digital transformation to flourish. We discuss the challenges, highlight the benefits, and see the importance of leading the way to become future proof.

A Dynamic Price Game Model in a Low-Carbon, Closed-Loop Supply Chain Considering Return Rates and Fairness Concern Behaviors.

In this paper, we developed a dynamic price game model for a low-carbon, closed-loop supply chain system in which (1) the manufacturer had fairness concern and carbon emission reduction (CER) behaviors, and market share and profit maximization were their objectives, and (2) the retailer showed fairness concern behaviors in market competition and provided service input to reduce return rates. The retailer recycled old products from customers, and the manufacturer remanufactured the recycled old products. The effects of different parameter values on the stability and utility of the dynamic price game model were determined through analysis and numerical simulation. Results found that an increasing customer loyalty to the direct marketing channel decreased the stable region of the manufacturer's price adjustment and increase that of the retailer. The stable region of the system shrank with an increase of CER and the retailer's service level, which expanded with return rates. The dynamic system entered into chaos through flip bifurcation with the increase of price adjustment speed. In the chaotic state, the average utilities of the manufacturer and retailer all declined, while that of the retailer declined even more. Changes to parameter values had a great impact on the utilities of the manufacturer and retailer. By selecting appropriate control parameters, the dynamic system can return to a stable state from chaos again. The research of this paper is of great significance to participants' price decision-making and supply chain operation management.

Comprehensive case management of malaria: Operational research informing policy.

In 2013, the Odisha state Vector Borne Disease Control Programme led a five year operational research project, under programmatic conditions, in close collaboration with several partners. This Comprehensive Case Management Project covered a population of 900,000 across paired control and intervention blocks in four districts, each with different transmission intensities. Key gaps in access to malaria services were identified through household surveys and a detailed situation analysis. The interventions included ensuring adequate stocks of rapid diagnostic tests and antimalarial drugs at the village level, the capacity building of health workers and ASHAs, setting up microscopy centres at the primary health care level, and conducting mass screening and treatment in poorly accessible areas. The programme strengthened the routine health system, and improved malaria surveillance as well as the access to and quality of care. Initially, the programme led to increased case reporting due to improved detection, followed by a decline in malaria incidence. Lessons from the project were then scaled up statewide in the form of a new initiative-Durgama Anchalare Malaria Nirakaran (DAMaN).

Operations research meets need related planning: Approaches for locating general practitioners' practices.

BACKGROUND: In most western countries a shortage of general practitioners (GP) exists. Newly qualified GPs often prefer to work in teams rather than in single-handed practices. Therefore, new practices offering these kinds of working conditions will be attractive in the future. From a health care point of view, the location planning of new practices will be a crucial aspect. In this work we studied solutions for locating GP practices in a defined administrative district under different objectives. METHODS: Using operations research (OR), a research discipline that originated from logistics, different possible locations of GP practices were identified for the considered district. Models were developed under two main basic requirements: that one practice can be reached by as many inhabitants as possible and to cut down the driving time for every district's inhabitant to the next practice location to less than 15 minutes. Input data included the demand (population), driving times and the current GP locations. RESULTS: Three different models were analysed ranging from one single practice solution to five different practices. The whole administrative district can reach the central community "A" in at most 23 minutes by car. Considering a maximum driving time of 15 minutes, locations in four different cities in the district would be sufficient. CONCLUSION: Operations research methods can be used to determine locations for (new) GP practices. Depending on the concrete problem different models and approaches lead to varying solutions. These results must be discussed with GPs, mayors and patients to find robust locations regarding future developments.

A review on ambulance offload delay literature.

Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.

Quality and management of care to tuberculosis/HIv coinfection in the State of São Paulo, Brazil / Calidad y gestión en la atención de la coinfección tuberculosis y VIH en el Estado de São Paulo / Qualidade e gestão da atenção à coinfecção tuberculose e HIV no Estado de São Paulo

ABSTRACT Objective: to analyze the quality and management of care to tuberculosis/HIV coinfection in the state of São Paulo, Brazil. Methods: a descriptive study involving municipalities having at least five cases of tuberculosis/HIV coinfection in the Brazilian state of São Paulo notified in the tuberculosis notification system. To analyze the quality and management of care to tuberculosis/HIV coinfection, indicators were designed, based on tuberculosis evaluability assessment studies, and validated in Brazil. The municipalities were grouped according to their care quality and then submitted to multiple correspondence analysis. Results: the study formed a group with 18 municipalities (42.86%) with satisfactory care and management quality, and another group with 24 municipalities (57.14%) with a quality characterized as unsatisfactory. In the municipalities that showed a satisfactory result, the investigation identified a low proportion of tuberculosis/HIV coinfection, a low AIDS incidence rate, intermediate population size, and high coverage of the Community Health Workers' Program and Family Health Strategy. The municipalities with unsatisfactory quality had a high proportion of tuberculosis/HIV coinfection and a high AIDS incidence rate. Conclusion: the study reveals the defining characteristics of quality and management of care to tuberculosis/HIV coinfection as chronic conditions, bringing relevant elements regarding the mobilization of resources and investments in the municipalities where these are necessary. Additionally, the investigation shows that health results are critical where care quality is unsatisfactory, pointing out the need for reorganizing care and the management of actions involving control of tuberculosis/HIV coinfection in these contexts.

RESUMEN Objetivo: analizar la calidad y gestión en la atención de la coinfección tuberculosis y VIH en el estado de São Paulo. Método: estudio descriptivo, realizado en municipios donde residen al menos cinco casos de coinfección de tuberculosis y VIH en el estado de São Paulo, informados al sistema de notificaciones de tuberculosis. Para analizar la calidad de atención y gestión de la coinfección tuberculosis/VIH fueron elaborados indicadores basados en estudios evaluativos en tuberculosis validados en Brasil. Los municipios fueron agrupados según su calidad de atención, sometiéndoselos luego a análisis de correspondencia múltiple. Resultados: el estudio conformó un grupo con 18 municipios (42,86%) de calidad de atención y gestión satisfactorias, y otro con 24 (57,14%) municipios caracterizados como no satisfactorios. En los municipios con resultados satisfactorios se identificó baja proporción de coinfección tuberculosis y VIH, baja tasa de incidencia de SIDA, cantidad poblacional mediana, elevada cobertura de Agentes Comunitarios de Salud y Estrategia Salud de la Familia. En los municipios no satisfactorios se observó alta proporción de coinfección tuberculosis e VIH y tasa de incidencia de SIDA. Conclusión: el estudio evidencia las características que definen la calidad de atención y gestión de la coinfección tuberculosis y VIH como condiciones crónicas, destacando elementos relevantes respecto de movilización de recursos e inversión en los municipios donde eso resulta necesario. Además, muestra que los resultados sanitarios son críticos donde no hay calidad de atención satisfactoria, expresando necesidad de reorganización de la atención y gestión de las acciones que involucran al control de la coinfección tuberculosis y VIH en tales contextos.

RESUMO Objetivo: analisar a qualidade e gestão da atenção à coinfecção tuberculose e HIV no estado de São Paulo. Método: estudo descritivo, realizado com municípios de residência de pelo menos cinco casos de coinfecção tuberculose e HIV no estado de São Paulo, notificados no sistema de notificações de tuberculose. Para análise da qualidade da atenção e gerenciamento da coinfecção tuberculose e HIV foram construídos indicadores, com base em estudos de avaliabilidade em tuberculose, validados no Brasil. Os municípios foram agrupados conforme sua qualidade da atenção e depois foram submetidos à análise de correspondência múltipla. Resultados: no estudo, formou-se um grupo com 18 municípios (42,86%) com satisfatória qualidade da atenção e gerenciamento, e outro grupo com 24 (57,14%) municípios caracterizados como não satisfatório. Nos municípios com resultado satisfatório, identificou-se baixa proporção de coinfecção tuberculose e HIV, baixa taxa de incidência de aids, porte populacional médio, elevada cobertura de Programas de Agentes Comunitários de Saúde e Estratégia Saúde da Família. Para os demais municípios com qualidade não satisfatória, observou-se alta proporção de coinfecção tuberculose /HIV e taxa de incidência de aids. Conclusão: o estudo evidencia as características definidoras da qualidade da atenção e gerenciamento da coinfecção tuberculose e HIV enquanto condições crônicas, trazendo elementos relevantes no que tange à mobilização de recursos e investimentos nos municípios onde isso se faz necessário. Além disso, mostra que os resultados sanitários são críticos onde não há satisfatória qualidade da atenção, mostrando a necessidade de reorganização da assistência e do gerenciamento das ações que envolvem o controle da coinfecção tuberculose e HIV nesses contextos.