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URC/CHS News Archives | Contact us | Home URC-CHS Health & Population Focus AreasHIV/AIDS Building Sustainable Systems to Deliver Quality ServicesAcross the world, countries and cooperating agencies are struggling to most effectively use the resources now available for the fight against HIV/AIDS, to create sustainable systems to deliver quality HIV/AIDS prevention, care, and support services, today and in the future. Through its projects funded by the U.S. Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC), URC is supporting over a dozen countries to strengthen HIV/AIDS service delivery and build systems to sustain quality HIV/AIDS care. URC's technical support for quality improvement in HIV/AIDS continues under the USAID Health Care Improvement (HCI) Project, the follow-on to the Quality Assurance Project (QAP). URC is helping local partners apply innovative approaches to improve health worker HIV/AIDS knowledge and performance and introduce and scale up best practices in the delivery of key HIV/AIDS services, including counseling and testing (C&T), prevention of mother-to-child transmission of HIV (PMTCT), home-based care, and antiretroviral therapy (ART) for both adults and children. URC is also working to strengthen integration of HIV and tuberculosis (TB) services and case management practices. Country Highlights of HIV/AIDS Activities Supported by URC-CHS
BeninURC Project: Integrated Family Health Project/Projet Intégré de Santé Familiale (USAID) In the Zou/Collines Region of central Benin, URC is working with traditional group insurance providers (Mutuelles de Santé) to expand the availability of HIV/AIDS services and products, including at the community level. The project team works with local health authorities to integrate new technical areas into the family health minimum package, including the provision of counseling and testing for HIV/AIDS, services to prevent mother-to-child transmission of HIV/AIDS, and antiretroviral therapy. URC is also leveraging Mutuelles as vehicles for HIV education and promotion. BotswanaURC Project: Building Human-Resource Capacity to Support Prevention, Care and Treatment, Strategic Information and Other HIV/AIDS Programs in the Republic of Botswana (CDC) URC is working in partnership with the Ministry of Health (MOH) Department of HIV/AIDS Prevention and Care and CDC to strengthen HIV/AIDS prevention and care services in the Republic of Botswana. The project is assisting the MOH to develop and implement strategies to strengthen delivery of routine HIV testing services. URC Project: USAID Health Care Improvement Project In collaboration with the National Program of HIV Care (PNPEC) and other implementing partners, URC is supporting an HIV care and treatment improvement collaborative involving 41 sites in 13 of the country’s 19 regions, addressing both antiretroviral treatment and PMTCT. To date the collaborative has focused on improving documentation of care in medical records, integration of services, patient retention in care, biosafety, and reducing stigma and discrimination. URC is also supporting the National OVC Program and Ministry of Women and Social Affairs to develop outcome-based standards for programs for orphans and vulnerable children which will be pilot tested in four sites in 2010. A similar activity was begun with the national Ministry to Fight AIDS to develop quality standards and monitoring indicators for the work of peer educators, who form a central part of Cote d’Ivoire’s HIV prevention strategy. URC Project: Strengthening Community Safety Nets: Scaling Up Care and Support for Ethiopian Orphans and Vulnerable Children Affected by AIDS (USAID) In partnership with prime contractor, The Christian Children’s Fund, Inc. (CCF), URC is working to promote healthy child development for 50,000 orphans and vulnerable children (OVC) and 8,500 primary and secondary caregivers in Addis Ababa and Oromia through comprehensive, family centered care and support. URC is collaborating with Vulnerable Child Committees to establish Quality Improvement Collaboratives that expand access to health and supportive services for HIV-affected children and their families through enhanced referral systems that leverage existing resources. In addition, CCF and URC are developing community data collection systems to monitor service implementation and support quality improvement in line with Ethiopia’s national OVC service standards. URC Project: USAID Health Care Improvement Project Antiretroviral Therapy Improvement Framework HCI has developed an ART Improvement Framework to help health care teams improve the quality care for HIV patients on antiretroviral therapy. The framework defines three key gaps in quality ART care that separate current levels of care from quality services: the coverage gap, the retention gap, and the clinical outcome gap. Each gap can be expressed as one indicator which health care teams can monitor on a monthly basis and use to prioritize areas for improvement and measure the impact of changes they implement. The model is being tested in Nicaragua, Tanzania and Uganda to develop locally appropriate program strategies that deliver ART to those who need it, retain patients in care, and improve overall health outcomes. An instructional guide is also being developed so that providers interested in setting up a data system and initiating quality improvement activities around the ART Framework would be able to do so with minimal external assistance (to be made available on the HCI website). As additional HIV programs adopt the ART framework, HCI will launch a virtual community of practice for providers as a forum to ask questions, discuss common barriers and share success stories. Organizational changes tested by providers, including common successes and failures, will be compiled into a change package also to be made available on the HCI website. Improving Quality of Services for Orphans and Vulnerable Children Affected by AIDS URC is helping the Office of HIV/AIDS of USAID promote quality services for children affected by HIV/AIDS through the regional Care That Counts Initiative that supports countries in applying the science of improvement to OVC services. Through the USAID Health Care Improvement Project, URC supports regional exchanges and dissemination of best practices to build capacity and foster networking among PEPFAR countries related to standards-based quality improvement of OVC programs. URC provides both virtual and on-site technical assistance to develop and roll out OVC service standards, recently assisting Nigeria, Swaziland, and Malawi. URC and its partner EnCompass are currently developing an e-Learning course on QI for OVC programs. Strengthening Laboratory Capacity for ART Programs URC implements laboratory improvement programs in three African countries. Through our CDC-funded PEPFAR in Nigeria, URC is renovating HIV laboratories, providing equipment and training for all HIV testing techniques as well as putting in processes and procedures for laboratory safety and QA/QC schemes. Through HCI, URC is collaborating with USAID and the Uganda Ministry of Health (MOH) Quality of Care Initiative (QoC) and with the Tanzania MOH to improve the quality of HIV/AIDS services offered by laboratories. HCI and QAP carried out detailed laboratory quality assessments in both countries that identified areas for improvement and introduced lab-related quality improvement activities, including ongoing monitoring of lab-specific quality indicators. HCI Uganda is currently implementing a laboratory-specific improvement collaborative focused on increasing numbers of clients receiving needed HIV tests by improving: procedures for all HIV-related testing and monitoring, coordination and communication between labs, clinic units and patients, equipment maintenance and referral processes. A similar laboratory improvement collaborative is being planned in Tanzania through HCI and is scheduled to begin in the spring of 2010. URC Project: USAID Health Care Improvement Project URC is providing technical assistance to improve the quality of services offered to the URC Project: USAID Health Care Improvement Project URC is assisting the Ministry of Health to organize high quality services for the URC Project: HIV and AIDS Comprehensive Care Program (CDC) URC is working to strengthen and expand HIV/AIDS services in the URC Project: HealthPro Project (USAID) While the prevalence of HIV infection in the Philippines remains low (below 1%), incidence among certain high risk groups is increasing, pointing to the need for information, education, and communication in HIV/AIDS prevention. Under the HealthPro Project, URC is working to increase the impact of behavioral change communication interventions and develop local institutional capacity to carry out health promotion efforts in HIV/AIDS and a range of infectious diseases. The team seeks to increase the impact of behavioral change communication interventions, develop institutional capacity to carry out health promotion efforts, and assist USAID’s partners and other organizations to strengthen their health communications programs. URC Project: USAID Health Care Improvement Project URC continues to provide technical assistance to local government authorities,
URC Projects: USAID Health Care Improvement Project ▪ TASC2 Tuberculosis (USAID) ▪ Increasing Access to HIV Confidential Voluntary Counseling and Testing and Enhancing HIV/AIDS Communications, Prevention and Care (CDC) URC is working with the National Department of Health and Provincial Departments of Health and facilities to operationalize national protocols and increase the uptake of services for C&T, PMTCT, HIV-TB integration, antiretroviral treatment, and basic care and support for persons living with HIV/AIDS. URC is helping local service delivery programs to integrate HIV counseling and testing with various high-priority clinical services, such as antenatal care, family planning, and treatment of sexually transmitted infections. Local URC staff work side-by-side facility staff to provide training and mentoring in quality improvement methods and to support 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. URC also works with community-based organizations to provide home-based palliative care and adherence support. URC’s technical assistance has enabled local health departments and facilities to adapt quality improvement methods to facilitate compliance with guidelines and integrate various services. URC also facilitated the introduction of new monitoring strategies whereby each patient encounter is monitored to determine whether care is provided according to guidelines and whether each patient adheres to the treatment regimen. Increased compliance, in turn, stimulates better service utilization. A most visible impact of URC’s intensive support to facility staff over the past three years has been an increase in the referral of patients for ART at the facility level by developing linkages and improving cross-referrals between different clinical services. URC-supported facilities have also increased the referral of patients on ART to home-based care facilities and coordination with community-based and faith-based organizations. URC Projects: USAID Health Care Improvement Project ▪ Increasing Access to HIV Confidential Voluntary Counseling and Testing and Enhancing HIV/AIDS Communications, Prevention and Care (CDC) URC is providing support to the Ministry of Health and Social Welfare to increase utilization of provider-initiated counseling and testing as part of Tuberculosis care and other basic health services. Support is also being provided to develop behavior change communication and social marketing interventions to create greater consumer demand for HIV testing. URC is working with the National TB Program (NTP) and the Swaziland National AIDS Programme 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 in Swaziland. URC assisted the NTP to update TB treatment guidelines and is also supporting clinical training in the management of TB-HIV co-infection. URC Project: USAID Health Care Improvement Project URC is working with the National AIDS Control Program (NACP) of the Tanzanian Ministry of Health and Social Welfare (MOHSW) and the PharmAccess Foundation to support implementing partners in carrying out regional ART/PMTCT improvement collaboratives in the Tanga, Morogoro, Mtwara, and Lindi regions. Planning has begun for scale up of regional ART/PMTCT improvement collaboratives to six new regions in 2010. At the national level, URC is supporting the development of policies and tools for institutionalizing HIV service quality improvement (QI), including a QI curriculum that will be used by Regional Health Management Teams (RHMT) to train district QI teams. URC is also supporting national infant feeding counseling activities in collaboration with the A new activity has recently started under the USAID Health Care Improvement Project to provide assistance to OVC implementers in Tanzania to pilot test and validate standards for OVC services using the collaborative approach. URC Projects: NuLife-Food and Nutrition Interventions for Uganda(USAID) ▪USAID Health Care Improvement Project NuLife-Food and Nutrition Interventions for Uganda supports the development and integration of a full range of food and nutrition interventions into HIV/AIDS prevention, care and treatment programs in Uganda. In addition to improving the nutritional and health status of people living with and affected by HIV/AIDS (PLHA), NuLife aims to increase the utilization, adherence to and efficacy of anti-retroviral treatment (ART) through nutritional assessment, counseling and provision of therapeutic foods. NuLife’s programs reach PLHAs, including adults and children; HIV positive pregnant and lactating women and their infants; and orphans and vulnerable children through a comprehensive food by prescription (FBP) approach, infant and young child feeding (IYCF) training and intervention, and a community intervention strategy linking the facility-based integration of nutrition services with community HIV/AIDS programs. In addition to URC, the NuLife consortium includes Save the Children and ACDI/VOCA. Through the USAID Health Care Improvement Project, URC is providing technical support These sites are participating in six improvement collaboratives, each of which addresses a specific
area of care: 1) coverage of eligible patients with ART, 2) patient retention in care, CHS Project: Migratory Agricultural Workers and Seasonal Farmworkers with Disabilities Service Project (United States Department of Education, Rehabilitation Services Administration) ▪ AIDS Partnership (New Jersey AIDS Partnership and the Hyacinth AIDS Foundation) ▪ Latinas Involved in Full Treatment (LIFT) (Health Resources and Services Administration) Under the AIDS Partnership, a new project, CHS is supporting HIV counseling and testing among minority populations in southern New Jersey. Through a new HRSA-funded project entitled Latinas Involved in Full Treatment, CHS is assisting HIV/AIDS positive women of color (in Cumberland County) in gaining access to quality health care. LIFT targets HIV/AIDS positive Latinas and female migrant and seasonal farmworkers. In addition, CHS offers HIV prevention classes to Migrant Farmworkers in Cumberland County, New Jersey, and manages a Hispanic Migrant Farmworker Task Force that mobilizes farmworkers who are disabled or who test positive for HIV and their family members, as well as representatives from organizations that serve farmworkers, to serve as HIV counselors. URC Project: USAID Health Care Improvement Project HCI concluded activities on the TB/HIV Collaborative implemented in partnership with the National Tuberculosis Program (NTP), the Vietnam Administration of HIV/AIDS Control (VACC), and other stakeholders in Thai Binh Province. In 2010 HCI will spread the collaborative to Hai Duong and Nam Dinh provinces. The project will focus on increasing uptake of HIV counseling and testing among TB patients as well as TB screening among PLWHA; improving infection control at provincial TB hospitals and AIDS control centers; establishing public-private partnership for increasing referral of suspects; and implementing data management and analysis. To assist countries in overcoming the programmatic challenges to implementing Recent studies
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