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Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries

INTRODUCTION:Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of comm... Full description

Journal Title: AIDS (London) 2015-07, Vol.29 Suppl 2, p.S155-S164
Main Author: Horwood, Christiane M
Other Authors: Youngleson, Michele S , Moses, Edward , Stern, Amy F , Barker, Pierre M
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: Copyright Wolters Kluwer Health, Inc
ID: ISSN: 0269-9370
Link: https://www.ncbi.nlm.nih.gov/pubmed/26102626
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title: Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries
format: Article
creator:
  • Horwood, Christiane M
  • Youngleson, Michele S
  • Moses, Edward
  • Stern, Amy F
  • Barker, Pierre M
subjects:
  • Africa South of the Sahara - epidemiology
  • AIDS/HIV
  • Anti-HIV Agents - therapeutic use
  • Community Health Services - organization & administration
  • Community Health Services - standards
  • Community Health Workers - organization & administration
  • Community Health Workers - standards
  • Cooperative Behavior
  • Data Collection - methods
  • Health Knowledge, Attitudes, Practice
  • Health Services Research
  • HIV Infections - drug therapy
  • HIV Infections - prevention & control
  • HIV Infections - transmission
  • Humans
  • Infectious Disease Transmission, Vertical - prevention & control
  • Lentivirus
  • Patient Acceptance of Health Care
  • Patient Education as Topic
  • Program Development - methods
  • Program Evaluation
  • Quality Improvement - organization & administration
  • Quality Improvement - standards
  • Retroviridae
ispartof: AIDS (London), 2015-07, Vol.29 Suppl 2, p.S155-S164
description: INTRODUCTION:Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. METHODS:Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. RESULTS:CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. CONCLUSION:Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care
language: eng
source:
identifier: ISSN: 0269-9370
fulltext: no_fulltext
issn:
  • 0269-9370
  • 1473-5571
url: Link


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titleUsing adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries
creatorHorwood, Christiane M ; Youngleson, Michele S ; Moses, Edward ; Stern, Amy F ; Barker, Pierre M
creatorcontribHorwood, Christiane M ; Youngleson, Michele S ; Moses, Edward ; Stern, Amy F ; Barker, Pierre M
descriptionINTRODUCTION:Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. METHODS:Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. RESULTS:CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. CONCLUSION:Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care
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subjectAfrica South of the Sahara - epidemiology ; AIDS/HIV ; Anti-HIV Agents - therapeutic use ; Community Health Services - organization & administration ; Community Health Services - standards ; Community Health Workers - organization & administration ; Community Health Workers - standards ; Cooperative Behavior ; Data Collection - methods ; Health Knowledge, Attitudes, Practice ; Health Services Research ; HIV Infections - drug therapy ; HIV Infections - prevention & control ; HIV Infections - transmission ; Humans ; Infectious Disease Transmission, Vertical - prevention & control ; Lentivirus ; Patient Acceptance of Health Care ; Patient Education as Topic ; Program Development - methods ; Program Evaluation ; Quality Improvement - organization & administration ; Quality Improvement - standards ; Retroviridae
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descriptionINTRODUCTION:Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. METHODS:Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. RESULTS:CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. CONCLUSION:Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care
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1AIDS/HIV
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3Community Health Services - organization & administration
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8Data Collection - methods
9Health Knowledge, Attitudes, Practice
10Health Services Research
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12HIV Infections - prevention & control
13HIV Infections - transmission
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15Infectious Disease Transmission, Vertical - prevention & control
16Lentivirus
17Patient Acceptance of Health Care
18Patient Education as Topic
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atitleUsing adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries
jtitleAIDS (London)
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date2015-07
risdate2015
volume29 Suppl 2
spageS155
epageS164
pagesS155-S164
issn0269-9370
eissn1473-5571
abstractINTRODUCTION:Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. METHODS:Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. RESULTS:CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. CONCLUSION:Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care
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pmid26102626
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