 |
|
|
URC 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 USAID-funded Quality Assurance Project (QAP) and other USAID and Centers for Disease Control-funded projects, URC has been dedicated to supporting countries in this effort. URC's technical support for quality improvement in HIV/AIDS and a wide range of healthcare services continues under the new USAID Health Care Improvement (HCI) Project, the follow-on to 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 improve HIV and tuberculosis (TB) cross-referrals 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. CambodiaURC Project: Health Systems Strengthening Project (USAID) URC is working to build the Cambodian Ministry of Health's capacity to plan, manage and implement HIV/AIDS and family health programs in seven of the country's provinces. The project is integrating blood and injection safety methods into routine care and is expanding confidential counseling and testing for HIV as part of antenatal, TB, and other clinical services, as well as improving provider skills in behavior change communication. URC has helped to refurbish and train staff at 30 counseling & testing centers, 8 PMTCT sites, and 2 sites that provide ART and treatment of opportunistic infections. The team also facilitates regular meetings throughout the country of people living with HIV/AIDS, to increase their access to health services and strengthen their support networks. HSSC is collaborating with the National Center for HIV/AIDS, Dermatology and STD (NCHADS) to contribute and identify opportunities for systems improvement in logistics, strategic information, and capacity development. The project provided NCHADS with technical assistance to review and revise the national policy for HIV counseling and testing as well as to develop the 2008-2010 national strategy plan for HIV/AIDS care and treatment. Assistance was provided to the National Maternal and Child Health Center to conduct a National PMTCT Joint Program Review as well as develop the National PMTCT Strategic Plan for 2008-2010. GlobalURC Projects: Quality Assurance Project/USAID Health Care Improvement Project (QAP/HCI) (USAID) Improving Quality of Services for Children Affected by AIDS Through QAP/HCI, URC is collaborating with OGAC, USAID, PACT, the AIDS Alliance, and Family Health International to develop a standards development approach that focuses on the quality of services provided to orphans and vulnerable children (OVC) affected by HIV/AIDS. In collaboration with PACT, QAP developed and tested the “Facilitator’s Guide to Establishing Service Standards for Quality Programs for Orphans and Vulnerable Children.” The approach laid out in the Guide has now been used in Ethiopia, Zimbabwe and Namibia, and QAP supported its updating based on these experiences. To foster a community of practice around quality improvement and air various OVC quality issues, URC is now leading regular Quality in Focus conference calls with participants from the USA and PEPFAR countries to support country teams in incorporating quality standards and improvement activities in their OVC programs. Strengthening Laboratory Capacity for ART Programs URC Projects: QAP/HCI (USAID) Through QAP/HCI, URC is collaborating with USAID and the Uganda Ministry of Health Quality of Care Initiative (QoC) to improve the quality of services offered by Uganda laboratories in HIV/AIDS and TB testing and monitoring. In collaboration with QoC, QAP developed and implemented a detailed laboratory quality assessment of QAP-supported laboratories and identified areas for improvement. QAP/HCI is discussing the results of this assessment and needed interventions with the Uganda MOH and is planning a laboratory-specific workshop in January 2008 for representatives of QAP/HCI-supported laboratories to provide training in quality improvement techniques and other areas of laboratory service, discuss interventions for improvement and establish indicators of laboratory quality to be monitored by laboratories and, subsequently, by the QAP/HCI Uganda laboratory team. GuatemalaURC Project: Calidad en Salud II (USAID) In Guatemala URC supports the Guatemalan Ministry of Health to strengthen and implement VCT with STI care targeting high-risk groups for improved quality of care. Central to this strategy is the integration of STI/HIV with reproductive health services to improve access to STI/HIV services and treatment for high-risk populations. At the same time, the project is working to mitigate stigma and discrimination in 34 health centers through participatory trainings and strong promotion efforts, having just completed a baseline study to guide its strategy. A demonstrative STI/VCT collaborative was also initiated in 2007 and will be expanded to all 34 health centers during 2008. Finally, in coordination with key national programs and the U.S. Centers for Disease Control and Prevention, the project is working towards enhanced national capacity STI/HIV rapid testing and diagnosis of chlamydia and gonorrhea to improve monitoring and evaluation in Guatemala. The STI and HIV sentinel surveillance system (VICITS) established in June 2007, in Zone 3 of Guatemala city, will be integral to this effort, with plans to expand this surveillance system to three other health centers throughout the country in 2008 for improved monitoring and prevention efforts. JamaicaURC Project: JA-STYLE— Jamaica’s Solution to Youth Lifestyle and Empowerment (USAID) URC is working in partnership with the Ministry of Health, the Ministry of Education, and other stakeholders to strengthen the capacity of the MOH to reduce high-risk sexual behavior among the adolescent population and the capactiy of NGOs in HIV-related community mobilization. In addition, the project team seeks to increase and improve youth-related educational messages and to support the implementation of policies related to reproductive health and HIV/AIDS within the ambit of healthy lifestyles. LesothoURC Projects: QAP/HCI (USAID)▪ 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 (MOHSW) in Lesotho to strengthen TB, TB/HIV and HIV testing and counseling programs in the country. Support is being provided to help the MOHSW to expand uptake of provider-initiated HIV testing and counseling in various clinical and community settings. In addition, URC is also strengthening labs as well as infection control in the TB settings. Prevention and control of MDR/XDR as well as TB treatment for children are other focuses of the program. URC is also supporting clinical training in TB-HIV and strengthening support systems in the National Tuberculosis Program and other service delivery partners. NamibiaURC Project: Improving Medical Injection Safety in Namibia (USAID) Under PEPFAR, URC assists the Namibian Ministry of Health and Social Services to implement the Medical Injection Safety Program, which has made significant gains in improving safe medical injection and waste management practices to reduce transmission of blood-borne pathogens, including HIV. URC is helping the Ministry to improve the rational use of medical injections by substituting oral drugs where feasible; improve occupational safety through the introduction of safe sharps disposal practices; promote better injection administration practices to reduce needle stick injuries; and increase the availability of post-exposure prophylaxis. To date, the program has trained over 3000 healthcare workers in safe injection and waste disposal practices and has scaled up to cover all 13 regions of the country. Since the beginning of the project, compliance with injection safety standards, including using protective barriers to open glass vials, removing needles from vials, reconstituting injections according to standard, and preparing injections in a clean, designated area, have increased from between 47% and 88% to between 88% and 95%, while sharps injuries per healthcare provider have decreased from 0.046 to 0.0075. The average number of injections prescribed per patient has dropped from 11.2 to 2.05. NicaraguaURC Project: QAP/HCI (USAID) URC is assisting the Ministry of Health to design quality services to identify, treat, and follow up with people infected with HIV and to develop a network of laboratory services to support HIV testing. The project team is working with local health authorities in 8 of the country’s 17 health regions to integrate voluntary counseling and testing for HIV into existing family planning services, strengthen capacity of personnel to process HIV lab tests, and introduce counseling and testing of pregnant women to prevent vertical transmission of HIV. URC has also facilitated discussions among hospital personnel to reduce stigma and discrimination towards persons infected with HIV and to create multi-disciplinary teams to support HIV counseling and testing. PhilippinesURC 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, the URC team 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. RussiaURC Projects: QAP/HCI ▪ PreventAIDS (USAID) URC is collaborating with national, regional, and local health authorities and partners to scale up to a comprehensive system of HIV/AIDS treatment, care, and support throughout St. Petersburg city and Leningrad and Orenburg oblasts to provide greater coverage for HIV-positive patients, including medical follow up and testing for TB. URC has implemented a range of models and services that are being scaled up, including a model for patient referrals from polyclinics to AIDS Centers, TB dispensaries, narcological dispensaries, social support service institutions, and NGOs. The URC team is also working to facilitate greater involvement of clients into HIV testing through further development and integration of CT services into the scope of health care providers’ roles in participating project institutions. URC is working with the Federal Center of TB Care in People Infected with HIV to implement intermittent preventive therapy and institutionalization of algorithms developed by improvement teams at project sites for TB screening in HIV-positive clients. Further, to improve monitoring of HIV/AIDS care, URC is facilitating the adaptation of CareWare (a software package designed by the U.S. Department of Health and Human Services/Health Resources and Services Administration for monitoring and management of HIV/AIDS services by the AIDS Centers in St. Petersburg and Orenburg). In St. Petersburg city, the collaborative team is working to increase enrollment of patients on ART and adherence to treatment, as well as to improve treatment and rehabilitation for drug users through integration of HIV and narcological services. The team provides training for care providers from polyclinics and narcological service institutions and develops informational materials on drug rehabilitation services and client referral forms for non-narcological service care providers. URC also continues to work to improve coordination of services among health and social services providers for better continuity of care for HIV-positive mothers in St. Petersburg. The work addresses adaptation and implementation of best practices of client needs assessments and social follow up developed by NGOs in municipal social service organizations, implementation of case management techniques for social follow-up of HIV-infected women, improvement of social service providers’ knowledge on HIV related issues to alleviate HIV-related stigma, and inter-institutional cooperation between health and social services providers. URC is cooperating with activities supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria to facilitate patients’ enrollment on ART as well as to reach better ART results in the supported regions. Teams in St. Petersburg, Saratov, Balakovo, and Togliatti are working to improve referrals of HIV-infected women to family planning services and increase the quality of family planning counseling. Under the PreventAIDS program, URC works with Population Services International and local government agencies and NGOs to improve access to HIV/AIDS services needed by most-at-risk populations and special risk groups. Under this project, URC has worked to develop referral systems between medical and social service providers and NGOs, improve the quality of counseling services, remove obstacles to accessing services, and improve the outreach of medical and social service providers. Cooperating facilities have seen significant increases in the number of patients from high risk groups who voluntarily are tested for HIV. South AfricaURC Projects: QAP/HCI ▪ TASC2 Global Health-Integrated ▪ 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 in five provinces to operationalize national protocols on C&T, PMTCT, HIV-TB integration, and antiretroviral treatment and counseling. Our technical assistance aims to increase the uptake of services related to VCT, PMTCT, HIV-TB integration, antiretroviral therapy, and palliative care and support activities 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. Read about results in South Africa health facilities. SwazilandURC Projects: QAP/HCI (USAID) ▪ 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 antenatal 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) 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. TanzaniaURC Projects: QAP/HCI (USAID) URC is supporting the Ministry of Health (MOH) to improve the quality of pediatric AIDS care and services through a pediatric hospital improvement collaborative that involves 19 hospitals in 7 of the country’s 25 mainland regions. Through learning sessions, training, and coaching, hospitals participating in the collaborative have introduced emergency treatment assessment and triage systems and a process for screening hospitalized children for HIV infection and channeling infected children to HIV care and treatment. A new activity within the collaborative this year was a focused effort to strengthen linkages between health care facilities and various points of service, including community-based organizations, traditional birth attendants, and community health care workers who provide HIV/AIDS-related services for children. In FY08, Kibaha/Tumbi will serve as a pilot area for the development of a community linkage network. URC has also provided technical leadership for the revision of HIV infant feeding job aids for PMTCT counselors and mothers that QAP and partners originally developed based on generic counseling materials developed by WHO and UNICEF. After the National AIDS Control Program (NACP) officially adopted the materials for nationwide implementation in December 2006, more than a million copies were printed for national distribution. (See HIV & infant feeding job aids.) In partnership with the Tanzania Commission for AIDS (TACAIDS), QAP supported the production of A Collection of HIV and AIDS Tools and Resources for Programme Managers in Tanzania – 2006, a CD-ROM collection of over 390 HIV and AIDS tools and resources for program managers in Tanzania. UgandaURC Projects: QAP/HCI (USAID) In Uganda, QAP/HCI is providing technical support for the Ministry of Health’s Quality of Care (QoC) Initiative, which is developing a sustainable quality improvement system for HIV/AIDS service delivery at national scale. As part of the QoC Initiative, URC is supporting a national Improvement Collaborative that is introducing more effective procedures for ensuring high quality antiretroviral therapy for patients with HIV/AIDS. A year after the ART Improvement Collaborative was introduced in 57 facilities, 32 new sites joined, bringing the total number of sites to 89, and an additional 30 sites will be added in the coming year. New improvement objectives and corresponding indicators were added to the Collaborative’s technical scope this year related to integration of family planning with HIV/AIDS services, diagnosis and treatment of HIV-positive children, and TB detection among HIV-positive clients. As a result of the ART Improvement Collaborative, the proportion of HIV patients who are assessed for ART eligibility at every visit has increased from 89.2% in December 2005 to 95.7% in June 2007 for the initial sites, and from 30.5% at start-up to 98.8% in June 2007 in the new sites. A high co-infection rate renders HIV-TB integration a priority area for all Collaborative teams. The proportion of HIV patients who were assessed for active TB at every clinic visit increased from 68.7% in December 2006 to 96.5% in June 2007 among original sites and from 57.2% in December 2006 to 93.6% in June 2007 for the new sites. A new focus has been placed on laboratory management to support ART monitoring, with the hiring of a laboratory focal person within QAP/HCI Uganda who has begun quality improvement activities in 22 laboratory facilities. URC has also collaborated with the National PMTCT program and other national stakeholders to adapt the HIV and infant feeding job aids developed by URC in Tanzania for use in Uganda. The materials are being used to train local health workers in new national guidelines on infant feeding counseling. United StatesCHS Projects: Migratory Agricultural Workers and Seasonal Farmworkers with Disabilities Service Project (United States Department of Education, Rehabilitation Services Administration) URC’s Center for Human Services (CHS) offers HIV prevention classes to Migrant Farmworkers in Cumberland County, New Jersey. Also in New Jersey, CHS manages a Hispanic Migrant Farmworker Task Force on which farmworkers who are disabled or who test positive for HIV and their family members, as well as representatives from organizations that serve farmworkers, serve as volunteers. The task force plans and develops HIV/AIDS prevention programs and conducts service delivery evaluations. VietnamURC Project: QAP/HCI URC is working closely with the National Tuberculosis Program (NTP), the Vietnam Administration of HIV/AIDS Control (VACC), and other stakeholders to implement a collaborative improvement model to increase TB-HIV cross-referrals in Thai Binh Province. The collaborative activities will aim to increase uptake of HIV counseling and testing among TB patients as well as TB screening among HIV patients. In addition, the program will develop linkages to refer co-infected patients for ARV treatment. Other elements of the program include strengthening of health worker skills, improved linkages with laboratories, and better functioning recording and reporting systems for TB-HIV co-infected patients. Operations ResearchTo assist countries in overcoming the programmatic challenges to implementing effective HIV/AIDS care, URC supports operations research to inform HIV/AIDS policy and program improvement. Recent studies
|
||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||
