Feasibility of implementing an integrated tool for improvement of treatment quality and early-warning indicators for HIV drug resistance: a pilot study of centres in India.
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Date
2015-07
Journal Title
Journal ISSN
Volume Title
Publisher
WHO Regional Office for South-East Asia
Abstract
With the rapid scale-up in use of antiretroviral therapy (ART), monitoring the
quality of care and factors that may lead to emergence of HIV drug resistance
(HIVDR) is an important focus point for programme managers. The National AIDS
Control Organisation of India embarked on strengthening the ART programme for
continuous quality improvement (CQI), using defined quality-of-care indicators
(QCIs), including World Health Organization (WHO) early-warning indicators
(EWIs) for HIVDR. In this feasibility study, done during July 2014, an integrated
QCI and EWI tool developed by WHO India was pilot tested across 18 purposively
selected ART centres. At seven ART centres, the EWI 1 target of >90% on-time
pill pick-up was achieved for adult patients, while among the paediatric age group
(<15 years old) it was not achieved by any centre. EWI 2 (retention of patients
in ART care at 12 months after initiation) showed that two centres had retention
of both adult and paediatric patients of >85% at 12 months of ART, while 11
centres had retention between 75% and 85%. EWI 3 (pharmacy stock-out) for
adult and paediatric patients showed that 11 ART centres reported a minimum
of one stock-out for the first-line ART drugs in the reporting period, while EWI 4
targets (pharmacy dispensing practices) were achieved by all the centres, for both
adults and children. Average retention in care at 6, 12 and 24 months after ART
initiation was 82%, 77% and 71%, respectively. This feasibility study showed that
EWI analyses were much simpler to conduct if information was sought only for
patients receiving ART, for whom the quality of record-keeping is better and more
consistent. The activity has highlighted the need for improved quality of recordkeeping
at the facilities and implementation of specific interventions to ensure
better patient follow-up. After modifications, use of the tool will be phased in across
all the ART centres in India.
Description
Keywords
antiretroviral therapy (ART), early-warning indicators, HIV drug resistance (HIVDR), India
Citation
WHO South-East Asia Journal of Public Health 2015;4(2): 184-188.