TITLE

The variability and predictors of quality of AIDS care services in Brazil

AUTHOR(S)
Battistella Nemes, Maria Ines; Melchior, Regina; Basso, Cáritas Relva; Lodeiro Castanheira, Elen Rose; de Britto Alves, Maria Teresa Seabra Soares; Conway, Shaun
PUB. DATE
January 2009
SOURCE
BMC Health Services Research;2009, Vol. 9, Special section p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery. Methods: The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality. Results: The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities. Conclusion: The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).
ACCESSION #
42633578

 

Related Articles

  • The cost of antiretroviral treatment service for patients with HIV/AIDS in a central outpatient clinic in Vietnam. Long Thanh Nguyen; Bach Xuan Tran; Cuong Tuan Tran; Huong Thi Le; Son Van Tran // ClinicoEconomics & Outcomes Research;2014, Vol. 6, p101 

    Introduction: Antiretroviral treatment (ART) services are estimated to account for 30% of the total resources needed for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) control and prevention in Vietnam during the 2011-2020 timeframe. With international funding...

  • Thirty Years of HIV, Part 2: Science & Politics. Schneider, Jr., Richard // Gay & Lesbian Review Worldwide;May/Jun2011, Vol. 18 Issue 3, p4 

    This article focuses on several scientific and political concerns related to AIDS within thirty years since 1981. It states that AIDS history has two periods, which are characterized by death and confusion in the first part and hope and normalcy in the HIV community in the other. It says that...

  • Severe morbidity after antiretroviral (ART) initiation: active surveillance in HIV care programs, the IeDEA West Africa collaboration. Abo, Yao; Djimon, Marcel Zannou; Messou, Eugène; Balestre, Eric; Kouakou, Martial; Akakpo, Jocelyn; Ahouada, Carin; de Rekeneire, Nathalie; Dabis, François; Lewden, Charlotte; Minga, Albert // BMC Infectious Diseases;2015, Vol. 15 Issue 1, p1 

    Background: The causes of severe morbidity in health facilities implementing Antiretroviral Treatment (ART) programmes are poorly documented in sub-Saharan Africa. We aimed to describe severe morbidity among HIV-infected patients after ART initiation, based on data from an active surveillance...

  • Indirect costs in ambulatory patients with HIV/AIDS in Spain: a pilot study. Oliva, Juan; Roa, César; del Llano, Juan; Roa, César // PharmacoEconomics;2003, Vol. 21 Issue 15, p1113 

    Objective: To estimate indirect costs in Spanish ambulatory patients with HIV/AIDS and to identify changes in employment status and their current QOL.Method: Information was obtained through 32 interviews/enquiries carried out with ambulatory patients receiving medical...

  • HIV monitoring in nurse-led clinics.  // Independent Nurse;9/5/2011, p5 

    The article focuses on the House of Lords committee on human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) report concluding that pressure on specialist services could be reduced with the monitoring and assessment of patients with HIV at nurse-led clinics.

  • Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatients. Nel, Y. M.; Jonsson, G. // South African Journal of Psychiatry;Aug2015, Vol. 21 Issue 3, p98 

    Background. Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART). There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative...

  • Many Africans stop HIV treatment because of cost. Day, Michael // BMJ: British Medical Journal (International Edition);10/27/2007, Vol. 335 Issue 7625, p848 

    This article reports on research which shows that half of all HIV patients in sub-Saharan Africa who take medication in the form of antiretroviral agents either die or stop treatment within two years of starting it due to the cost of the medication or because treatment centers are too far from...

  • Delivering HIV Services to Vulnerable Populations: A Review of CARE Act-Funded Research. McKinney, Martha; Marconi, Katherine // Public Health Reports;Mar/Apr2002, Vol. 117 Issue 2, p99 

    Summarizes the findings from evaluation and research studies that have received financial support from the HIV/AIDS Bureau of the Health Resources and Services Administration or from Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grantees. Environmental changes influencing HIV...

  • Access to antiretrovirals in developing countries attainable.  // PharmacoEconomics & Outcomes News;1/17/2004, Issue 444, p2 

    Discusses research being done on the access to antiretrovirals among HIV-infected individuals in developing countries. Reference to a study by S. J. Whittaker et al, published in the December 2003 issue of the journal "Nature Medicine"; Importance of the introduction of highly active...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics