Partnership Defined Quality: A tool for improving VCT/STI screening services

Stigma, privacy and confidentiality have been articulated as barriers in accessing VCT services among men who have sex with men (MSM) and female sex workers (FSWs). Distrust of health personnel and perceived negative attitudes of providers prevent individuals from getting tested and receiving counseling that can modify behaviors and result in healthy outcomes.

The Partnership Defined Quality methodology was applied in Nicaragua, El Salvador and Guatemala to develop a shared vision of high quality VCT/STI services among public and private-sector providers, MSM, and FSWs. The methodology links quality assessment and improvement with community participation. PDQ workshops explored attitudes and practices regarding service provision and utilization. Following individual meetings, vulnerable groups and providers met to discuss findings and develop a shared vision for quality services.

Workshop participation was higher among MSM than the FSWs, because of FSW's work schedules, MSM higher literacy and socioeconomic backgrounds. Both groups had similar concerns including discrimination and lack of confidentiality/privacy. Providers expressed frustration with inadequate supplies, stress and concerns about protecting their own health. Findings highlighted the social distance between providers and clients as well as common fears and misconceptions, and showed that providers lacked knowledge and skills to serve vulnerable groups. PDQ was an effective tool for stimulating providers to reflect on their treatment of vulnerable groups and for creating quality improvement partnerships.

Findings will guide development of training, supervision and marketing activities to increase quality and utilization of VCT/STI services, and help establish indicators and mechanisms to assess quality improvement efforts.