Quality of care for three HIV prevention interventions: A multi-country study in Africa

Background: While healthcare services become increasingly available in developing countries, there is heterogeneity in the quality of service delivery across health providers. As part of a cost-efficiency project (ORPHEA) conducted in Kenya, Zambia, South Africa and Rwanda, we assessed the quality of three HIV prevention interventions: Voluntary Medical Male Circumcision (VMMC), Prevention of Mother-to-Child Transmission (PMTCT), and HIV Testing and Counseling (HTC).

 

Description: We used multistage sampling techniques to select 60-80 health facilities per country stratifying by facility location, size and type. We conducted cross-sectional provider vignettes and patient exit interviews (PEI) to assess service quality measures by estimating provider competence and performance scores. Provider competence scores were compared with average scores for provider performance at the facility level to estimate potential performance.

 

Results: Results are currently available for two (Kenya, Zambia) of the four countries*, where we surveyed 799 providers and 1,161 clients. On average, HTC healthcare providers had a vignette score of 59% and a PEI score of 26%; PMTCT providers had a vignette score of 56% and a PEI score of 32%; and VMMC providers had a vignette score of 67% and received a score of 48% from PEI.

 

Conclusions: We found, there is significant opportunity to increase quality of services without additional health resources but rather by reallocating labor resources. There is therefore need to investigate how different service delivery models could be implemented to reach full performance.

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* Results from the remaining two countries may be available by the time of the conference.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Assess the quality of three HIV prevention interventions in Kenya, Rwanda, South Africa and Zambia.

Keyword(s): HIV Interventions, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a researcher at the Center for Health Systems Research at the Mexico National Institute of Public Health (INSP) where I have been involved in multi-country economic, impact, and efficiency evaluations in in low- and middle-income countries. I hold a master's degree in economics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4330.0: HIV/AIDS in International Settings