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A management tool and process to improve access to high-quality HIV and TB services

Date: Poster sessions
Source: Forum 11
Authors: Vera Scott, Researcher, School of Public Health, Community Health Sciences, University of the Western Cape, South Africa
with Virginia Azevedo, Judy Caldwell, Uta Lehmann, Pren Naidoo, Jabuliswa Zulu and Mickey Chopra


The dual burden of HIV and tuberculosis (TB) presents a pressing health service need in South Africa. Civil pressure has highlighted the issue of adequate access to high-quality HIV prevention and treatment provision as a priority for the general primary care services, which provide the programme delivery platform. The components of the HIV and TB programmes are in the process of being integrated.

The objectives of this project were: 1) To develop an evaluation tool to measure access, service capacity and quality within the HIV, TB and sexually transmitted infection (STI) programmes. (This tool should also be suitable to monitor equity of service provision between districts.) 2) To model a participatory process that engages with middle managers and empowers them to use health information to improve programme performance at the level of implementation, i.e. the primary care facility.

A team of managers and researchers designed a comprehensive health systems framework outlining key conditions for effectiveness. This was used to identify tracer indicators to measure implementation of four of the key components of an integrated HIV/TB/STI package. Sixteen clinics were reviewed and 495 records were sampled. Results were analysed in a participatory process with facility managers.

Half the primary care facilities regularly deferred (turned away) clients because of service overload; three quarters of these facilities offered clients the opportunity to make an appointment to secure subsequent access to services. 64% of voluntary counselling and testing for HIV (VCT) clients who were diagnosed HIV positive (77 out of 144) were referred for further assessment and care. 68% of HIV positive clients who qualified for antiretroviral treatment were referred appropriately. 70% of STI clients and 94% of TB clients were offered VCT.

Access to this priority programme is threatened by inadequate access to the general primary care services. There are opportunities to improve access within the programme to prevention, detection and care by using each client-staff interaction and referring appropriately. We have found that the deliberate measurement of access, referral and integration of the HIV/TB/STI programme and the participatory process of analysis has empowered managers to plan specific strategies to improve access at the facility level.