Implementation of a Quality Improvement Process to Improve Provider Performance in Care and Treatment of People Living with HIV IAS 2013, 3 rd July 2013 Kuala Lumpur, Malaysia Presenter: Joseph Banda This work has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Department of Defense (DOD).

 Zambia population: 13.3 million  HIV prevalence: 14.3%  ART coverage: 82% of eligible people (2011 WB report)  Jhpiego supported 20 military units on ART quality improvement  80% clients – civilians  Quasi-experimental design with 4 matched intervention and control sites  Observers assessed provider conformity to 9 ART standards 2

The Intervention  Onsite trainings – in ART, STI, TB and PITC  Provision of equipment and supplies  Supportive supervision and mentorship  Task shifting – Military Medical Assistants  Facility action plans – performance gaps  Periodic performance assessments 3

Results and Conclusion Results I  354 observations  109 provider interviews - Two-thirds nurses, the rest non-doctor cadres  Significant improvement in scores in 8/9 standards in the intervention group compared to only 4/9 in comparison  Provider performance improves with quality improvement intervention 4 Results II