Massoud M Rashad, Shakir Fazila, Livesley Nigel, Muhire Martin, Nabwire Juliana, Ottosson Amanda, Jean-Baptiste Rachel, Megere Humphrey, Karamagi-Nkolo Esther, Gaudreault Suzanne, Marks Pamela, Jennings Larissa
University Research Co, LLC, Bethesda, Maryland, USA.
AIDS. 2015 Jul;29 Suppl 2:S187-94. doi: 10.1097/QAD.0000000000000742.
To improve quality of care through decreasing existing gaps in the areas of coverage, retention, and wellness of patients receiving HIV care and treatment.
The antiretroviral therapy (ART) Framework utilizes improvement methods and the Chronic Care Model to address the coverage, retention, and wellness gaps in HIV care and treatment. This is a time-series study.
The ART Framework was applied in five health centers in Buikwe District, Uganda.
Quality improvement teams, consisting of healthcare workers and expert patients, were established in each of the five healthcare facilities.
The intervention period was October 2010 to September 2012. It consisted of quality improvement teams analyzing their facility and systems of care from the perspective of the Chronic Care Model to identify areas of improvement. They implemented the ART Framework, collected data and assessed outcomes, focused on self-management support for patients, to improve coverage, retention, and wellness gaps in HIV care and treatment.
MAIN OUTCOME MEASURE(S): Coverage was defined as every patient who needs ART in the catchment area, receives it. Retention was defined as every patient who receives ART stays on ART, and wellness defined as having a positive clinical, immunological, and/or virological response to treatment without intolerable or unmanageable side-effects.
Results from Buikwe show the gaps in coverage, retention, and wellness greatly decreased a gap in coverage of 44-19%, gap in retention of 49-24%, and gap in wellness of 53-14% during a 2-year intervention period.
The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.
通过缩小接受艾滋病毒护理和治疗的患者在覆盖范围、留存率和健康状况方面的现有差距，提高护理质量。
抗逆转录病毒疗法（ART）框架运用改进方法和慢性病护理模式来解决艾滋病毒护理和治疗中的覆盖范围、留存率和健康状况差距问题。这是一项时间序列研究。
ART框架应用于乌干达布基韦区的五个健康中心。
在五个医疗设施中的每个设施都成立了由医护人员和患者专家组成的质量改进团队。
干预期为2010年10月至2012年9月。在此期间，质量改进团队从慢性病护理模式的角度分析其设施和护理系统，以确定改进领域。他们实施了ART框架，收集数据并评估结果，重点是为患者提供自我管理支持，以缩小艾滋病毒护理和治疗中的覆盖范围、留存率和健康状况差距。
覆盖范围定义为集水区内每个需要抗逆转录病毒疗法的患者都能获得该疗法。留存率定义为每个接受抗逆转录病毒疗法的患者持续接受治疗，健康状况定义为对治疗有积极的临床、免疫和/或病毒学反应，且无无法耐受或难以管理的副作用。
布基韦的结果显示，在为期两年的干预期内，覆盖范围、留存率和健康状况方面的差距大幅缩小，覆盖范围差距从44%降至19%，留存率差距从49%降至24%，健康状况差距从53%降至14%。
ART框架是艾滋病毒项目管理人员改善艾滋病毒护理和治疗的一种创新且实用的工具。
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