The Global Fund to Fight AIDS, TB and Malaria, Geneva, Switzerland.
Boston University School of Public Health, Boston, MA.
J Acquir Immune Defic Syndr. 2019 Aug 15;81(5):533-539. doi: 10.1097/QAI.0000000000002064.
With the scale-up of antiretroviral treatment, many health facilities in low- and middle-income countries have implemented innovative practices targeted at overcoming operational challenges and delivering efficient quality HIV services. However, many of these practices remain largely unexplored as a means to better reach the global 90-90-90 targets.
A study was conducted on selected facilities in districts of country programs supported by The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The aims of the study were to understand how facilities seek to improve the delivery and uptake of HIV services and to examine what innovative practices might be contributing to their success.
The study used a qualitative approach through observations, document reviews, and semistructured interviews with site management and clinical staff to identify service delivery innovations in 30 health facilities in Kenya and Uganda.
Eleven innovative practices were observed along the HIV care cascade. These practices led to improvements in the quality of testing, treatment, and retention across the facilities. Effective human resource and data management processes also enabled the implementation of these innovative practices.
Many facilities use innovative practices along the HIV care cascade to address bottlenecks and challenges. These have the potential to improve the quality and efficiency of service delivery and support the attainment of the 90-90-90 treatment targets. Replicating these practices would require further implementation research and a mind shift of donors, governments, and implementers from a metric of coverage to a stronger focus on efficiency and impact.
随着抗逆转录病毒治疗的规模扩大，许多中低收入国家的卫生机构已经实施了创新实践，旨在克服运营挑战，提供高效优质的艾滋病毒服务。然而，许多这些实践在很大程度上仍未被探索，因为它们是实现全球 90-90-90 目标的一种手段。
在受全球抗击艾滋病、结核病和疟疾基金支持的国家规划地区的选定机构进行了一项研究。该研究的目的是了解机构如何寻求改善艾滋病毒服务的提供和利用，并研究哪些创新实践可能有助于其成功。
该研究采用了一种定性方法，通过观察、文件审查和对肯尼亚和乌干达 30 个卫生机构的现场管理人员和临床工作人员进行半结构化访谈，确定服务提供方面的创新。
在艾滋病毒护理链中观察到 11 种创新做法。这些做法提高了各机构检测、治疗和保留治疗的质量。有效的人力资源和数据管理流程也使这些创新实践得以实施。
许多机构在艾滋病毒护理链中使用创新实践来解决瓶颈和挑战。这些做法有可能提高服务提供的质量和效率，并支持实现 90-90-90 治疗目标。复制这些做法需要进一步开展实施研究，并促使捐助方、政府和执行者从覆盖范围的衡量标准转变为更加注重效率和影响。
