Gaga Sisanda, Mqoqi Nokuzola, Chimatira Raymond, Moko Singilizwe, Igumbor Jude O
Beyond Zero, East London, South Africa.
Centers for Disease Control and Prevention, Pretoria, South Africa.
South Afr J HIV Med. 2021 May 12;22(1):1202. doi: 10.4102/sajhivmed.v22i1.1202. eCollection 2021.
Continuous quality improvement (CQI) is essential for HIV and tuberculosis (TB) services. Similarly, a thorough understanding of the requirements and impact of CQI is critical to its successful institutionalisation. However, this is currently lacking.
The objective of this study is to describe the CQI implementation process and examine its effect on HIV and TB service delivery at selected primary healthcare facilities in two South African districts.
We used a separate sample, pre- and post-test, quasi-experimental study design based on data collected from the clinical audit of patient cohorts seen in 2014 and 2015 respectively. Quality was measured based on the extent to which prescribed services were provided. Tailored CQI interventions were implemented based on service delivery gaps identified by the 2014 CQI audit. Data were summarised and analysed using a combination of univariate and multivariate analysis.
The services identified as low quality were related to opportunistic infections management and laboratory practices. Compliance to prescribed service items in antiretroviral treatment initiation and monitoring, pharmacy and laboratory management, exceeded 70% across study sites. Over 80% of low quality service delivery items were optimised in less than six months with targeted quality improvement support.
The observed improvements signal the effectiveness of the CQI approach, its capacity to rapidly improve under-performance, its high replicability and the need to provide quality maintenance support to sustain or improve healthcare facilities performing well. The study strongly underscores the need to improve the management of opportunistic infections and complications, particularly TB.
持续质量改进（CQI）对于艾滋病病毒（HIV）和结核病（TB）服务至关重要。同样，全面了解CQI的要求和影响对于其成功制度化至关重要。然而，目前这方面还很欠缺。
本研究的目的是描述CQI的实施过程，并考察其对南非两个地区选定的初级卫生保健机构的HIV和TB服务提供的影响。
我们采用了一种单独样本、前后测试的准实验研究设计，该设计基于分别从2014年和2015年所见患者队列的临床审计中收集的数据。根据规定服务的提供程度来衡量质量。基于2014年CQI审计发现的服务提供差距实施了量身定制的CQI干预措施。使用单变量和多变量分析相结合的方法对数据进行汇总和分析。
被确定为低质量的服务与机会性感染管理和实验室操作有关。在所有研究地点，抗逆转录病毒治疗启动及监测、药房和实验室管理方面对规定服务项目的依从性超过了70%。在有针对性的质量改进支持下，超过80%的低质量服务提供项目在不到六个月的时间内得到了优化。
观察到的改善表明了CQI方法的有效性、其迅速改善表现不佳情况的能力、其高可复制性以及为维持或改善表现良好的医疗设施而提供质量维持支持的必要性。该研究强烈强调了改善机会性感染和并发症管理的必要性，尤其是结核病。
