title: Quality assurance and quality improvement using supportive supervision in a large-scale STI intervention with sex workers, men who have sex with men/transgenders and injecting-drug users in India.
abstract: BACKGROUND
  Documentation of the long-term impact of supportive supervision using a monitoring tool in STI intervention with sex workers, men who have sex with men and injection-drug users is limited. The authors report methods and results of continued quality monitoring in a large-scale STI services provided as a part of a broader HIV-prevention package in six Indian states under Avahan, the India AIDS Initiative.
  
  
  METHODS
  Guidelines and standards for STI services, and a supportive supervisory tool to monitor the quality were developed for providing technical support to STI component of large-scale HIV-prevention intervention through 372 project-supported STI clinics. The tool contained 80 questions to track the quality of STI services provided on a five-point scoring scale in five performance areas: coverage, quality of clinic and services, referral networks, community involvement and technical support.
  
  
  RESULTS
  The tool was applied to different STI clinics during supportive supervision visits conducted once in every 3 months to assess quality, give immediate feedback and develop a quality score. A total of 292 clinics managed by seven lead implementing partners in six Indian states were covered in 15 quarters over 45 months. Overall quality indicators for the five performance areas showed a three- to sevenfold improvement over the period.
  
  
  CONCLUSIONS
  It was possible to improve quality over the long-term in STI interventions for sex workers, men who have sex with men and injection-drug users using an interactive and comprehensive supportive supervision tool which gives on-the-spot feedback. However, such an effort is time-consuming and resource-intensive, and needs a structured approach.
authors.affiliation: Family Health International, New Delhi, India. vmogasale@gmail.com
authors.forename: Vittal
authors.initials: V
authors.lastname: Mogasale
authors.forename: Teodora C
authors.initials: TC
authors.lastname: Wi
authors.forename: Anjana
authors.initials: A
authors.lastname: Das
authors.forename: Sumit
authors.initials: S
authors.lastname: Kane
authors.forename: Aman Kumar
authors.initials: AK
authors.lastname: Singh
authors.forename: Bitra
authors.initials: B
authors.lastname: George
authors.forename: Richard
authors.initials: R
authors.lastname: Steen
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards; D005260:Female; D006293:Health Promotion / Q000458:organization & administration / Q000592:standards; D018451:Homosexuality, Male; D006801:Humans; D007194:India; D008297:Male; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000150:complications / Q000517:prevention & control* / Q000635:transmission; D015819:Substance Abuse, Intravenous / Q000150:complications; D014189:Transsexualism