title: Improving HIV outcomes in resource-limited countries: the importance of quality indicators.
abstract: BACKGROUND
  Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped.
  
  
  METHODS
  Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment.
  
  
  RESULTS
  This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level.
  
  
  CONCLUSIONS
  An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow.
authors.affiliation: Divisions of Infectious Disease, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, MA 02114, USA. aahonkhai@partners.org
authors.forename: Aima A
authors.initials: AA
authors.lastname: Ahonkhai
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care / Q000592:standards; D003906:Developing Countries; D015658:HIV Infections / Q000188:drug therapy*; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D015397:Program Evaluation / Q000379:methods; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011788:Quality of Life
chemical_list: D044966:Anti-Retroviral Agents