title: Development of a technical assistance framework for building organizational capacity of health programs in resource-limited settings.
abstract: BACKGROUND
  Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs.
  
  
  METHODS
  Qualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation.
  
  
  RESULTS
  Stakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework.
  
  
  CONCLUSIONS
  A systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs.
authors.affiliation: International Training and Education Center for Health, University of California San Francisco, 50 Beale Street, Suite 1300, San Francisco, CA, USA. michael.reyes@ucsf.edu.
authors.forename: E Michael
authors.initials: EM
authors.lastname: Reyes
authors.forename: Anjali
authors.initials: A
authors.lastname: Sharma
authors.forename: Kate K
authors.initials: KK
authors.lastname: Thomas
authors.forename: Chuck
authors.initials: C
authors.lastname: Kuehn
authors.forename: José Rafael
authors.initials: JR
authors.lastname: Morales
mesh_terms: D057191:Capacity Building / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007391:International Cooperation; D007407:Interviews as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development / Q000379:methods*; D036301:Qualitative Research