title: Improving rates of cotrimoxazole prophylaxis in resource-limited settings: implementation of a quality improvement approach.
abstract: OBJECTIVE
  To demonstrate the effectiveness of quality improvement methods to monitor and improve administration of cotrimoxazole (CTX) prophylaxis to improve health outcomes among adults living with HIV/AIDS in low resource countries.
  
  
  METHODS
  Program evaluation.
  
  
  METHODS
  HIV/AIDS health care facilities in Uganda, Mozambique, Namibia and Haiti.
  
  
  METHODS
  Performance measures based on national guidelines are developed in each country. These may include CD4 monitoring, ART adherence and uptake of CTX prophylaxis. CTX prophylaxis is routinely selected, because it has been shown to reduce HIV-related morbidity and mortality. Patient records are sampled using a standard statistical table to achieve a minimum confidence interval of 90% with a spread of ±8% in participating clinics. If an electronic medical record is available, all patients are reviewed. Routine review of performance measures, usually every 6 months, is conducted to identify gaps in care. Improvement interventions are developed and implemented at health facilities, informed by performance results, and local/national public health priorities.
  
  
  METHODS
  Median clinic rates of CTX prophylaxis.
  
  
  RESULTS
  Median performance rates of CTX prophylaxis generally improved for adult HIV+ patients between 2006 and 2013 across countries, with median clinic rates higher than baseline at follow-up in 16 of 18 groups of clinics implementing CTX -focused improvement projects.
  
  
  CONCLUSIONS
  Quality management offers a data-driven method to improve the quality of HIV care in low resource countries. Application of improvement principles has been shown to be effective to increase the rates of CTX prophylaxis in national HIV programs in multiple countries.
authors.affiliation: New York State Department of Health AIDS Institute, HEALTHQUAL International, 90 Church Street, 13th Floor, New York, NY 10007, USA.
authors.forename: J
authors.initials: J
authors.lastname: Bardfield
authors.affiliation: New York State Department of Health AIDS Institute, HEALTHQUAL International, 90 Church Street, 13th Floor, New York, NY 10007, USA.
authors.forename: B
authors.initials: B
authors.lastname: Agins
authors.affiliation: New York State Department of Health AIDS Institute, HEALTHQUAL International, 90 Church Street, 13th Floor, New York, NY 10007, USA.
authors.forename: M
authors.initials: M
authors.lastname: Palumbo
authors.affiliation: University of California, San Diego School of Medicine, 9500 Gilman Drive, San Diego, CA 92093, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Wei
authors.affiliation: Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.
authors.forename: J
authors.initials: J
authors.lastname: Morris
authors.affiliation: Global AIDS Program, CDC, 1600 Clifton Road, Atlanta, GA 30329, USA.
authors.forename: B
authors.initials: B
authors.lastname: Marston
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D017954:Africa South of the Sahara; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D003906:Developing Countries; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy*; D006205:Haiti; D006801:Humans; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: pepfar; performance measurement; quality improvement; quality management