title: External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon using dried tube specimens: results of an effectiveness evaluation.
abstract: BACKGROUND
  In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodeficiency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction.
  
  
  METHODS
  Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program's logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program.
  
  
  RESULTS
  The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program's first round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance.
  
  
  CONCLUSIONS
  All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study findings highlight the need to improve certain program components. Additionally, long-term follow-ups is needed to provide a more thorough picture of the process for external quality assessment.
authors.affiliation: Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brazil.
authors.forename: Andréa Mônica Brandão
authors.initials: AM
authors.lastname: Beber
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Sabidó
authors.affiliation: Instituto de Pesquisas Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brazil.
authors.forename: Janete Maria Rebelo
authors.initials: JM
authors.lastname: Vieira
authors.affiliation: Departmento de Análises Clínicas, Universidade Federal de Santa Carina, Florianópolis, SC, Brazil.
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Bazzo
authors.affiliation: Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
authors.forename: Adele Schwartz
authors.initials: AS
authors.lastname: Benzaken
mesh_terms: D001938:Brazil; D003376:Counseling; D059788:Dried Blood Spot Testing / Q000379:methods / Q000592:standards*; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D011785:Quality Assurance, Health Care