title: Improving care for patients on antiretroviral therapy through a gap analysis framework.
abstract: OBJECTIVE
  To improve quality of care through decreasing existing gaps in the areas of coverage, retention, and wellness of patients receiving HIV care and treatment.
  
  
  METHODS
  The antiretroviral therapy (ART) Framework utilizes improvement methods and the Chronic Care Model to address the coverage, retention, and wellness gaps in HIV care and treatment. This is a time-series study.
  
  
  METHODS
  The ART Framework was applied in five health centers in Buikwe District, Uganda.
  
  
  METHODS
  Quality improvement teams, consisting of healthcare workers and expert patients, were established in each of the five healthcare facilities.
  
  
  METHODS
  The intervention period was October 2010 to September 2012. It consisted of quality improvement teams analyzing their facility and systems of care from the perspective of the Chronic Care Model to identify areas of improvement. They implemented the ART Framework, collected data and assessed outcomes, focused on self-management support for patients, to improve coverage, retention, and wellness gaps in HIV care and treatment.
  
  
  METHODS
  Coverage was defined as every patient who needs ART in the catchment area, receives it. Retention was defined as every patient who receives ART stays on ART, and wellness defined as having a positive clinical, immunological, and/or virological response to treatment without intolerable or unmanageable side-effects.
  
  
  RESULTS
  Results from Buikwe show the gaps in coverage, retention, and wellness greatly decreased a gap in coverage of 44-19%, gap in retention of 49-24%, and gap in wellness of 53-14% during a 2-year intervention period.
  
  
  CONCLUSIONS
  The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.
authors.affiliation: University Research Co, LLC, Bethesda, Maryland, USA.
authors.forename: M Rashad
authors.initials: MR
authors.lastname: Massoud
authors.forename: Fazila
authors.initials: F
authors.lastname: Shakir
authors.forename: Nigel
authors.initials: N
authors.lastname: Livesley
authors.forename: Martin
authors.initials: M
authors.lastname: Muhire
authors.forename: Juliana
authors.initials: J
authors.lastname: Nabwire
authors.forename: Amanda
authors.initials: A
authors.lastname: Ottosson
authors.forename: Rachel
authors.initials: R
authors.lastname: Jean-Baptiste
authors.forename: Humphrey
authors.initials: H
authors.lastname: Megere
authors.forename: Esther
authors.initials: E
authors.lastname: Karamagi-Nkolo
authors.forename: Suzanne
authors.initials: S
authors.lastname: Gaudreault
authors.forename: Pamela
authors.initials: P
authors.lastname: Marks
authors.forename: Larissa
authors.initials: L
authors.lastname: Jennings
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control; D006268:Health Facilities / Q000592:standards*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D015397:Program Evaluation; D058996:Quality Improvement; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012648:Self Care; D014454:Uganda / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents