Improving care for patients on antiretroviral therapy through a gap analysis framework.

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. DESIGN: 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. SETTING: The ART Framework was applied in five health centers in Buikwe District Uganda. PARTICIPANTS: Quality improvement teams consisting of healthcare workers and expert patients were established in each of the five healthcare facilities. INTERVENTION: 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. MAIN OUTCOME MEASURE(S): 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. CONCLUSION: The ART Framework is an innovative and practical tool for HIV program managers to improve HIV care and treatment.