Health Care Improvement Project (HCI) -- Russia [begun under Quality Improvement Project (QAP)]

Category 2

HCI Project and earlier QAP work in Russia provided demonstrations of the now broadly diffused quality improvement collaborative approach for problem-focused improvements in HIV care and scale-up. The major goal initially was on improving diagnosis and treatment, but the project added components of social support and family planning services for HIV-positive women, counseling and testing for most-at-risk populations, capacity building and improved monitoring and evaluation. In addition to facility-based quality improvement, the project continues to support training of trainers in voluntary counseling and testing to expand the number of providers trained in VCT, work with drug rehabilitation and building linkages between health facilities and social services provision.

Goal of the Practice
  • Improvement of Access to Basic HIV/AIDS Care and ART
  • Improvement of Detection, Prevention and Treatment of HIV-TB Co-Infection
  • Improvement of Social Support for HIV-positive Families
  • Improvement of Access to Drug Rehabilitation Services for PLWHA
Core Components
  • The formation and development of the improvement collaborative has been the centerpiece of program implementation. These involve facility-based, interdisciplinary teams focused on treatment and intervention problem solving.
  • Coaching and support for quality improvement began with centralized project advisors, but has expanded to national experts and ultimately regional and district professionals as "spread" or scale-up occurs.
  • The emphases through the course of the project have involved domains most relevant to facility-based treatment, and care and support: Access and patient retention; Coordination of care; Patient management and adherence to treatment; Coordinated HIV and TB co-infection detection and treatment.
  • Additional community components were developed, using the collaborative methodology in integration of social services for HIV-positive pregnant women and drug rehabilitation services for intravenous drug users (IDU).
  • The project has worked with local health authorities to develop orders (prikaz) that "hard wire" the changes developed and tested by teams, to spread new approaches and practices throughout the geographic area.
Noteworthy Results
  • The number of patients screened for TB increased by roughly 2 ½ times during 2007-2008 in St. Petersburg (from 257 to 600). TB testing in Orenburg Oblast increased by over a factor of 4 in the same period (from 270 to 1237).
  • Coverage of newly diagnosed HIV patients with medical follow-up increased from 54% to 89% between 2006 and late 2008.
  • CARE Ware software for tracking HIV patients through systems was translated to Russian under the earlier QAP phase of work and had continued to be diffused across the project, dealing with key limitations in patient records and data collection to inform M&E.
Lessons Learned
  • Flexibility in improvement collaborative structure has proven important; evolution occurs in the course of project implementation and best responds to local needs. Other organizational elements include involvement of a pool of national experts, involvement of leadership and enhancing a sense of project ownership.
  • Priority selection should be data-based and aligned with national ministry of health goals and priorities.
  • Spread or scale-up is most effective when planned for in advance, rooted in local capacity building and reflective of a trajectory toward quality on the part of the ministry of health.
Focus Areas
Care and Support
Counseling and Testing
Implemented By
University Research Corporation (URC)
Participating Organization
  • Ministry of Health and Social Development (Russian Federation)
  • Federal Public Health Institute (Russia)
  • Federal AIDS Center
  • Federal Center for TB/HIV Co- Infection
  • Healthy Russia Foundation
  • Russian Association for the Prevention of Sexually Transmitted Diseases
  • St. Petersburg City Health Committee
  • Orenburg Oblast Ministry of Health
Region
Russia & Eastern Europe
Country
Russia
Environment
Clinic/Health facility
Setting
Urban
Target Population
  • Adults (over 18)
  • Males
  • Females
  • General Public
  • Injecting Drug Users (IDU)
Scope
25000 - 50000
Implementation Years
01/2004 - ongoing