The variability and predictors of quality of AIDS care services in Brazil

• Published in: BMC health services research Vol. 9; no. 1; p. 51
• Main Authors: Nemes, Maria Ines Battistella, Melchior, Regina, Basso, Cáritas Relva, Castanheira, Elen Rose Lodeiro, de Britto e Alves, Maria Teresa Seabra Soares, Conway, Shaun
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20-03-2009; BioMed Central; BMC
• Subjects: Acquired Immunodeficiency Syndrome - therapy; Administrative Personnel; AIDS (Disease); Ambulatory Care Facilities - standards; Anti-Retroviral Agents - therapeutic use; Antiviral agents; Benchmarking; Care and treatment; Cluster Analysis; Health aspects; Health Care Surveys; HIV (Viruses); HIV Infections - therapy; Humans; Logistic Models; Patient outcomes; Patients; Quality of Health Care; Surveys and Questionnaires; Brazil
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-9-51

Since establishing universal free access to antiretroviral therapy in 1996, the Brazilian Health System has increased the number of centers providing HIV/AIDS outpatient care from 33 to 540. There had been no formal monitoring of the quality of these services until a survey of 336 AIDS health centers across 7 Brazilian states was undertaken in 2002. Managers of the services were asked to assess their clinics according to parameters of service inputs and service delivery processes. This report analyzes the survey results and identifies predictors of the overall quality of service delivery.
The survey involved completion of a multiple-choice questionnaire comprising 107 parameters of service inputs and processes of delivering care, with responses assessed according to their likely impact on service quality using a 3-point scale. K-means clustering was used to group these services according to their scored responses. Logistic regression analysis was performed to identify predictors of high service quality.
The questionnaire was completed by 95.8% (322) of the managers of the sites surveyed. Most sites scored about 50% of the benchmark expectation. K-means clustering analysis identified four quality levels within which services could be grouped: 76 services (24%) were classed as level 1 (best), 53 (16%) as level 2 (medium), 113 (35%) as level 3 (poor), and 80 (25%) as level 4 (very poor). Parameters of service delivery processes were more important than those relating to service inputs for determining the quality classification. Predictors of quality services included larger care sites, specialization for HIV/AIDS, and location within large municipalities.
The survey demonstrated highly variable levels of HIV/AIDS service quality across the sites. Many sites were found to have deficiencies in the processes of service delivery processes that could benefit from quality improvement initiatives. These findings could have implications for how HIV/AIDS services are planned in Brazil to achieve quality standards, such as for where service sites should be located, their size and staffing requirements. A set of service delivery indicators has been identified that could be used for routine monitoring of HIV/AIDS service delivery for HIV/AIDS in Brazil (and potentially in other similar settings).