Optimizing Performance by Improving Quality (OPIQ) in HIV and HIV/TB Programs in the Republic of South Africa under PEPFAR

The Challenge

The dual epidemics of HIV and TB have yet to be controlled in South Africa to achieve the UNAIDS 95-95-95 HIV and the End TB Strategy’s 90-90-90 targets. Also, wide geographical variations exist in prevalence of these diseases, including a high HIV burden in metropolitan districts.

Overview and Objectives

The goal of the OPIQ project is to improve the quality of HIV and HIV/TB prevention and care services in facilities and increase the number of people on HIV treatment, with a focus on the 27 highest-burden districts and priority populations for prevention and care. OPIQ is working to achieve this by providing technical assistance (TA) to PEPFAR South Africa’s implementing partners (IPs) and the South African Government’s National, Provincial, and District Departments of Health (DOH). This includes:

• Assessment of performance gaps and implementation of remedial plans in DOH HIV/TB prevention and treatment services;
• Ensuring that DOH HIV/TB prevention and treatment service delivery meets global and national quality standards;
• Assistance with operationalization and interpretation of complex data analyses, visualizations, and presentations; and
• Capacity building of IPs and the national-, provincial-, and district-level DOH to deliver high-quality HIV/TB prevention and treatment services.

This project is working in five districts in Gauteng and Northwest Provinces to develop, coordinate, and implement quality improvement (QI) activities across all of PEPFAR’s technical areas to improve performance and establish standardized processes for sustained achievement in HIV and TB service delivery in districts supported by PEPFAR South Africa. This activity will provide valuable information on how best to deliver interventions and assess quality to enhance HIV/TB program performance.

The project is providing a package of QI TA on HIV and HIV/TB service delivery to the South African Government at national, provincial, and district levels, PEPFAR South Africa IPs, and non-PEPFAR IPs, with a focus on the 27 highest-burden districts and priority populations for prevention and care.

The project is optimizing HIV and HIV/TB program performance by improving:

• Early identification of HIV/TB performance gaps;
• The capacity of IPs and DOH to use QI and quality assurance approaches to address those gaps;
• The harvesting and dissemination of best practices to scale up proven interventions; and
• The use of innovative data-driven platforms to improve data-based planning and management.

Achievements

Quality improvement: Since September 2020, 90% of facilities showed improvement in the number of patient files retrieved in less than five minutes.

Data management and analytics: The project updated several Centers for Disease Control and Prevention (CDC) reporting tools, including the CDC Excel Dashboard and CDC Scorecard, making them more usable locally. More sophisticated data analytics and visualizations were also developed to demonstrate the data collected with these tools.

Knowledge management and sharing: The project finalized the filing/records management system change package and retention change package. Standard operating procedures were developed to guide QI coaches during facility improvement visits. At least five case studies were synthesized from facilities that showed improvement. The project also held routine and periodic learning sessions with CDC and designated service providers.