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Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda.

Byabagambi J, Marks P, Megere H, Karamagi E, Byakika S, Opio A, Calnan J, Njeuhmeli E - PLoS ONE (2015)

Bottom Line: In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality.Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events.Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

View Article: PubMed Central - PubMed

Affiliation: USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC (URC), Kampala, Uganda.

ABSTRACT

Background: Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality.

Methods and findings: Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the "good" range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring "good" rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events.

Conclusion: Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

No MeSH data available.


Related in: MedlinePlus

Percentage of VMMC clients who experience moderate to severe adverse events.
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pone.0133369.g005: Percentage of VMMC clients who experience moderate to severe adverse events.

Mentions: Documenting and measuring moderate to severe adverse events (AEs) is important in ensuring optimal outcomes. In January 2013, 18 sites reported on the medical circumcision procedure, but only nine (50 percent) had information documented related to the presence or absence of adverse events. By March 2014, all sites that reported on VMMC also reported on AEs. Fig 5 shows that at baseline the rate of adverse events was below 1% at the nine sites that had the data. After orienting staff on identification and grading of adverse events, the rate initially rose to 2% across all 30 sites and to 5.2% at one regional referral hospital, as sites improved their documentation of adverse events. Following efforts to actively reduce adverse events, the rate dropped below 1% across all sites and below 2% at the regional referral hospital for 10 months until April 2014, when it rose above 2%.


Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda.

Byabagambi J, Marks P, Megere H, Karamagi E, Byakika S, Opio A, Calnan J, Njeuhmeli E - PLoS ONE (2015)

Percentage of VMMC clients who experience moderate to severe adverse events.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4514600&req=5

pone.0133369.g005: Percentage of VMMC clients who experience moderate to severe adverse events.
Mentions: Documenting and measuring moderate to severe adverse events (AEs) is important in ensuring optimal outcomes. In January 2013, 18 sites reported on the medical circumcision procedure, but only nine (50 percent) had information documented related to the presence or absence of adverse events. By March 2014, all sites that reported on VMMC also reported on AEs. Fig 5 shows that at baseline the rate of adverse events was below 1% at the nine sites that had the data. After orienting staff on identification and grading of adverse events, the rate initially rose to 2% across all 30 sites and to 5.2% at one regional referral hospital, as sites improved their documentation of adverse events. Following efforts to actively reduce adverse events, the rate dropped below 1% across all sites and below 2% at the regional referral hospital for 10 months until April 2014, when it rose above 2%.

Bottom Line: In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality.Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events.Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

View Article: PubMed Central - PubMed

Affiliation: USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project, University Research Co., LLC (URC), Kampala, Uganda.

ABSTRACT

Background: Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President's Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality.

Methods and findings: Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the "good" range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring "good" rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events.

Conclusion: Public sector providers can be engaged to address the quality of VMMC using a continuous quality improvement approach.

No MeSH data available.


Related in: MedlinePlus