Abstract
BackgroundLittle information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). This paper describes the methods used to adapt the Primary Care Assessment Tool (PCAT) framework, which has successfully strengthened HIV primary care services in the US, into one that could strengthen the capacity of local partners to deliver priority health programs in resource-constrained settings by identifying their specific technical assistance needs.MethodsQualitative methods and inductive reasoning approaches were used to conceptualize and adapt the new Clinical Assessment for Systems Strengthening (ClASS) framework. Stakeholder interviews, comparisons of existing assessment tools, and a pilot test helped determine the overall ClASS framework for use in low-resource settings. The framework was further refined one year post-ClASS implementation.ResultsStakeholder interviews, assessment of existing tools, a pilot process and the one-year post- implementation assessment informed the adaptation of the ClASS framework for assessing and strengthening technical and managerial capacities of health programs at three levels: international partner, local indigenous partner, and local partner treatment facility. The PCAT focus on organizational strengths and systems strengthening was retained and implemented in the ClASS framework and approach. A modular format was chosen to allow the use of administrative, fiscal and clinical modules in any combination and to insert new modules as needed by programs. The pilot led to refined pre-visit planning, informed review team composition, increased visit duration, and restructured modules. A web-based toolkit was developed to capture three years of experiential learning; this kit can also be used for independent implementation of the ClASS framework.ConclusionsA systematic adaptation process has produced a qualitative framework that can inform implementation strategies in support of country led HIV care and treatment programs. The framework, as a well-received iterative process focused on technical assistance, may have broader utility in other global programs.
Highlights
Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR)
As part of the initial United States President’s Emergency Plan for AIDS Relief (PEPFAR Phase I), the United States Department of Health and Human Services (US DHHS), through the Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC), funded four implementing partners to rapidly scale up HIV care and treatment in countries carrying a high burden of HIV [1]
The Clinical Assessment for Systems Strengthening (ClASS) framework to meet the needs of HIV care and treatment programs in low-resource settings Stakeholder discussions and interviews, comparison of existing tools, pilot-testing and additional stakeholder feedback one year after ClASS had been implemented, together resulted in the development of the ClASS framework, approach, assessment and review team composition and roles, modules and tools, a model for provision of technical assistance and implementation process [15]
Summary
Little information exists on the technical assistance needs of local indigenous organizations charged with managing HIV care and treatment programs funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR). As part of the initial United States President’s Emergency Plan for AIDS Relief (PEPFAR Phase I), the United States Department of Health and Human Services (US DHHS), through the Health Resources and Services Administration (HRSA) and Centers for Disease Control and Prevention (CDC), funded four implementing partners to rapidly scale up HIV care and treatment in countries carrying a high burden of HIV [1]. These four implementing partners (Columbia University, Elizabeth Glaser Pediatric AIDS Foundation, Catholic Relief Services/AIDSRelief and Harvard University) received United States Government (USG) funding to manage and deliver antiretroviral therapy (ART) and other HIVrelated services in resource-limited settings. HRSA, with a long history of assessing and strengthening domestic HIV primary care programs, adapted their domestic HIV primary care clinic technical assistance assessment tool to the international context [6]
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