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Ensuring quality of care in the scale-up of HIV care and treatment in resource-limited settings: a challenge for all

Lisa R Hirschhorn

Work to expand access to HIV care and treatment in resource-limited settings has been focused on reaching as many people living with HIV in as short a time as possible. As these programs mature and treatment continues to expand, there is a growing need to better understand how care is being delivered and where efforts need to be made to ensure that quality and effective services are being delivered. While there has been considerable work on measuring and improving the quality of HIV care in resource-richer settings, efforts have been much more limited in more resource-constrained settings. This article will present an argument for the need to expand and strengthen both work to measure and to improve quality. In addition, a case will be made that research and rigorous evaluation need to be integrated into this work to more rapidly and fully understand factors associated with gaps in quality, which models of care are more effective in delivering this care and the impact of quality improvement efforts as implemented and replicated. This collaboration between the different disciplines and stake holders, including research, quality management, care providers, people living with HIV, national programs and international funders, will help ensure that the scale-up efforts result in provision of quality and effective HIV care and treatment.