Evaluation of HIV/AIDS clinical care quality: the case of a referral hospital in North West Ethiopia

OBJECTIVE: To assess the quality of clinical care provided to patients with HIV in Felege Hiwot Referral Hospital. APPROACH AND DESIGN: Normative evaluation based on Donabedian's structure–process–outcome model of health care quality. Cross-sectional study design was employed to gather data in September 2007. SETTING: Felege Hiwot Referral Hospital is a government hospital in North West Ethiopia. The hospital is providing clinical care for patients infected with HIV free of patient charge since 2005. MEASURES: The evaluation used 10 process and 5 outcome indicators of quality measured by reviewing 351 randomly selected patient records and interview with 368 patients. Resource inventory was conducted to assess the availability of trained staff, laboratory facilities and drugs required for provision of HIV care. RESULTS: All resources recommended by the national antiretroviral therapy (ART) Implementation Guideline including trained staff, laboratory facilities and drugs were continuously available, except for a shortage of cotrimoxazole. Despite this, important components of care and treatment recommended by national treatment guidelines were not delivered for significant portion of patients. The study showed that only 45.9% of patients eligible for cotrimoxazole prophylactic therapy (CPT) and 76.8% of patients eligible for ART were actually taking CPT and ART, respectively. Compliance with national guidelines to monitor patients was also found to be a major problem. CONCLUSION: Availability of resources alone does not ensure the quality of HIV care and treatment. The study results indicate a need for regular monitoring and improvement of processes and outcomes of care in the Ethiopian Health System.