A review of how the quality of HIV clinical services has been evaluated or improved.

PURPOSE: To examine approaches being used to evaluate and improve quality of HIV clinical services. DATA SOURCES: MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases. STUDY SELECTION: Articles and abstracts focused on evaluating or improving quality of HIV clinical services. DATA EXTRACTION: Country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. RESULTS OF DATA SYNTHESIS: Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were program evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or program, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. CONCLUSION: Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programs develop their HIV care quality improvement frameworks.