Self-Assessment Tool for Hospitals and Other Medical Institutions Caring for People Living with HIV/AIDS

Organisers conducted an operations research study in three New Delhi hospitals (one private; two government-run). Formative research revealed that PHLA and their caregivers report receiving differential treatment, relative to other patients, that limits their access to care. The study team also found in the baseline survey that within the health care setting, misconceptions about HIV transmission, negative attitudes about PLHA, inadequate training and supplies for infection control, and lack of institutional policies on confidentiality and HIV testing all exist and may exacerbate inequality in treatment.

As part of the study, a practical Checklist was developed that can be used by managers and other staff to identify institutional strengths, pinpoint problems, and set goals for improvement of services for PLHA and staff safety. In India, the title of the Checklist, which will be distributed to all government medical facilities throughout India, is "Self-assessment Checklist for Institutions Caring for PLHA." A generic form of this tool, entitled "The PLHA-Friendly Achievement Checklist", is available in hard-copy or PDF format.

The Checklist is designed in a simple format that can be adapted to a variety of institutional settings, and may be used by individual managers or by groups of managers and/or staff. Users of the Checklist can use hospital records, survey data, observations, or simply estimates to rate their own institution on each of five broad domains:

1. Access to Care Services
2. Testing and Counseling
3. Confidentiality
4. Infection Control
5. Quality of Care

Within each of these domains, there are four sub-domains: practice, training, quality assurance, and policy. There are between one and five Checklist items under each sub-domain. For example, in the infection control domain, under practice, one is asked to assess this statement in the context of one's own institution: "Universal precautions are practiced in the same manner with all patients at all times."

Using a participatory process that included discussion of the baseline data and the self-assessment tools, managers at each hospital worked with the project team to draft an action plan to improve services for PLHA and working conditions for staff. The action plans vary by hospital but include such actions as posting information on universal precautions, training more health care workers from each department in pre- and post-test HIV counseling, and offering staff participatory sensitisation training on HIV/AIDS that is designed and implemented by local AIDS organisations, including their HIV-positive staff.

HIV/AIDS, Health, Rights.

Stigma and discrimination against PLHA are reported to be severe in many public and private hospitals in India, a problem that is likely aggravated by insufficient training of health care workers, lack of supplies to enact universal precautions, and inadequate policies.

"Gold standards" were compiled from national and international guidelines and policies on the human rights of PLHA, HIV testing and counseling, infection control, and care and management of HIV/AIDS. These standards were reviewed and endorsed by the participating National AIDS Control Organisation (NACO) and hospitals involved in the study through a series of consultative discussions. These standards, along with research data, informed the development of the Checklist.

In the upcoming year, the project team will evaluate the intervention by implementing a follow-up evaluation, and analysing pre-post data and institutional progress on checklist scores and action plans. The checklist will be revised for broader use in India at the end of the project and will be distributed by NACO, along with the policy guidelines. The generic version is available for use by any institution or group providing clinical care for PLHA.