Enhancing HIV/AIDS Care in South India

Article excerpt

As of 2002, nearly 4 million adults in India were infected with HIV, according to UNAIDS. The number of new HIV infections in India is rapidly increasing, and the health care system is experiencing a substantial growth in the demand for services. To address this challenge, the Population Council's Horizons program began collaborating with the International HIV/MDS Alliance in September 1999 to examine the experiences of the Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE), a nongovernmental organization based in Chennai, India. YRG CARE provides a range of successful prevention, care, and support services for people with HIV/MDS. The organization wanted to expand services in Chennai as well as introduce its style of services to organizations in four other locations in India: Calicut, Chirala, Mysore, and Pondicherry. Horizons employed operations research to facilitate this expansion of services.

In the HIV/AIDS field, operations research applies systematic research techniques to analyze factors that are under the control of program managers, such as improving the quality of services and counseling. An important objective of operations research is to provide managers with the information they need to improve and expand services.

This Horizons study includes components focusing on clients' quality of life and satisfaction with services, in addition to institutional costs, clients' willingness to pay for services, and the effect of treatment costs on clients' budgets. The researchers investigated these issues using client surveys and in-depth interviews, personnel training and assessment, and the development of case studies for each location.

The USAID-funded Horizons research program is implemented by the Population Council in collaboration with the International Center for Research on Women, the International HIV/AIDS Alliance, the Program for Appropriate Technology in Health, Tulane University, Johns Hopkins University, and Family Health International.

Scaling up

Because of its reputation as a source of high-quality, affordable, and confidential care, YRG CARE has attracted clients not only from the Chennai area but from throughout South India, some of whom travel hundreds of miles for services. From its facilities in Chennai, the organization provides voluntary HIV counseling and testing, nutrition counseling, inpatient and outpatient care, and many other services. One of the main goals of the study was to find ways to transfer the clinic's services and core concept--providing economical, high-quality HIV/AIDS care--to the new locations without necessarily imposing the Chennai managerial structure.

"It's important to acknowledge that concepts and values rather than rigid organizational structures and models are the critical elements to export to a new environment," says Chris Castle of Horizons/International HIV/MDS Alliance.

For example, most of the services available at YRG CARE are provided in-house, with a few services being outsourced. …