External quality assessment in the voluntary counseling and testing centers in the Brazilian Amazon Using dried tube specimens: Results of an effectiveness evaluation

Abstract

Introduction: In 2011, the Brazilian Ministry of Health rolled out a program for the external quality assessment of rapid human immunodefi ciency virus (HIV) tests using the dried tube specimen (DTS) method (EQA-RT/DTS-HIV). Our objective was to evaluate the implementation of this program at 71 voluntary counseling and testing centers (VCTCs) in the Brazilian Legal Amazonian area one year after its introduction. Methods: Quantitative and qualitative study that analyzed secondary data and interviews with healthcare workers (HCWs) (n=39) and VCTC coordinators (n=32) were performed. The assessment used 18 key indicators to evaluate the three dimensions of the program’s logical framework: structure, process, and result. Each indicator was scored from 1-4, and the aggregate results corresponding to the dimensions were expressed as proportions. The results were compared to the perceptions of the HCWs and coordinators regarding the EQA-RT/DTS-HIV program. Results: The aggregate scores for the three dimensions of structure, process, and result were 91.7%, 78.6%, and 95%, respectively. The lowest score in each dimension corresponded to a different indicator: access to Quali-TR online system 39% (structure), registration in Quali-TR online system 38.7% (process), and VCTC completed the full process in the program’s fi rst round 63.4% (result). Approximately 36% of the HCWs and 52% of the coordinators reported enhanced trust in the program for its rapid HIV testing performance. Conclusions: All three program dimensions exhibited satisfactory results (>75%). Nevertheless, the study fi ndings highlight the need to improve certain program components. Additionally, long-term followups is needed to provide a more thorough picture of the process for external quality assessment.