• Aima A Ahonkhai, Ifeyinwa Onwuatuelo, Susan Regan, Abdulkabir Adegoke, Elena Losina, Bolanle Banigbe, Juliet Adeola, Timothy G Ferris, Prosper Okonkwo, and Kenneth A Freedberg.
• Division of infectious Disease, Massachusetts General Hospital, Boston, MA, USA.
• Int J Qual Health Care. 2017 Oct 1; 29 (5): 654-661.

ObjectiveHIV care delivery in resource-limited settings (RLS) may serve as a paradigm for chronic disease care, but comprehensive measurement frameworks are lacking. Our objective was to adapt the patient-centered medical home (PCMH) framework for use in RLS, and evaluate the performance of HIV treatment programs within this framework.Design And SettingCross-sectional survey administered within the AIDS Prevention Initiative in Nigeria (APIN) network.ParticipantsMedical directors at APIN clinics.Main Outcome MeasuresWe adapted the 2011 US National Committee on Quality Assurance's PCMH standard to develop a survey measuring five domains of HIV care: (i) enhancing access and continuity, (ii) identifying and managing patient populations, (iii) planning and managing care, (iv) promoting self-care and support and (v) measuring and improving performance.ResultsThirty-three of 36 clinics completed the survey. Most were public (73%) and urban/semi-urban (64%); 52% had >500 patients in care. On a 0-100 scale, clinics scored highest in self-care and support, 91% (63-100%); managing patient populations, 80% (72-81%) and improving performance, 72% (44-78%). Clinics scored lowest with the most variability in planning/managing care, 65% (22-89%), and access and continuity, 61% (33-80%). Average score across all domains was 72% (58-81%).ConclusionsOur findings suggest that the modified PCMH tool is feasible, and likely has sufficient performance variation to discriminate among clinics. Consistent with extant literature, clinics showed greatest room for improvement on access and continuity, supporting the tool's face validity. The modified PCMH tool may provide a powerful framework for evaluating chronic HIV care in RLS.© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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