The Four Phases of Enhancing Care

Through the situation analysis assessment based on the ECI framework, each AIDS Care Team determined two or more areas of care on which to focus. As priorities for care were identified, each Team worked through four phases of analysis and intervention, including the initial situation analysis followed by research planning, implementation of interventions, and evaluation. After five years, comparison of differences in AIDS Care Team experiences in process and outcome within each of the four common phases can now provide a rich experience base from which lessons for enhancing HIV care in resource-constrained can be drawn.

Phase I: Situation Analysis
During the situation analysis, AIDS Care Team members collected available evidence regarding the status of each of the ten areas of HIV/AIDS care in their specific country or region and analyzed the data according to the team’s focus. The information obtained during this phase provided an overview of care, and identified gaps or deficiencies in care that might be addressed by ECI.

Phase II: Research and Planning
The situation analysis was followed by a planning phase during which the AIDS Care Teams selected an area of care to connect the needs of their country or region with the knowledge and resources available through the expertise of Team members. This phase used a "scenario planning" approach that considered various options for future policies, programs, and procedures directed at improving care, and assessed the feasibility of those strategies. Specific methods for improving care were determined during this phase. Proposed strategies for interventions were assessed on the basis of technical soundness and feasibility, accessibility, economic efficiency and sustainability, and ethical desirability and acceptability within their legal and political context.

Phase III: Implementation
Phase III involved the implementation of the interventions selected by each AIDS Care Team for improving the care of people with HIV/AIDS. Once the AIDS Care Teams identified gaps in HIV/AIDS care services, they considered strategies that could be implemented immediately given the current level of resources in their country or region. Given constrained resources, strategies that required additional personnel, equipment, drugs, or facilities were usually foregone in favor of immediately feasible interventions.

Phase IV: Evaluation
Evaluation of the outcomes of interventions selected by each Team constitutes Phase IV. Although the evaluation procedure itself represents a separate phase, the method for assessing the intervention began as part of the planning phase (Phase II) and was determined prior to the initiation of Phase III. Evaluation methods include standard process and outcome measures relating to the specific interventions led by each AIDS Care Team, as well as more generally applicable criteria that can be applied across all Teams.