Development and validation of a composite indicator of the organizational quality of outpatient services provided by the Brazilian Unified Health System to individuals living with HIV/AIDS

Abstract

When the care provided by health services extends beyond the administration of effective medication, it becomes equitable, capable of modifying, or at the very least, mitigating the impact of existing inequalities between individuals who access the services. In Brazil, the care network for people living with HIV/AIDS (PLWHA) is heterogeneous in terms of both size and organizational arrangement, having been constructed on pre-existing structures. An additional layer of complexity is introduced by the fact that the federal government is responsible for the development and implementation of clinical protocols, as well as the provision of antiretroviral drugs and specific tests. However, the provision and maintenance of all other resources, as well as the organization of care processes, fall under the purview of the other levels of government. Serial surveys conducted by the Qualiaids study, initiated in the early 2000s, have demonstrated that these discrepancies are reflected in disparate care configurations, in the number of individuals receiving antiretroviral therapy, in the manner in which care is structured, organized, and coordinated, and in other aspects. This information is derived from a set of indicators encompassing the three domains (care, management, and resources) of the Qualiaids Questionnaire. Composite indicators are capable of synthesizing intricate multidimensional concerns, thereby facilitating the assessment of performance and progress. The dissemination of results among stakeholders is rendered more expedient through the use of composite indicators. In this regard, the objective of this project is to develop and validate composite indicators that can be used to inform the quality targets of the Unified Health System (SUS) outpatient services for people living with HIV (PLHIV). The development and validation of the composite indicators will be based on the Qualiaids 2023 Survey. The following steps will be undertaken in the course of data analysis, namely the development of the composite indicator: definition of the theoretical model; exploratory analysis of the indicators; multiple analysis; normalization, weighting and aggregation; strength and sensitivity assessment; association with treatment results; decomposition; and visualization. The database will be divided into two subsets for the purposes of indicator construction and validation.