Kevany, S., Khumalo-Sakutukwa, G., Singh, B., et al. PLOS ONE (February 2016), 11(2):e0149335. doi: 10.1371/journal.pone.0149335.
The authors described the methodology, results, and effects of quality assurance and control (QAC) monitoring during the three-year implementation of the Project Accept trial (HPTN 043), a community-based HIV counseling and testing study conducted in sub-Saharan Africa and Thailand. The QAC monitoring comprised steps to the intervention's three components—mobile voluntary counseling and testing (MVCT), community mobilization (CM), and post-test support services (PTSS). Supervisors observed a random sample of 5 to 10 percent of sessions each month, and evaluated staff against multiple criteria on scales of 1–5. A score of 5 indicated 100 percent adherence, 4 indicated 95 percent adherence, and 3 indicated 90 percent adherence. The authors reported that the QAC scores of MVCT and CM staff across the study sites were 4 or higher, and continued to improve over time. QAC scores for the PTSS component were initially lower, because of the wide range of activities in the PTSS component and new staff hires or changes in staff responsibilities, but increased to 4 by Year 2. The authors concluded that the constant staff monitoring and support provided by QAC monitoring is essential to ensure quality implementation in large-scale interventions.