Community Empowerment Research

We help churches and nonprofits
measure needs of the people they serve,
set strategies to meet those needs, and
assess the impact of their work in service, evangelism, and outreach.

Doing Well at Doing Good

Presentation Made by Professor Michael E. Porter at Willow Creek Leadership Summit, August 2007

HIV/AIDS Care Delivery Value Chain

INFORMING & ENGAGING

  Prevention counseling on modes of transmission on risk factors

  Explaining diagnosis and implications

  Explaining course and prognosis of HIV

  Explaining approach to forestalling progression

  Explaining medical instructions and side effects

  Counseling about adherence; understanding factors for non-adherence

  Explaining co-morbid diagnoses

  End-of-life counseling

PATIENT VALUE

MEASURING

  HIV testing

  TB, STI screening

  Collecting baseline demographics

  HIV testing for others at risk

  CD4+ count, clinical exam, labs

  Monitoring CD4+

  Continuously assessing co-morbidities

  Regular primary care assessments

  Lab evaluations for initiating drugs

  HIV staging, response to drugs

  Managing complications

  HIV staging, response to drugs

  Regular primary care assessments

ACCESSING

  Meeting patients in high-risk settings

  Primary care clinics

  Testing centers

  Primary care clinics

  Clinic labs

  Testing centers

  Primary care clinics

  Food centers

  Home visits

  Primary care clinics

  Pharmacy

  Support groups

  Primary care clinics

  Pharmacy

  Support groups

  Primary care clinics

  Pharmacy

  Hospitals, hospices

PREVENTION & SCREENING
DIAGNOSING & STAGING
DELAYING PROGRESSION
INITIATING ARV THERAPY
ONGOING DISEASE MANAGEMENT
MANAGEMENT OF CLINICAL DETERIORATION
(Health outcomes per unit of cost)

  Connecting patient with primary care

  Identifying high-risk individuals

  Testing at-risk individuals

  Promoting appropriate risk reduction strategies

  Modifying behavioral risk factors

  Creating medical records

  Formal diagnosis, staging

  Determining method of transmission

  Identifying others at risk

  TB, STI screening

  Pregnancy testing, contraceptive counseling

  Creating treatment plans

  Initiating therapies that can delay onset, including vitamins and food

  Treating co-morbidities that affect disease progression, especially TB

  Improving patient awareness of disease progression, prognosis, transmission

  Connecting patient with care team

  Initiating comprehensive ARV therapy, assessing drug readiness

  Preparing patient for disease progression, treatment side effects

  Managing secondary infections, associated illnesses

  Managing effects of associated illnesses

  Managing side effects

  Determining supporting nutritional modifications

  Preparing patient for end-of-life management

  Primary care, health maintenance

  Identifying clinical and laboratory deterioration

  Initiating second- and third-line drug therapies

  Managing acute illnesses and opportunistic infection through aggressive outpatient management or hospitalization

  Providing social support

  Access to hospice care