The "Key Change Concepts" document highlights two years of work in South Africa to scale up ARV treatment and quality improvement in five of South Africa's provinces. Created at the 2006 Drakensberg Conference on HIV/AIDS, this document draws upon success and challenges faced by local partners at a variety of health care facilities. Through their continual quality improvement, these IHI partners have developed methods to increase access to excellent HIV/AIDS care in resource-constrained settings. The goal of this document is to provide guidance and insight to scale-up of HIV/AIDS care not only across South Africa, but to other developing countries as well.