HIVQUAL-T: monitoring and improving HIV clinical care in Thailand, 2002-08

• Published in: International journal for quality in health care Vol. 24; no. 4; pp. 338 - 347
• Main Authors: THANPRASERTSUK, SOMBAT, SUPAWITKUL, SOMSAK, LOLEKHA, RANGSIMA, NINGSANOND, PEERAMON, AGINS, BRUCE D., MCCONNELL, MICHELLE S., FOX, KIMBERLEY K., SRISONGSOM, SAOWANEE, CHUNWIMALEUNG, SUCHIN, GASS, ROBERT, SIMMONS, NICOLE, CHAOVAVANICH, ACHARA, JIRAJARIYAVEJ, SUPUNNEE, LEUSAREE, TASANA, AKKSILP, SOMSAK, MOCK, PHILIP A., CHASOMBAT, SANCHAI, LERTPIRIYASUWAT, CHEEWANAN, TAPPERO, JORDAN W., LEVINE, WILLIAM C.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.08.2012
• Subjects: Acquired Immunodeficiency Syndrome - therapy; AIDS-Related Opportunistic Infections - prevention & control; Anti-Retroviral Agents - administration & dosage; Benchmarking; CD4 Lymphocyte Count; Clinics; Health policy; HIV Infections - therapy; Hospitals; Human immunodeficiency virus; Humans; Information Systems - organization & administration; Infrastructure; Measurement; Medical service; Outpatient Clinics, Hospital - organization & administration; Outpatient Clinics, Hospital - standards; Pilot Projects; Program Evaluation; Public Sector - organization & administration; Quality Improvement - organization & administration; Quality Improvement - standards; Quality Indicators, Health Care - organization & administration; Self Care - methods; Syphilis; Thailand; Tuberculosis; Thailand
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzs008

Objective. We report experience of HIVQUAL-T implementation in Thailand. Design. Program evaluation. Setting. Twelve government hospital clinics. Participants. People living with HIV/AIDS (PLHAs) aged ≥ 15 years with two or more visits to the hospitals during 2002-08. Intervention. HIVQUAL-T is a process for HIV care performance measurement (PM) and quality improvement (QI). The program includes PM using a sample of eligible cases and establishment of a locally led QI infrastructure and process. PM indicators are based on Thai national HIV care guidelines. QI projects address needs identified through PM; regional workshops facilitate peer learning. Annual benchmarking with repeat measurement is used to monitor progress. Main Outcome Measure. Percentages of eligible cases receiving various HIV services. Results. Across 12 participating hospitals, HIV care caseloads were 4855 in 2002 and 13 887 in 2008. On average, 10-15% of cases were included in the PM sample. Percentages of eligible cases receiving CD4 testing in 2002 and 2008, respectively, were 24 and 99% (P < 0.001); for ARV treatment, 100 and 90% (P = 0.74); for Pneumocystis jiroveci pneumonia prophylaxis, 94 and 93% (P = 0.95); for Papanicolau smear, 0 and 67% (P < 0.001); for syphilis screening, 0 and 94% (P < 0.001); and for tuberculosis screening, 24 and 99% (P < 0.01). PM results contributed to local QI projects and national policy changes. Conclusions. Hospitals participating in HIVQUAL-T significantly increased their performance in several fundamental areas of HIV care linked to health outcomes for PLHA. This model of PM-QI has improved clinical care and implementation of HIV guidelines in hospital-based clinics in Thailand.