Peeramon Ningsanond MD. Bureau of AIDS TB STI, DDC, MOPH Thailand

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Presentation transcript:

Peeramon Ningsanond MD. Bureau of AIDS TB STI, DDC, MOPH Thailand Countrywide Scaling Up Quality Improvement in HIV Care and Treatment Partnerships for National Scale-up of the HIVQUAL-T Model for Quality Improvement in HIV Care Peeramon Ningsanond MD. Bureau of AIDS TB STI, DDC, MOPH Thailand

Thailand ART profile In 2007 170,000 ART cases 84% coverage in AIDS cases 960 ART sites 820 Government ART sites in 76 provinces

Why we need Quality Improvement ? Start baseline assessment for HIV services : October 2002 Results : 84% provided primary prophylaxis for Pneumocystis carinii pneumonia 39% provided primary prophylaxis for Cryptococcal meningitis 58% screened for tuberculosis 32% ever receivied antiretroviral therapy 51% ever received a CD4 testing (Pilot Sites for HIQUAL-T model in 3 provinces in high prevalence region, northern Thailand ) Main Objective: To develop comprehensive HIV care model in northern Thailand

What is HIVQUAL-T model ? Infrastructure Group Learning HIVQUAL T software CQI process

Part of HIVQUAL-T Indicators (version 4.3) CD4 and Viral Load testing PCP, Cryptococcosis Pennicilosis .and MAC primary prophylaxis Antiretroviral therapy Follow up rate Adherence Tuberculosis screening and treatment Prevention with positive STI screening Pap smear screening

Performance Measurement by HIVQUAL-T in northern provinces of Thailand, during 2002 - 2005

We need collaboration for scale up !! Collaboration with 4 partners TUC : Thailand MOPH – U.S.CDC Collaboration center BATS : Bureau of AIDS TB STIs IHQIA : The Institute of Hospital Quality Improvement and Accreditation NHSO : National Health security office

Expansion of HIVQUAL-T model in Thailand 2004: 12 piloted sites 2005: 57 piloted sites 2006: 63 hospitals 2007 – 2008 : 820 Hospitals

Project Management Structure Ministry of Public Health (MOPH) Bureau of Planning and Strategies (BOPS) Thailand MOPH – U.S.CDC Collaboration (TUC – Care & Counseling Team) Department of Disease Control (DDC) National Health Security Offices (NHSO) BATS Working team Hospital Accreditation (HA) Regional office of DDC/ PHO Consultant team Countrywide Scaling Up Quality Improvement in HIV Care and Treatment Hospitals

Responsibilities of Partners Department of Disease Control and Thailand MOPH – U.S.CDC Collaboration center Directly coordinate with Regional office of DDC/Provincial Public Health Offices and hospitals Create group learning networks in regional and local level Update HIVQUAL T indicators Report HIVQUAL T National data to partners Responsible for technical oversight Countrywide Scaling Up Quality Improvement in HIV Care and Treatment

Responsibilities of Partners National Health Security Office Formulate HIV/ AIDS care policies and benefit packages Coordinate, monitor and ensure the quality of clinical services in HIV/AIDS Care The Institute of Hospital Quality Improvement and Accreditation To support CQI process in hospital by using HA guideline

Number of Performance measurement reports, QI projects and Total Budget : 2002-2007 Expansion

Classification and Number of Quality Improvement Projects July 2008 Group 1: ARV treatment = 11 projects Group 2: Tuberculosis screening in PLHAs = 6 projects Group 3: STDs screening and Cervical cancer screening in PLHAs = 50 projects Group 4: HIV Comprehensive care = 75 projects

Classification of Quality Improvement Projects Group 5: Developing database system = 2 projects Group 6: Couple counseling in hospitals and health care unit = 11 projects Group 7 : Capacity Building in health staff and developing HIV care system = 21 projects Total = 142 projects

Examples: Quality Improvement projects Medical service check lists Care package for each unit/service/visit HIVAIDS clinic flow chart Management in Loss FU cases Campaign for Pap smear screening Risk reduction counseling Condom use promotion peer Care network with health centers Care service in disclosure patients

Treatment innovation

Treatment innovation Cervical cancer screening STI screening

Key success factors HIVQUAL-T PM/QI QI Budget Group learning Policy : National standard / National Quality indicators HIVQUAL-T PM/QI Group learning meeting Consultant teams QI Budget

Acknowledge TUC NHSO DDC Kimberley Fox MD. Somsak Supawitku MD. Chiratda Utipibun MD Rangsima Lolekha MD. Saowanee Srisongsom Suchin Chunwimaleung Suchada Muktier NHSO Sorakij Bhakeecheep MD. Kajeerata Prugago MD. DDC Pachara Sirivongrangson MD. Sombat Thanprasertsuk MD.

Welcome Thailand