1. Scale up and Beyond: Continuous Quality Improvement at HUEH

2. HIV Care and Treatment at HUEH  Hôpital de l’Université d’Etat d’Haiti is a university training hospital and largest hospital in Haiti  800 beds;169,000 patients annually  Complex and underfunded  April 2006, HIV Care and Treatment Program initiated  December 2006, 40 patients enrolled on ART  April 2007, 259 patients ever enrolled in program, 151 ever placed on ART  Loss to follow up: 30%  No system for regular evaluation of adherence to ART  Clinical mentors began implementation of PDSA cycles to improve loss to follow up and adherence evaluation

3. Results  Loss to follow up in April 2008 was down to less than 19% even while the number of tests performed at HUEH rose dramatically  Clear system established for adherence evaluation  The number of patients receiving adherence evaluation and counseling increased from 4% in April of 2008 to 21% in May and 46% in June of 2008.

4. Next Steps  Clinical mentoring team developing a Quality Improvement Plan for HUEH to define indicators and institutionalize CQI processes  Next questions potentially relevant for future PDSA cycles:  Does the higher proportion of patients who enroll in the clinic after testing HIV+ translate into steady retention once enrolled?  How can results of adherence evaluations be used to improve patient outcomes?

5. Acknowledgements  I-TECH clinical mentors:  Jean Gabriel Balan MD  Yves Lambert MD  Marinho Elisma MD  Nathaelf Hyppolitte MD  Estère Michel RN  Rachel Labbe Coq MD  Shay Bluemer MPH  Nancy Puttkammer MPH  Nika Nola Lamothe MD  Joseph Adrien Emmanuel Demes MD MPH  Jean Ronald Cornelly MD  Patrice Joseph MD (CDC)  Yves Marie Bernard MD (CDC)  MOH and HUEH Administration

6. I-TECH Clinical Mentoring Team Thank you