1. 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

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

3. Why we need Quality Improvement ?
Start baseline assessment for HIV services : October 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

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

5. 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

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

7. 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

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

9. 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

10. 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

11. 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

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

13. 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

14. 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

15. 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

16. Treatment innovation

18. Treatment innovation
Cervical cancer screening
STI screening

19. 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

20. 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.

21. Welcome Thailand