HIVQUAL-T: monitoring and improving HIV clinical care in Thailand, 2002-08.
OBJECTIVE
We report experience of HIVQUAL-T implementation in Thailand.


METHODS
Program evaluation.


METHODS
Twelve government hospital clinics.


METHODS
People living with HIV/AIDS (PLHAs) aged ≥15 years with two or more visits to the hospitals during 2002-08.


METHODS
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.


METHODS
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.
Thailand Ministry of Public Health (MOPH), Nonthaburi 11000, Thailand. sombat.than@yahoo.com
Sombat
S
Thanprasertsuk
Somsak
S
Supawitkul
Rangsima
R
Lolekha
Peeramon
P
Ningsanond
Bruce D
BD
Agins
Michelle S
MS
McConnell
Kimberley K
KK
Fox
Saowanee
S
Srisongsom
Suchin
S
Chunwimaleung
Robert
R
Gass
Nicole
N
Simmons
Achara
A
Chaovavanich
Supunnee
S
Jirajariyavej
Tasana
T
Leusaree
Somsak
S
Akksilp
Philip A
PA
Mock
Sanchai
S
Chasombat
Cheewanan
C
Lertpiriyasuwat
Jordan W
JW
Tappero
William C
WC
Levine
D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy; D044966:Anti-Retroviral Agents / Q000008:administration & dosage; D019985:Benchmarking; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D007256:Information Systems / Q000458:organization & administration; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration* / Q000592:standards; D010865:Pilot Projects; D015397:Program Evaluation; D017150:Public Sector / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D012648:Self Care / Q000379:methods; D013785:Thailand
D044966:Anti-Retroviral Agents