title: Implementation of HIV treatment as prevention strategy in 17 Canadian sites: immediate and sustained outcomes from a 35-month Quality Improvement Collaborative.
abstract: BACKGROUND
  Rapid scale-up of effective antiretroviral therapy (ART) is required to meet global targets to eliminate new HIV infections and AIDS-related deaths. Yet, gaps persist in all nations striving for these targets. In the intervention setting of British Columbia (BC), Canada, where ART is publicly funded, 73% of HIV-diagnosed were on ART in 2011, and only 49% were achieving viral suppression.
  
  
  METHODS
  An observational case descriptive study of HIV care sites in BC recruited to participate in a 35-month Breakthrough Series Quality Improvement Collaborative and sustainability network. Sites collected four quality indicators, qualitative change descriptions and implemented the chronic care model (CCM) and HIV care and treatment guidelines. Two reviewers assigned monthly implementation scores to evaluate site progress (January 2011-2012). All quality indicators were pooled and analysed using probability-based run chart rules.
  
  
  RESULTS
  Seventeen teams with a pooled median population of 2296 HIV patients joined the initiative. Comprehensive CCM implementation and evidence of improvement was achieved by 29% of sites (implementation score of 4.0 or higher on 5.0 scale). Evidence of sustained improvement was observed for patient engagement (88.8-90.4%), ART uptake among patients unequivocally in need (92.9-94.8%), and ART uptake (≥6 months) and achieving viral suppression (57.3-78.4%) (all p<0.05).
  
  
  CONCLUSIONS
  This study shows evidence of sustained improvements in HIV care processes and treatment outcomes for an estimated population of 2296 HIV patients in 17 BC sites. Overall success points to opportunities for other high-income countries seeking to improve HIV health outcomes.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Clarke
authors.affiliation: Department of Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
authors.forename: Tessa
authors.initials: T
authors.lastname: Cheng
authors.affiliation: Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Reims
authors.affiliation: National Quality Center, New York State Department of Health AIDS Institute, New York, New York, USA.
authors.forename: Clemens M
authors.initials: CM
authors.lastname: Steinbock
authors.affiliation: BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Meaghan
authors.initials: M
authors.lastname: Thumath
authors.affiliation: Department of Blood Borne Pathogens, Chronic Disease, Northern Health, Prince George, British Columbia, Canada.
authors.forename: Robert Sam
authors.initials: RS
authors.lastname: Milligan
authors.affiliation: BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Rolando
authors.initials: R
authors.lastname: Barrios
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000517:prevention & control; D000998:Antiviral Agents / Q000627:therapeutic use*; D001955:British Columbia; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents
keywords: Chronic disease management; Collaborative, breakthrough groups; Control charts, run charts; Primary care; Quality improvement