Background and Need
Thailand , with a population of 62.5 million, is one of the Asian countries
hard hit by the HIV epidemic since 1984. As of the end of 2005, there have been
an estimated 1.1 million cumulative persons infected with HIV and 560,000 AIDS
related deaths, and there are 540,000 persons living with HIV/AIDS. National
comprehensive care programs including ARV treatment since 2001 have increased
care accessibility. As of the end of 2005, more than 80,000 persons had
received ARV treatment under the national program. During the first
GAP/Thailand cooperative agreement, BATS adapted an HIV care quality
improvement (QI) model to Thailand (HIVQUAL-T), and successfully improved care
quality in 63 hospitals. Data below show the percentage of eligible patients
who received each service, from 2002 through 2005:
Year
|
No. of hospitals
|
No. of patients
|
% CD4 tested
|
% received ARV
|
% received OI prophylaxis
|
% screened
|
PCP
|
Crypto
|
TB
|
Syphilis
|
Pap
smear
|
2002
|
12
|
4,855
|
28
|
87
|
77
|
52
|
NA
|
16
|
6
|
2003
|
41
|
11,786
|
58
|
78
|
80
|
57
|
42
|
5
|
5
|
2004
|
63
|
15,702
|
80
|
81
|
79
|
69
|
57
|
9
|
8
|
2005
|
63
|
22,122
|
93
|
88
|
87
|
84
|
81
|
40
|
45
|
|
The
Institute of Hospital Quality Improvement & Accreditation (IHQIA) in
Thailand also supports quality systems for clinical care. Currently, 914
government and private hospitals have initiated quality processes for hospital
accreditation with support from IHQIA. Recently, the national HIV care program
has been transferred, and integrated with the national health insurance scheme
(30-baht scheme) managed by NHSO. Therefore, cooperation among these
organizations is important to establishing a common national system (HIVQUAL-T)
for HIV care monitoring and QI. BATS, IHQIA and NHSO propose this project to
develop and scale up a national QI system and to establish mechanisms to make
HIV care QI sustainable.
Capacity
BATS
has experience leading the national HIV programs for many years, is responsible
for technical oversight of the national HIV treatment program, and has direct
experience developing and implementing the HIVQUAL-T model since 2002. The 12
regional Offices of Disease Prevention and Control (ODPC) have experience and
responsibility to improve the quality of HIV care and prevention, and have
direct relationships with hospitals in their regions. They can provide regular
supervision of participating hospitals and lead the local (regional and
provincial) learning networks. Provincial health offices have responsibility
for providing technical supervision and coordination for services delivered
under the 30-baht scheme. NHSO has the role of service purchaser, and therefore
needs to monitor and ensure the quality of clinical services, including HIV
care and treatment. NHSO will take the lead in formulating national policies
and plans for care packages, standards of quality, benchmarks, and QI
resources. Its 13 regional offices will help support training, M&E, and
strengthening learning networks for sustainability. IHQIA has had direct
responsibility for QI for most hospitals in Thailand since 1997. Its QI
processes, hospital surveyors, and hospital staff experience provide strong
support for scale-up of the HIVQUAL-T system. See Appendix B – CT1 – Attachment
1 for project management structure details.
Objectives and technical approaches
1. Expand hospital
implementation of the HIVQUAL-T system (strengthen existing QI committee and
working team, annual performance measurement, continuous QI processes) to cover
900 hospitals by 2011.
a.
Develop common policies and practices on HIV care QI with NHSO and IHQIA,
develop program and performance measurement tools, conduct training of trainers
for regional ODPCs, provincial health offices, and key hospital staff for each
province, to train hospitals for implementation
b.
Promote implementation of hospital-led QI cycles, including annual performance
measurement with HIVQUAL-T software, supervised by local and regional trainers
c.
Benchmark HIVQUAL-T performance measurement results at the provincial,
regional, and national level
d.
Establish and build capacity for provincial and regional learning networks, and
local QI coaching, with support from regional NHSO and IHQIA surveyor offices
e.
Organize annual national forum on quality HIV care, as an IHQIA Forum satellite
2. Evaluate
the accessibility and utilization of care and treatment services and address
barriers to services, annually
a.
Regional ODPCs jointly conduct national survey
3. Develop
care networks among hospitals and health centers
a.
Develop guidelines (HIV care package) for health centers, pilot implementation
(first year) and scale-up (2 nd -5 th year)
4. Develop
ARV adherence model
a. Develop guidelines and pilot in 2-4 sites
5. Develop
new national occupational HIV post-exposure prophylaxis guidelines (medical
practices, nursing practices, case management, report-support system)
a. Hold working group meeting to develop guidelines, conduct expert reviews and
revise guidelines, print and distribute guidelines, train hospitals and monitor
implementation by monthly reports to regional ODPCs and BATS
The project will
result in a sustainable system because it is based on existing resources
(hospital infrastructure, hospital accreditation system, 30-baht program,
national guidelines) and coordination among responsible organizations (BATS,
IHQIA, NHSO). In addition, the project will support capacity building on QI for
trainers from regional offices and for hospital staff. NHSO will fund the
hospital performance measurement and QI activities, and will monitor and
benchmark the performance measurement results.
Plan for evaluation
Implemented sites
Hospitals in 75 provinces of Thailand
Period
5 Years
(September 2006 – August 2011)
Organizations
• Bureau of AIDS, TB and STIs (BATS)
• National Health Security Office
(NHSO)
• The Institute of Hospital Quality
Improvement and Accreditation (HA)
• 12 Departments of Disease
Prevention and Control
• 75 provincial health offices
Workplan (1st Year: 2007 )
List
|
Activity
|
Oct.
|
Nov.
|
Dec.
|
Jan.
|
Feb.
|
Mar.
|
Apr.
|
May.
|
Jun.
|
Jul.
|
Aug.
|
1
|
Set working group meeting |
|
2
|
Hold Advisory Board and committee meeting |
|
|
|
|
|
|
|
|
|
|
3
|
Set meetings for developing HIVQUAL-T software |
|
|
|
|
|
|
|
|
|
|
|
4
|
Set the collaboration meeting among partnerships (Tri-party meeting) |
|
|
|
|
|
|
|
|
|
|
5
|
Train HIVQUAL-T software to trainers (DPC, PHO, and hospitals) |
|
|
|
|
|
|
|
|
|
|
6
|
Conduct monitoring and coaching |
|
|
|
|
|
|
|
|
|
|
7
|
Hold local group learning |
|
|
|
|
|
|
|
|
|
|
|
8
|
HIVQUAL-T National Forum
|
|
|
|
|
|
|
|
|
|
|
|
9
|
Develop the referral project |
|
10
|
Set meeting to develop PEP guideline |
|
|
|
|
|
|
|
|
11
|
Train PEP guideline for 12 DPCs |
|
|
|
|
|
|
|
|
|
|
|
|
Project management structure
Project director: Dr.Patchara Sirivongrangsan
(BATS)
Project assistant director: Dr.Benjawan
Raluek (BATS)
|