Objective: We report experience of HIVQUAL-T implementation in Thailand. Design: Program evaluation. Setting: Twelve government hospital clinics. Participants: People living with HIV/AIDS (PLHAs) aged ≥15 years with two or more visits to the hospitals during 2002-08. Intervention: 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. Main Outcome Measure: 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.
- Performance measurement
- Quality improvement
ASJC Scopus subject areas
- Health Policy
- Public Health, Environmental and Occupational Health