HIVQUAL-Uganda Pushes Ahead at Full Speed
May, 2008HIVQUAL-Uganda continues to stride forward with the completion of a second round of performance measurement, expansion to additional sites and a new partnership with UNICEF to bring quality improvement to pediatric care. Performance at the national level has improved across nearly all indicators, showing the importance of quality improvement strategies.
This collaboration between Uganda’s Ministry of Health, CDC Uganda, HIVQUAL International, and now UNICEF began in mid 2005 to address the rapid scale up of antiretrovirals. Seven indicators of HIV care were developed and in 2006 baseline data collection for 20 pilot sites, spread across 4 regions, were completed. During regional Quality Improvement trainings, each pilot site worked as a team to choose a focus area for improvement based on their own data. Back at their sites, each team expanded its members, refined their improvements and implemented their interventions. A multitude of such interventions were put into action, including patient outreach to promote CD4 testing, and clinic staff participation in MOH-sponsored prevention education and counseling courses. System improvements to promote better linkages between TB and HIV programs were also addressed by several programs.
The second data collection was completed December 2007, and a report was issued in February 2008. Improvement has been demonstrated across most indicators at most of the pilot sites. Across all sites, CD4 testing and continuity of care improved by approximately 10%, while adherence assessment and TB assessment and screening increased up to 15-20%. Prevention education increased nearly 30%.
HIVQUAL-U is led by its core in-country team, based in the Ministry of Health. This dedicated team consists of Dr Godfrey Kayita (Program Officer) and Julius Ssendiwala (Data Manager). Vital assistance is also provided by the support staff within the MOH AIDS Control Programme. The group is also joined by Prosper Behumbiize, who is an informatics analyst based with CDC-Uganda. Supported by Ministry of Health senior leadership, this dynamic and skillful team has worked to build a sustainable long term approach to quality improvement in Uganda. For more background on Dr Kayita, see his profile in this month’s “Faces of HIVQUAL” feature.
The ambitious in-country team is also currently working hard at spreading HIVQUAL to an additional 80 sites throughout the country, including regions in the North. 20 of these new sites are pediatric care facilities; in collaboration with UNICEF, HIVQUAL-U is spreading HIVQUAL beyond adult care to the care of HIV+ children. In July 2007, a two day meeting was held of key stakeholders and leading pediatricians to develop a set of pediatric indicators. Dr Bruce Agins (Medical Director, AIDS Institute) and Dr. Rangsima Lolekha (CDC-Thailand) were in attendance to help lead the process. The end result was a list of 11 indicators ranging from ARV therapy to malaria prevention. Planning is also ongoing to use the HIVQUAL-U model to improve the quality of care for all children, not just those infected with HIV. To date, the first round of data collection has been completed for pediatric indicators and quality improvement activities are underway. For an example of a pediatric QI project, see the special feature box on page 1.
As the second country to implement HIVQUAL International (the first to do so under PEPFAR), we hope HIVQUAL-U’s experiences and lessons can inform the efforts of other current and future country projects.
INT NEWS HEADLINES
HQI Update - August 2010 - Improving TB Care and Treatment through Quality ImprovementClick here for full story
HQI Update - May 2010 - Retention
Click here for full story
HQI Update - April 2010 - ACLN
Click here for full story
HQI Update - March 2010 Now Available
Click here for full story
HIVQUAL at 2010 Int'l Forum on Quality and Safety in Health Care
Click here for full story
HIVQUAL International is supported through HRSA as the International Quality Center
for PEPFAR and through funding from UNICEF.
HIVQUAL International partners with the National Quality Center.
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