The HIV Care Cascade: Facing the Challenges of Scaling Up
The HIV Care Cascade: Facing the Challenges of Scaling Up
In his consideration of the implementation of the cascade in Thailand, Dr. Sombat Thanprasertsuk, Senior Technical Advisor for the Department of Disease Control, focused on care provided to people with HIV and considered whether they are receiving the best possible care.
He described the national scale-up of HIVQUAL-T, a system for measuring and improving care that has been taken to scale in Thailand. This platform, which is managed by the Ministry of Public Health, offers an easy-to-use software program for easy reporting as well as benchmarking of data that can be viewed by providers across the country. In addition, a Website offers an overview of the program and shows performance trends over the past several years.
Applied to both adult and pediatric care settings, the work of HIVQUAL-T, along with parallel applications for improvements in counseling, testing, and care for sexually transmitted infections, underscores the importance of providing comprehensive care to patients who are maintained so that they may remain healthy and virologically suppressed. Ultimately, although not measured in the cascade, the end goal is to reduce the likelihood of mortality.
The Thai system emphasizes improvement interventions based on local analysis and context in hospitals, along with exchange of stories and peer learning to accelerate improvements. The Thai model also promotes human capacity development, which has resulted in increased job satisfaction in HIV programs across the country. This system has been integrated into the national hospital accreditation program and is linked to the national financial reimbursement scheme. Moreover, evaluation data indicate that participating hospitals have better performance than those that do not participate.
Most important, the Thai system, which is headed toward a sustainable, integrated model, offers many useful lessons for other countries in terms of feasibility and implementation. It reinforces the importance of providing the best possible care to patients while achieving the larger population goals defined by the treatment cascade. In concluding, Dr. Thanprasertsuk clearly articulated the justification for focusing on quality of care: to address gaps, reinforce adherence to standards of care, and build capacity for providers to measure their own care. Thailand has done just that -- with remarkable success.
Building on Local and National Successes
In his consideration of the implementation of the cascade in Thailand, Dr. Sombat Thanprasertsuk, Senior Technical Advisor for the Department of Disease Control, focused on care provided to people with HIV and considered whether they are receiving the best possible care.
He described the national scale-up of HIVQUAL-T, a system for measuring and improving care that has been taken to scale in Thailand. This platform, which is managed by the Ministry of Public Health, offers an easy-to-use software program for easy reporting as well as benchmarking of data that can be viewed by providers across the country. In addition, a Website offers an overview of the program and shows performance trends over the past several years.
Applied to both adult and pediatric care settings, the work of HIVQUAL-T, along with parallel applications for improvements in counseling, testing, and care for sexually transmitted infections, underscores the importance of providing comprehensive care to patients who are maintained so that they may remain healthy and virologically suppressed. Ultimately, although not measured in the cascade, the end goal is to reduce the likelihood of mortality.
The Thai system emphasizes improvement interventions based on local analysis and context in hospitals, along with exchange of stories and peer learning to accelerate improvements. The Thai model also promotes human capacity development, which has resulted in increased job satisfaction in HIV programs across the country. This system has been integrated into the national hospital accreditation program and is linked to the national financial reimbursement scheme. Moreover, evaluation data indicate that participating hospitals have better performance than those that do not participate.
Most important, the Thai system, which is headed toward a sustainable, integrated model, offers many useful lessons for other countries in terms of feasibility and implementation. It reinforces the importance of providing the best possible care to patients while achieving the larger population goals defined by the treatment cascade. In concluding, Dr. Thanprasertsuk clearly articulated the justification for focusing on quality of care: to address gaps, reinforce adherence to standards of care, and build capacity for providers to measure their own care. Thailand has done just that -- with remarkable success.
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