Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery

Abstract

BackgroundThe global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care.MethodsWe trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans.ResultsAfter 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program.ConclusionsWe successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Do Quality Improvement Initiatives Improve Outcomes for Patients in Antiretroviral Programs in Low- and Middle-Income Countries? A Systematic Review

“…In this study, documentation improved from 83% to 99% at the provincial level and from 54% to 97% at the district level. 16 In terms of ART retention, the 1 reporting study found no impact associated with the intervention, with no statistically significant difference in retention of postpartum women after 6 months in the intervention and control arms. 18…”

“…One study reported a district level increased uptake of 62%–91% over 30 days. 16 In another setting, monthly ART initiation rose 185.5% after initiation of the intervention, from 179 initiations per month to 511. 19 ART adherence and retention were only reported in 1 study each.…”

“…1): health systems approaches using QI methods (n = 20), 21,22,24–26,29–43 standard-based methods that use QI tools to improve performance gaps (n = 2), 17,23 campaigns that use QI methods (n = 1), 28 and QI learning networks including collaboratives (n = 6). 15,16,18–20,27 Initiatives were performed in 13 LMICs, including South Africa, 15,19,20,28 Vietnam, 16,35 Zambia, 17,23 Nigeria, 18,27 Uganda, 21,22,31,36,40 Mozambique, 21,22 Namibia, 21,22,29,34,42,43 Haiti, 21,22,24,32,36,41 Thailand, 25,26 Nicaragua, 33 Kenya, 38 Tanzania, 37 and Guyana, 34,39 (Fig. 3).…”

A quality improvement approach to the reduction of HIV-related stigma and discrimination in healthcare settings

“…While the specific content and length of these trainings vary by country, they are all embedded into ongoing HIV quality programming activities and, wherever possible, make use of existing funding streams and QI and S&D-reduction curricula. On-site coaching and mentoring, a well-documented enabler of QI implementation,27 28 is provided by Ministries of Health and implementing partners (Cambodia, Vietnam) to guide sites in the analysis of data from HCWs and PLWH, and the development and testing of S&D-reduction interventions to address identified areas for improvement.…”

Building HIV healthcare worker capacity through telehealth in Vietnam

“…3 As in other settings, training and on-site mentoring of clinic health workers has been a critical factor in the success of ART scale-up efforts. [4][5][6][7][8] This support has largely been delivered through collaborations between international organisations and national training institutions. However, the HIV response in Vietnam, as in many countries, is in a period of transition from a donor-supported programme to one supported and financed by national institutions.…”