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Haiti QI Resources
ACLN 2010 Intro to HIVQUAL-Haiti

HIVQUAL-Haiti: Integration of Performance Indicators in the National EHR

ACLN 2010 Proceedings

HIVQUAL - The Haitian Model

HIVQUAL-Haiti Storyboard: TB Screening at Grace Children's Hospital

ACLN 2011 Proceedings

HIVQUAL International Update, February 2009

HIVQUAL International Update, March 2010

HEALTHQUAL International Update, TB Issue II

HEALTHQUAL International Update, January 2012

Impact Of HIVQUAL Activities In The Haitian Health System

Improvement of ART enrollment through improvement of quality of service Experience of Hopital Universitaire de la Paix

Using QI interventions to sustain ART enrollment and adherence in HIV+ children

HEALTHQUAL Update - October 2012

Use of an electronic medical record to implement, monitor, and improve HEALTHQUAL clinical care indicator performance rates

Adult TMP-SMX prophylaxis for HIV+ patients on antiretroviral Treatment

Facilitating CD4 Monitoring Through Quality Improvement Methodology

Improving Vital Signs Monitoring for hospitalized patients using the PDSA method

Enrollment on HAART at Hôpital Saint Damien /Nos Petits Frères et Soeurs (HSD/NPFS)

Enhancing Acceptance of Family Planning Methods among HIV positive Women

Quality of Care through Improvement of ART Enrollment: Hôpitalde la CommunautéDame-Marienne/AEADMA

Success in Rapidly Increasing Enrollment of HIV-infected Patients on ART at the Hospital Foyer St-Camille

Impact of Quality Improvement methodology “HEALTHQUAL” on patients and staff in the context of retention in ARV treatment

Improving isoniazid prophylaxis in HIV care

Tuberculosis screening in respiratory symptomatic primary care patients

Addressing adherence of patients on Antiretroviral Therapy with Quality Improvement interventions

Improving TB Screening in HIV positive patients through Quality Improvement

Ensuring continuity of care for patients on Antiretroviral Therapy in resource-limited facility

Impact of Coaching on HIV Care in Haiti

Using Quality Improvement strategies for successful HAART Enrollment

Improving CD4 monitoring at Hôpital Saint Damien /Nos Petits Frères et Soeurs (HSD/NPFS)

Improving Pediatric Immunization at Hôpital Saint Damien /Nos Petits Frères et Soeurs (HSD/NPFS)

Interview with Haitian delegation at 2014 International Forum on Quality and Safety in Healthcare

Haiti Overview

Background

 

HIVQUAL-Haiti was launched in 2007 with completion of baseline data collection in 2008, along with Organizational Assessments at all 19 initial clinics. Implementation has since expanded to 74 clinics throughout the country.

The data collection process for HIVQUAL-Haiti has been enhanced and facilitated by an electronic medical records (EMR) system used by clinics supported by the Ministry of Health and Population throughout Haiti. The system has been customized to incorporate the HIVQUAL-Haiti indicators, and allow for the automatic generation of HIVQUAL reports. The EMR was developed by ITECH, a PEPFAR partner, in collaboration with CDC-Haiti.

 

The National Quality Committee - which developed and defined indicators, chose participating facilities and developed an organizational system to support these activities – maintains oversight of the national program. The Committee and HQ-Haiti have confirmed an operational plan for coaching and mentoring which includes 2 coaching visits per year, an annual organizational assessment, and regular communication with facilities to support and collect QI project information.

 

Despite severe disruptions in service (and in some cases complete termination of services at certain facilities) due to the 2010 earthquake, the HIVQUAL-Haiti team has continued to implement the HQ model to improve quality of care for adults and children living with HIV/AIDS. The in-country team is also currently planning regional trainings to support on-going improvement activities.

 

HIV/AIDS Epidemic

 

Haiti has the most significant HIV/AIDS burden in the Caribbean. The prevalence rate in adults aged 15-49 was 2.2% in 2006. Haiti’s epidemic has partly been fueled by high poverty, illiteracy, internal migration, and sexually transmitted infections. Out of a total population of 10,085,214 people, 111,000 people 15 years and older and 12,000 people under 15 years are HIV infected. The life expectancy at birth is 61(58.1) years and the infant mortality rate is 6%(8.6%). Prevalence rates amongst females age 15-24 is 1.4% (2.1% - 2009) while prevalence rates amongst males in the same age group is 0.6%  

 

Demographic Data

 

Population: ~10 million cf. Rapport de situation nationale a l’intention de l’UNGASS. MARS 2010

  • HIV prevalence:
  • -250,000 adult and pediatric population (with 123,858 enrolled in care)
  • TB/HIV prevalence: ~ 23% of TB patients have HIV
  • Other pertinent Demographics: About half (61,0000 of HIV+ are eligible for ART
  • About half of the eligible for ART (32,000) are on ART
  • Year Program Began: September 2007
  • Scope: HIV, pediatrics and PMTCT
  • Prevalence in Pregnancy women : 2.5%
  • Orphan due to AIDS : 93,000
  • Number of HIVQUAL facilities: 57 (as of December 2011)

Haiti Health System Infrastructure

 

The Haitian health system is composed of public, semi-public and private sector entities. The Ministry of Health is organized into central, departmental and community levels. One third of the nation’s 663 health institutions fall under the auspices of the public sector. Political transitions have represented a significant challenge to the public health care system.

 

The semi-public sector is made up primarily of non-governmental organizations staffed by the public sector but managed by private entities.

 

The majority of private health facilities and private physicians, nurses and other health care personnel are centered in the capital, Port-au-Prince.

 

Coordination of Haiti’s HIV/AIDS response is under the direction of the Ministry of Health. Towards the end of 2008, Haiti initiated a strategic approach to engage key ministries other than the Ministry of Health—such as the ministries of Justice, Youth and Sports, Women, Social Affairs and Education. These ministries were made aware of the existing plan to address HIV/AIDS in the country and were encouraged to develop plans that would align their areas of action to the national HIV/AIDS efforts. Civil society has also played a key role in confronting the HIV/AIDS epidemic in Haiti by providing essential services during times of weakened government capacity.

 

In 2006, Haiti set goals to increase access to HIV prevention, treatment, care, and support. After setting these goals the country started taking steps towards universal access to care. One of these steps was increasing the number of sites throughout the country that provide ART. The number of sites providing ART increased from 20 sites in 2005 to 75 sites in 2012. As a result, total ART coverage increased from 22% in 2005 to 33% in 2006 to 41% in 2011. The number of HIV infected women receiving ART to prevent mother to child transmission of HIV also increased from 17% in 2005 to 22% in 2007 to 83% in 2011. The rates of ART coverage continued to increase throughout 2012.

 

References: Accessed 7/16/10

http://www.unaids.org/en/CountryResponses/Countries/haiti.asp

http://apps.who.int/globalatlas/predefinedReports/EFS2008/full/EFS2008_HT.pdf

http://data.unaids.org/pub/FactSheet/2008/sa08_hai_en.pdf

http://www.mesi.ht

Team/Leadership
Mr. Nicasky Celestin
Data Manager
CDC Haiti
Dr. Reginald Jean Louis
West & North West Care and Treatment specialist
CDC Haiti
Dr. Nika-Nola Lamothe
HIVQUAL Haiti Program Manager
MSPP
Ms. Nirva Duval
Epidemiologist, M&E
MSPP
Dr. Jean Gabriel Balan
Contractor
ITECH-Haiti
Program Organigram

Data Profile

Overview

  • HQ-Haiti has submitted 13 rounds of data reviewing care provided from January 1, 2008 through March 31, 2014
  • 106 HQ-Haiti clinics have participated in HIVQUAL data collection, representing 74% of 143 HIV clinics and 12% of 908 health facilities in-country
  • Performance rates have been measured for the following 10 indicators: clinical visits, CD4 monitoring, ARV Therapy, adherence assessment, CPT, TB clinical screen, nutrition evaluation, immunization, PMTCT ARV prophylaxis and family planning
  • HIVQUAL Haiti indicators are programmed directly into a fully integrated national electronic medical record system
Background
HIVQUAL-Haiti began in 2007 through a collaboration between the MOH, CDC and implementing partners. Technical support and guidance is provided by CDC-Haiti. The National Quality Committee developed and defined indicators, chose participating facilities and developed an organizational system to support these activities. HIVQUAL Haiti’s data collection process is fully integrated with a nationally implemented electronic medical records system.  
 
Data Collection
The first round of data collection reviewed care provided at 18 clinics from January 1st, 2008 through June 30th, 2008. Indicators addressed a range of services including palliative care, PMTCT and ART. Six additional clinics collected baseline data for review period 2: July - December 2008. Twenty-four clinics collected baseline data for review period 4: July - December 2009. Four clinics collected baseline data for review period 6: July - December 2010. Six clinics collected baseline data for review period 8: July - December 2011, and 10 clinics collected baseline data for review period 10: April - September 2012. Haiti’s EMR allows them to retrospectively look at data for any review period. In 2011, Haiti data were retrospectively stratified into adult and pediatric (<15 years old) data for all but 9 clinics. Data for those 9 clinics (except for CPT) are not included in the aggregate results for the first 6 review periods. Beginning in the 7th review period, January - June 2011, all data from all clinics are stratified and included in the aggregate results. Due to low numbers of eligible patients, pediatric data from clinics that collected baseline data in the 6th - 10th rounds are first included in the 10th round aggregate scores. Clinic scores were averaged to calculate a mean clinic score for each indicator.