STOP HIV/AIDS Structure Learning Collaborative

About

The STOP HIV/AIDS Structured Learning Collaborative (the ‘Collaborative’) was launched on December 2nd 2010 to improve the quality of HIV care and services, improve patient engagement in care, and strengthen partnerships in care. The Collaborative followed Breakthrough Series Collaborative Methodology, to provide diverse healthcare sites a framework for learning, sharing, collaborating, and improving their HIV care. Collaborative staff supported teams across BC to develop quality improvement (QI) capacity to implement the Chronic Care Model (CCM) to achieve these aims. A total of 17 teams participated, with 12 teams located in STOP HIV/AIDS funded communities and 5 in other communities across BC.

  • Primary Outcomes

    • Participants learned and implemented the CCM to deliver proactive and organized needs-based HIV care, with supports for patient self-management.
    • Improvements were observed in nearly all QI indicators. After three years, gains have been sustained and additional improvements have been observed (see attached report).
    • 88% of teams collected patient satisfaction data at least once during the Collaborative.
    • A post-Collaborative survey highlighted the value of participation to be: ability to develop beneficial province-wide networks and working relationships, make “high clinical standards the norm”, and learn skills to develop improvement capacity.

  • Secondary Outcomes

    Participating teams have been observed over time to have developed greater system capacity for change, effective chronic illness care, and ability to meet increased demand with high quality HIV care and services. These are important secondary outcomes that can be attributed to the Collaborative and pilot project, and point to a legacy of improvement capability in 17 different BC sites. To illustrate:

    • Greater capacity for change and improvement.
    • Implementation of the Chronic Care Model (CCM) benefits whole systems.
    • Greater system capacity to meet greater demand for high quality HIV care and services.

  • Publications

    Background

    Rapid scale-up of effective antiretroviral therapy (ART) is required to meet global targets to eliminate new HIV infections and AIDS-related deaths. Yet, gaps persist in all nations striving for these targets. In the intervention setting of British Columbia (BC), Canada, where ART is publicly funded, 73% of HIV-diagnosed were on ART in 2011, and only 49% were achieving viral suppression.

    Methods

    An observational case descriptive study of HIV care sites in BC recruited to participate in a 35-month Breakthrough Series Quality Improvement Collaborative and sustainability network. Sites collected four quality indicators, qualitative change descriptions and implemented the chronic care model (CCM) and HIV care and treatment guidelines. Two reviewers assigned monthly implementation scores to evaluate site progress ( January 2011–2012). All quality indicators were pooled and analysed using probability-based run chart rules.

    Results

    Seventeen teams with a pooled median population of 2296 HIV patients joined the initiative. Comprehensive CCM implementation and evidence of improvement was achieved by
    29% of sites (implementation score of 4.0 or higher on 5.0 scale). Evidence of sustained improvement was observed for patient engagement (88.8–90.4%), ART uptake among patients unequivocally in need (92.9–94.8%), and ART uptake (≥6 months) and achieving viral suppression (57.3–78.4%) (all p<0.05).

    Conclusions

    This study shows evidence of sustained improvements in HIV care processes and treatment outcomes for an estimated population of 2296 HIV patients in 17 BC sites. Overall success points to opportunities for other high-income countries seeking to improve HIV health outcomes.

    Access article here: 2015-07-03 BMJ Qual Saf-Clarke-C

Conclusions

The Structured Learning Collaborative has helped 17 sites around BC improve the quality of HIV/AIDS care and services, improve patient engagement in care, and strengthen partnerships in care.  In addition to positive gains for these primary aims, participants and teams have been observed to have developed greater system capacity for change, effective chronic illness care, and ability to meet increased demand with high quality HIV care and services.  Important secondary outcomes can be attributed to participation in the STOP HIV/AIDS Structured Learning Collaborative and to STOP HIV/AIDS Pilot Project support.

Tools & Resources

All documents, resources, webinars, and event recordings related to the Collaboratives are available for viewing in the Tools and Resources section. If you would like more information, please contact hivcollaborative@cfenet.ubc.ca.

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