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Vietnam
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Vietnam| TB/HIV Collaborative-Thai Binh Province
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Collaborative Profile
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Improving TB detection and TB-HIV integration in Vietnam
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Publications
This short report describes the results of quality improvement activities supported by HCI to improve TB case detection and TB-HIV case management and service integration in Hai Duong and Nam Dinh provinces of Vietnam.
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Results of Collaborative Improvement: Effects on Health Outcomes and Compliance with Evidence-based Standards in 27 Applications in 12 Countries
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Publications
This paper summarizes 10 years of evidence of the effectiveness of collaborative improvement in improving health outcomes and compliance with health care standards. The collaborative improvement approach was designed by the Institute for Healthcare Improvement (IHI) in the United States to produce rapid, significant improvements in a targeted area of health care. The paper was commissioned by USAID and analyzes the results achieved by over 1,300 teams of health care providers who participated in 27 improvement collaboratives supported by USAID during 1998-2008. Data analyzed consisted of 135 time-series charts representing pooled data from groups of teams from 12 countries. All together, the data covered 81 distinct measures of compliance with standards and outcomes for maternal, newborn and child health, HIV/AIDS care, family planning, and malaria and tuberculosis diagnosis and treatment.
The study found that improvement collaboratives were able to achieve large increases in compliance with health care standards and in some cases, in health outcomes, across all care areas addressed, regardless of the baseline level of quality. Of the 135 analyzed time-series charts, 88% attained performance levels of at least 80%, and 76% reached at least 90%, even though more than half had baseline levels at 50% or below. The data provide compelling evidence that collaborative improvement can achieve large increases in performance, regardless of baseline level, and that results can be achieved relatively rapidly. Across collaboratives, time series charts showed average increases of 52%. Teams reached performance levels of 80% in about 13 months on average when baselines levels were below 50% and in about 6 months when baselines were above 50%.
The analysis also suggests that moving beyond 80% performance requires different efforts (system redesign) to make high quality the routine and that deliberate spread reduces time required to raise performance of new sites.
The strength of a health system is measured in its ability to deliver good health outcomes. By achieving significant, sustained improvements in compliance with standards and outcomes, collaborative improvement is a viable tool for health systems strengthening in developing countries. -
Program evaluation of TB-HIV interventions in Thai Binh Province, Vietnam
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Publications
This 18-month study aimed at increasing the quality and quantity of TB/HIV detection by implementing the TB testing corner at HIV C&T Center in Thai Binh city; conducting routine surveillance of HIV/TB detection and management at provincial and district health facilities and PPM activity; and organizing training on skill of TB/HIV detection and management for health staff of Thai Binh province. Key results include strengthening TB control network, treatment management, and training. A number of activities to expand TB/HIV integration were carried out, including policy development; capacity building; maintaining the continuum of care; quality assurance of services; support for public and private partnerships; strengthening the monitoring and evaluation system; and conducting information, education, and communication activities. Evaluation: The assessment looked at the capacity of TB/HIV systems; the process of implementation of HCI support at provincial and district level; the linkages developed among different stakeholders; and the impact of the interventions on the coverage and quality of TB and HIV services. The program’s degree of success was assessed by reviewing epidemiological data to provide pre- and post-intervention data on specific indicators; interviewing key informants from the National TB Program, the Thai Binh Provincial Health Services, TB hospital, the HIV/AIDS Center, and the TB/HIV coordination committee; observing of the use of instruments and equipment provided by QAP/HCI at TB hospitals and at the district level; and conducting in-depth discussions with heads of private clinics in Thai Binh City. The proportion of TB patients receiving HIV counseling increased remarkably, up to 99% in the last quarter, compared with the baseline of 47%. The HIV testing rate among TB patients also increased from 38% to 90%. TB screening was provided to 563 people with HIV during the project period, yielding TB diagnosis in 16% of screened people. With these improvements, the case detection of TB/HIV increased considerably, from only 33 patients in 2006 to 66 in 2007 and 77 in the first three quarters of 2008. The HIV prevalence among all TB patients increased from 1.9% in 2006 to 3.7% (66/1774) in 2007 and 5.4% (77/1421) in 2008 (data from first three quarters). Apart from the quality improvement of TB/HIV services, the interventions contributed to a significant improvement in overall TB case detection. The overall TB notification rate increased from 93 per 100,000 population in 2006 to 97 in 2007 and is projected to increase to 104 in 2008 (assuming 4th quarter notifications are equal to average of the first three quarters in 2008). These figures translate to an annual increase of 4.6% in 2007 and 11.7% in 2008.
Related Publication: Expanding TB and TB/HIV Integrated Services in Thai Binh Province, Vietnam
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Expanding TB and TB/HIV Integrated Services in Thai Binh Province, Vietnam
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Publications
This report provides an evaluation of an 18-month quality improvement intervention supported by the USAID-funded Quality Assurance Project (QAP) and its successor, the Health Care Improvement (HCI) Project, in Thai Binh Province of Vietnam. The province, located in the Red River’s Delta in northern Vietnam, has 1.8 million population, an annual TB case load of 1600–1800 cases, and an cumulative number of 2188 HIV-infected cases. In April 2007, QAP, in collaboration with NTP and Thai Binh Department of Health, initiated an 18-month work plan to pilot-test a model for TB/HIV integration activities at the provincial level and in all the eight districts in the province. Assistance to the intervention transitioned from QAP to HCI in 2008. The project also promoted partnerships between the TB program and other public and private health providers in order to maximize coverage of the DOTS program. A number of activities to expand TB/HIV integration were carried out, including policy development; capacity building; maintaining the continuum of care; quality assurance of services; support for public and private partnerships; strengthening the monitoring and evaluation system; and conducting information, education, and communication activities.
