Optimising Quality of Care: How to Enmesh quality improvement into routine HIV Care

Jennifer Hoy: Director HIV Medicine, Alfred Hospital and Monash University

Most cities and countries have now achieved the 90-90-90 HIV target: 90% of people living with HIV (PLHIV) are diagnosed, 90% of HIV-positive people receiving antiretroviral (ARV) treatment and 90% of PLHIV have viral load suppression. Now a push for a 4th 90 is on the table – 90% receiving Quality HIV care.  

Jennifer discussed two perspectives on this approach to quality care: the patient’s and the healthcare provider’s perspective.

From a patient’s perspective, approaches to quality care can be measured through patient satisfaction surveys and reported patient outcome measures. Such reportable measures includes individualised patient-centred care encounters, experiences of HIV related discrimination and stigma and ease of access to care.

From the healthcare providers perspective, quality care means establishing appropriate management, monitoring and screening of HIV related co-morbidities, ensuring efficient care in a patient-centred manner delivery.

Adapting a new culture of quality of care improvement in HIV treatment would be crucial. This new culture is the key to future sustainability of this 4th 90% target, with clinical audit being its main driver. Clinical audit scrutinises care delivery at different care provision levels. Starting at individual healthcare level providers, to health care settings, the state level and to the highest national level. Vital shortfalls in care delivery could then be identified, feedback these outcomes, for crucial brainstorming of targeted intervention strategies. 

Therefore, to achieve this 4th 90% of HIV care which is ‘Quality of Care’, audits are important! The “measurement-intervention-measurement-intervention” approach to care, because viral suppression is not the end goal of HIV treatment. It is health-related ‘quality of life’.