Source: Ibrahim Dandakoye, Part A/MAI Grant and Quality Management Coordinator | Marion County Public Health Department Ryan White/HIV Services Program

Once upon a time, people infected by the Human Immunodeficiency Virus (HIV) had little hope to live beyond 6 months. Nowadays, with the discovery of the Antiretroviral Therapy (ART), HIV-infected individuals live a normal life, and life expectancy for People Living with HIV (PLWH) is almost the same as the general population, thus making HIV a chronic disease. With chronicity comes management; management requires measurement, and measurement leads to quality and improvement. The Marion County Public Health Department (MCPHD)’s Ryan White HIV services program is dedicated to ensure that all HIV patients living in the Transitional Grant Area (TGA) get the best quality of care defined by the Health Resources and Services Administration (HRSA). This goal is achievable by measuring services sub-recipients provide and program staff providing technical assistance in areas where improvement is needed.

Quality of Care

The HRSA’s HIV/AIDS Bureau (HAB) is committed to improving the quality of HIV care and treatment services for people living with HIV. Under the Ryan White HIV/AIDS Program, quality management is a series of activities that focus on enhancing the quality of HIV care provided and increasing access to services. These efforts focus on how health and social services meet established professional standards and user expectations.

The HIV/AIDS Bureau’s quality initiatives are designed to help Ryan White HIV/AIDS Program recipients implement quality management programs that target clinical, administrative, and support services.[1] Clinical Quality Management is the coordination of activities aimed at improving patient care, health outcomes, and patient satisfaction. Under the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Public Law 109-415), all Ryan White HIV/AIDS Program recipients are required to establish clinical quality management programs to:

• Assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infections.
• Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services.

Clinical quality management activities should be continuous and fit within and support the framework of grant administration functions. Components of a clinical quality management program include: infrastructure, performance measurement, and quality improvement.

In an effort to align with these policies and procedures mentioned in the Policy Clarification Notice (PCN-15-02), the MCPHD Ryan White HIV Services Program is undertaking quality management monitoring starting fiscal year 2019-2020.

Quality Management Monitoring Site Visits

The Marion County Public Health Department (MCPHD) Ryan White Services Program will undertake QM monitoring site visits to all its sub-recipients. The goals of these visits are to measure the quality of services provided to clients, to offer technical assistance if needed and to provide support to sub-recipients in their day to day activities that they have misunderstandings in regard to QM. The site monitoring will also ensure that providers (sub-recipients) are compliant with Health Resources Services Administration (HRSA)/HIV AIDS Bureau (HAB) guidelines in quality HIV services. 

QM site visits are recommended by PCN 15-02[2] in order to: (1) assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Guidelines for the treatment of HIV disease and related opportunistic infections; (2) develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services; (3) collect data in a timely manner in CAREWare; (4) provide services as mentioned in PCN 16-02, and; (5) ensure QM plan(s) is implemented as mentioned in Indianapolis TGA QM plan. QM site visits are solely designed to assist Ryan White sub-awardees provide the best of care to PLWH, and therefore, PLWH are getting quality standard of care (Quality Assurance).

In sum, the goal of quality improvement is achievable with monitoring and technical assistance provided by the MCPHD, and quality of care for PLWH is feasible as “Ending the Epidemic” is looming on the horizon for the next decade or so. Quality improvement aiming at 95% of viral load suppression[3] among PLWH and increasing number of at risk populations getting to know their status[4] at 95% will help in Ending the Epidemic.

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[1] Quality of care: https://hab.hrsa.gov/clinical-quality-management/quality-care

[2] Policy Clarification Notice: https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters

[3] https://www.cdc.gov/hiv/pdf/risk/art/cdc-hiv-art-viral-suppression.pdf

[4] Ending the Epidemic: https://www.hiv.gov/ending-hiv-epidemic