28/03/17 to 29/03/17
3rd Cross-Regional QI Collaborative Learning Session


Following a series of regional QI (Quality Improvement) learning sessions conducted during November-December 2016, representatives of QI Collaborative from eight regions where QI initiative is being implemented convened on March 27-29 for their 3rd Cross-Regional Meeting.

The objectives of the meeting were to share successful changes supported by data across the regions (indicators, run-charts, and cascades); revise the current change packages by regions for April-September 2017; revise the regional QI charters beyond the current timeline of the RESPOND project (setting targets, identifying areas of improvement and potential changes, and the structure of the improvement Collaborative on the regional level).

Welcoming the participants, Deputy Minister of Health of Ukraine Oksana Syvak emphasized that during this time of healthcare reform especially valuable is Collaborative’s experience in engaging primary health physicians in HIV care provision.

Director of the Public Health Center of the Ministry of Health of Ukraine Nataliya Nizova gave an overview of the current state of the healthcare reform in Ukraine. Larysa Hetman, Adviser to the Public Health Center Director, introduced the audience to HIV detection and treatment approaches under the new National Unified Protocol.

Director of Health Office at the USAID Ukraine Jeri Dible emphasized that USAID will continue to support Ukrainian partners in their efforts to provide quality health services.

UNAIDS Strategic Information Adviser Eleonora Gvozdeva in her presentation on Fast-Track Cities highlighted that more Ukrainian cities will be joining the Fast Track Cities Initiative.

During the three-day event, the regional QI teams presented achievements, analyzed challenges, and used shared knowledge to revise the current change packages as well as began to develop Regional Roadmaps 2020. FHI 360 international experts Bruno Bouchet and Danielle Darrow De Mora actively participated in by providing feedback and contributing to the planning of the teams’ activities.

Today, 156 local QI teams work at ART sites in eight regions of Ukraine (Dnipropetrovska, Khersonska, Kirovohradska, Kyivska, Mykolayivska, Odeska and Zaporizka Oblasts and the city of Kyiv). Local QI teams consists of TB, STI, Primary Health Care doctors, obstetricians-gynecologists, nurses, and social workers. Each region tests from 6 to 27 changes to HIV-service continuum out of 42 changes from the General Change Package.

To fill the gaps in HIV detection, members of the QI Collaborative have been screening patients for risk behavior, performing provider-initiated HIV testing, and testing sexual partners of PLHIV for HIV.

To enroll more PLHIV in medical care, local QI teams have introduced completing all required lab work  (ELISA, CD4 and blood chemistry) in one patient’s visit to the ART site, extended working hours of ART sites, improved logistics between ART sites and labs, involved primary health care service in provision of care for PLHIV, begun testing in-patients for HIV and registering them in AIDS service prior to discharge from a hospital, provided reminder text messages, phone calls or letters to patients.

Changes implemented in the regions have led to the improvement in HIV testing yield, increase in the percentage of PLHIV registered and initiated on ART, and improvement in the effectiveness of treatment.

Examples of successful changes implemented during the last six months in eight regions of QI Collaborative are available at the links listed below (PDF, in Ukrainian).

Dnipropetrovska Oblast
Change:    Transfer patients on ART from AIDS Centers to local ART sites
Gap:  Treatment gap

Khersonska Oblast
    HIV risk assessment by specialty physicians (STI, TB and narcology specialists)
Gap:  Testing and referral/linkage gap

Kirovogradska Oblast
Change:    HIV risk assessment by specialty physicians and/or PHC providers 
Gap:  Testing and referral/linkage gap

Kyiv City
    Providing the required lab tests (2 rapid tests + ELISA, CD4 and biochemical screening) over one patient visit to the Trust Office/ART site
Gap:  Testing and referral/linkage gap

Kyivska Oblast
    Returning lost to follow up patients to care using text messages, phone calls or letters
Gap:  Linkage to care and retention gaps

Mykolayivska Oblast
Change:    Involvement of primary health care in HIV care provision
Gap:  Linkage gap

Odeska Oblast
  Provider-initiated HTS by specialty physicians (TB, STI, narcology, OB/GYN)
Gap:  Testing and referral/linkage gap

Zaporizka Oblast
    Cooperation with NGOs (case management by social workers) for linkage to care for PLHIV from key populations
Gap:  Linkage and retention gap

To facilitate the process of sharing successful changes between the regions RESPOND team created an open resource in the form of Electronic Regional Storyboards offering information on the milestones and members of the QI Collaborative in each region, regional change packages and implementation dynamics, current regional treatment cascades, maps of ART sites and their coverage with services provided by NGOs, examples of successful changes, interactive run-charts featuring HIV testing, detection, patient registration and treatment indicators.

Watch video on how to use the Electronic Stroryboards.

The event Agenda and presentations are available as attachments below.

To view picture, please follow this link.