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Implementation of HIV treatment as prevention strategy in 17 Canadian sites: immediate and sustained outcomes from a 35-month Quality Improvement Collaborative
  1. Christina M Clarke1,
  2. Tessa Cheng2,
  3. Kathleen G Reims3,
  4. Clemens M Steinbock4,
  5. Meaghan Thumath5,6,
  6. Robert Sam Milligan7,
  7. Rolando Barrios1,8
  1. 1BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
  2. 2Department of Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
  3. 3Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
  4. 4National Quality Center, New York State Department of Health AIDS Institute, New York, New York, USA
  5. 5BC Centre for Disease Control, Provincial Health Services Authority, Vancouver, British Columbia, Canada
  6. 6School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7Department of Blood Borne Pathogens, Chronic Disease, Northern Health, Prince George, British Columbia, Canada
  8. 8School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Rolando Barrios, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada V6Z 1Y6; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, V6T 1Z4


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.

  • Collaborative, breakthrough groups
  • Quality improvement
  • Chronic disease management
  • Primary care
  • Control charts, run charts
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