Adopting a Pediatric HIVQUAL-H Framework in Measuring the Quality of Pediatric HIV Care in Haiti

Abstract

Objective: Haiti has the largest pediatric HIV population in the Americas. The U.S. President’s Emergency Plan for AIDS Relief has been instrumental to increase access to care for Haiti’s pediatric HIV population. Though electronic medical records (EMRs) have facilitated this care, there are limited published data on the quality of care. This study aimed to use an adapted quality of pediatric HIV care framework in Haiti.Methods: This is a retrospective study of active pediatric HIV patients less than 15 years of age seen at the Saint Damien Hospital HIV clinic in Tabarre, Haiti from January 2012 to December 2016. Clinical and laboratory data were abstracted from the EMR based on a Pediatric HIVQUAL-H framework generated by incorporating Haitian pediatric HIV guidelines into the Thai HIVQUAL model focusing on eight core and four expanded indicators.Results: There were 393 different patients analyzed separately by calendar year, accounting for 1473 patient-years analyzed. Overall, 96.8% received clinical monitoring (1426), 99.4% PJP prophylaxis (1465), 98.5% TB screening (1452), and 98.7% growth (1454) and 98.8% oral health (1455) assessments; 89.8% received yearly CD4 monitoring (1323), 94.6% antiretroviral treatment (1394), and 92.5% adherence monitoring (1362); viral load monitoring was only done 50% of the time (730). The overall hospitalization rate was 4% (66/1473). Only 31% (181/589) of patients over 10 years old were disclosed to their diagnosis. Immunizations were not reliably documented.Conclusion: The HIVQUAL-H framework identified rates of important clinical indicators, highlighting those needing improvement in an easy to track format. Viral load monitoring, oral health care, HIV disclosure, and immunizations are areas that could use focused interventions at this facility to improve standard of care for this population. This tool could be easily adapted for other pediatric HIV programs in developing countries with similar resource constraints.