Building up quality of PrEP services offered by key population-led clinics through a continuous quality improvement approach: A case study of Glink Hanoi clinic in Vietnam

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) has been scaled-up in Vietnam through public, private and key population (KP)-led clinics. With this expansion, it is vital to ensure PrEP services are of quality and meet national standards and client expectations.
DESCRIPTION: The USAID/PATH Healthy Markets project and Ministry of Health (MOH) piloted PrEP in 2017 and defined collaborative continuous quality improvement (CQI) system in PrEP clinics. Standardized forms and checklists were developed and vetted by clinic, community and MOH stakeholders to help CQI teams (consisting of PrEP providers, community representatives and provincial CQI coordinators) pause-and-reflect on PrEP service quality. CQI teams conduct Plan-Do-Study-Act (PDSA) cycles every quarter to pinpoint quality challenges, implement solutions and measure their effect. We provide a case study of Glink-Hanoi, a KP-clinic delivering PrEP since 2020.
LESSONS LEARNED: Glink's first CQI session was conducted by clinic staff, technical program officers and community workers in September 2020 who identified three areas for improvement: (i) sufficiently completing client medical records; (ii) properly documenting reasons for drop-out; and (iii) establishing client feedback channels. These were reflected in Glink's action plan, with staff assigned to oversee each follow-up action. Subsequent CQI visits were conducted in January, June and October 2021 to review progress and identify priorities for continuously improving services. From September 2020-October 2021, Glink-Hanoi demonstrated a systematic medical record system, enhanced documentation of drop-out reasons and staff capacity to counsel clients, and established client feedback channels. Client feedback was increasingly positive: from January-June 2021, 84%, 90%, and 89% clients reported high satisfaction and 0%, 1%, and 1% reported dissatisfaction with waiting time, staff attitudes, and service quality, respectively; from July 2021-January 2022, 91%, 94%, and 92% reported high satisfaction with these same quality indicators and 1% reported dissatisfaction with service quality (n=387). From October 2020-September 2021, Glink-Hanoi recruited 713 new PrEP clients, with 99% continuing on PrEP after three months despite severe COVID-19 social distancing.
CONCLUSIONS: Our results demonstrate that applying regular collaborative CQI-PDSA cycles can help clinics identify gaps in PrEP services and actively improve quality. Strong CQI systems enable KP-clinics like Glink to play a leading role in Vietnam's PrEP program.

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