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The Philippine Stigma & Discrimination Reduction Quality Improvement Learning Network

Reducing HIV-related stigma and discrimination in healthcare settings through peer learning and application of quality improvement (QI) methods

What is the problem?

HIV-related stigma and discrimination (S&D) in healthcare settings is a major barrier to achievement of UNAIDS’ 95-95-95 targets, discouraging people living with HIV (PLWH) and key populations (KP) at high risk of HIV acquisition from accessing treatment and prevention, engaging in care, and adhering to treatment. In the Philippines, where the HIV epidemic is highly concentrated among KPs of men who have sex with men, sex workers, transgender people, and people who inject drugs, HIV-related S&D is further compounded by cultural, social, and institutional factors that discourage care seeking, undermine treatment self-efficacy, and normalize marginalization1.

A study made in 20162 demonstrated the presence of HIV-related stigma at a Philippine tertiary-level teaching hospital. The study recommended the development and implementation of programs addressing the individual, environmental, and policy levels to reduce HIV-related stigma of healthcare workers towards KPs & PLHIV and have a lasting impact on their healthcare. The responsibility of addressing S&D experienced by PLHIVs in hospitals lies with institutional leadership to ensure that HCWs are not purveyors of stigma and discrimination among PLHIV, and instead, are stewards of the safe space that healthcare should provide. For this to happen, assessment should be done at an institution level, and quality improvement (QI) measures established and promulgated. Mitigating S+D is critical to creating environments that enable health care institutions to reach these KPs and ensure that they receive HIV prevention and treatment services that are responsive to their unique identities, needs, and circumstances.

What is the solution?

In 2016, The Southeast Asia Stigma Reduction QI Learning Network (QI S+D) was set up by the University of California San Francisco (UCSF)-HEALTHQUAL, with support from Gilead Sciences and ViiV Healthcare to accelerate integration of S&D-reduction activities into routine HIV quality management programming in Cambodia, Lao PDR, Thailand, and Vietnam, through continuous measurement, QI methods, and peer-to-peer learning and knowledge exchange4.

In 2019, the Philippines joined the Network. The national QI S+D initiative is led by the Philippine Society of Microbiology & Infectious Disease (PSMID), Sustained Health Initiatives of the Philippines (SHIP), Inc., and UNAIDS Philippines, in partnership with public and private hospitals.

 PARTICIPATING HOSPITALS (as of December 30, 2020)
Bataan General Hospital (Bataan Haven)
Jose B. Lingad Memorial Regional Hospital (Bahay Lingad)
Bicol Regional Training & Teaching Hospital
Makati Medical Center (Center for Travel & Tropical Medicine)
Philippine General Hospital (Sagip Clinic)
Research Institute for Tropical Medicine
San Lazaro Hospital
St. Luke’s Medical Center – BGC
The Medical City (i-REACT Clinic)
Corazon Locsin Montelibano Memorial Regional Hospital
Cebu Provincial Hospital (Balamban)
Vicente Sotto Sr. Medical Center
Southern Philippines Medical Center

Continuous measurement

As part of activities of the Philippine Network, participating hospitals will measure HIV-related S&D among healthcare workers (HCW) on a continuous basis using common indicators from a validated survey tool. In addition, these facilities will regularly collect data on patients’ experience and treatment literacy through structured questionnaires, patient fora, and clinical encounters.

QI methods

Using data from HCW surveys, patient feedback, and clinical performance data, facilities apply QI methods (e.g., process mapping, plan-do-study-act cycles) to identify root causes of suboptimal outcomes and implement contextually tailored interventions to improve identified gaps. Through this process, a broader conceptualization of quality of care is forged in which S&D reduction activities and people-centered service delivery are explicitly aligned with 95-95-95 targets (Figure 2).

How does this project work?

The Philippine QI S+D Network project seeks to accelerate progress toward achievement of UNAIDS’ 95-95-95 targets in the Philippines, by linking S&D reduction activities to routine quality improvement activities in healthcare facilities.

The Philippine project objectives are to:

  1. Develop & implement a multi-level measurement tool to determine the challenges in providing high-quality care for PLHIV in healthcare facilities in the Philippines, including issues such as stigma and discrimination
  2. Make use of data collected from the tool for improving services to provide high quality care that includes reducing stigma & discrimination
  3. Create health policy/guidelines to address challenges of providing equitable health care for PLHIVs, while improving their health care experience and increase treatment adherence
  4. Lobby for the adoption of the HIV Quality Improvement measurement tool into the nationwide HIV prevention, treatment, care, and support programs in all health facilities.

SHIP will conduct institutional S&D baseline assessments, and over the next 12 months, UCSF-HEALTHQUAL, SHIP and other implementation partners will provideongoing mentorship and support to the teams in participating hospitals, Our long-term aim is expand the Network to other hospitals & health facilities, and integration into national HIV program.

Progress and Impact

Implementation progress across participating countries, including the Philippines, is monitored by UCSF-HEALTHQUAL and shared with at the multi-country Network Meetings. Monitoring focuses on five broad domains: planning and organization, performance measurement, quality improvement, training, coaching and support. Leveraging its expertise in HIV quality management programming, UCSF-HEALTHQUAL provides technical assistance to health ministries & facilities seeking mentorship on implementation of Network activities. Activities to assess patient experience and treatment literacy through common indicators are currently being implemented, with the goal of routinely monitoring, and acting upon, these data as part of ongoing S&D reduction activities.

References

  1. UNAIDS. Confronting discrimination: overcoming HIV-related stigma and discrimination in healthcare settings and beyond. 2017.
  2. Lopez, S., et al. Measuring stigma and discrimination towards people living with HIV among health workers in a tertiary, government teaching hospital in the Philippines. Acta Medica Philippina. 2017:51(4)
  • Courtesy of Laura Nyblade, RTI International
  • Ikeda, D. et.al.,  A quality improvement approach to the reduction of HIV-related stigma and discrimination in healthcare settings. BMJ Global Health. 2019; 4(3): e001587.
  • Courtesy of UCSF-HEALTHQUAL
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Asia-Pacific survey: HIV patients in PH most affected by pandemic

The results show that more than 90 percent of people living in the Philippines with HIV, and others at-risk, reduced or delayed their visits to HIV clinics amid the COVID-19 pandemic.

December 7, 2020

Gilead Sciences, Inc. and the Sustained Health Initiatives of the Philippines (SHIP) recently revealed results from a survey to evaluate the impact of COVID-19 on the access and delivery of care in HIV (human immunodeficiency virus) infections, which includes testing, treatment and prevention, in Asia-Pacific.

The results show that more than 90 percent of people living in the Philippines with HIV, and others at-risk, reduced or delayed their visits to HIV clinics amid the COVID-19 pandemic.

Moreover, eight in 10 Filipino respondents were concerned about their long-term ability to access antiretroviral medications, one of the highest percentages among all respondents in the Asia-Pacific region.

The Philippines has the highest new HIV infection rates in the region.

The disruption caused by the pandemic can set back efforts in trying to reduce this infection rate.

The survey “Impact of COVID-19 on Access and Delivery of HIV Care in Asia Pacific” was conducted online, from October to mid-November, in 10 countries/territories in Asia-Pacific (Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam) by Kantar Health, funded by Gilead Sciences.

It was disseminated to local medical societies, HIV patient groups and care centers.

A total of 1,265 respondents, including people living with HIV (PLHIV), individuals at-risk, and HIV care prescribers, were interviewed in the region.

Insights
A total of 153 of these respondents were from the Philippines.

An analysis into the responses in the survey provides additional insights into the disruptions caused by the COVID-19 pandemic:

• COVID-19 has impacted HIV testing most severely in the Philippines: The Philippines reported the highest decline in frequency of testing across all respondent groups in the region.

Access to testing was reported to be most disrupted among individuals at-risk, with 64 percent of them reporting decrease in frequency of testing.

Travel restrictions (68 percent) and concerns of getting infected at point-of-care (68 percent) were the main reasons for the change in behavior.

The Department of Health (DoH) previously raised concerns over the lack of HIV testing in the country due to quarantine restrictions and travel constraints.

Newly diagnosed cases in the Philippines dropped by 68 percent in the second quarter of 2020 compared to 2019, but the DoH’s epidemiology bureau noted that there has been limited access to HIV services since March.

• COVID-19 has also disrupted preventive care: More than half of at-risk respondents in the Philippines have reported that they had either decreased or stopped their intake of preventive medications, with 100 percent of them citing travel restrictions as the cause for the disruption.

“Proper routine testing, as well as preventive care, are important for affected populations to manage their health to avoid higher risk of health complications.

It is crucial to find new ways to provide support and access to adequate HIV care when they experience such constraints,” said Dr. Kate Leyritana of SHIP. “The increased adoption of telehealth services observed during the pandemic is one such mode of care delivery and we believe that telehealth can bridge the gap in access to HIV care in the long-term.”

SHIP, established in 2015, aims to bridge gaps in HIV response by strengthening the continuum of care through innovation, partnerships, and capacity building.

A leader and enabler in the HIV community, SHIP has been providing new learning approaches to HIV primary care.

Source: https://tribune.net.ph/index.php/2020/12/07/asia-pacific-survey-hiv-patients-in-ph-most-affected-by-pandemic/

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HIV tagged a public threat as cases rise daily, DOH says

ByClaudeth Mocon-Ciriaco

WHILE the country is combating the Covid-19 pandemic, the Department of Health (DOH) assured the public that the agency “remains focused and resolute” in its mandate of preventing and reducing transmission of HIV as 21 new cases are being reported every day.

According to the Department of Health (DOH)  HIV/AIDS and ART Registry of the Philippines (HARP), there are a total of 81,169 HIV and AIDS cases reported from January 1984 to October 2020. 

In October 2020, there were a total of 735 confirmed HIV-positive individuals, 96 percent (704) of whom were male.

Among the total number of  81,169 diagnosed cases from January 1984 to October 2020, 94 percent (76,216) were male and more than half (51 percent, 41,163) were 25-34 years old at the time of diagnosis.

The regions with the most number of reported cases were the National Capital Region (NCR) with 30,622 cases (38 percent), Calabarzon with 12,467 (15 percent), Central Luzon with 8,005 (10 percent), Central Visayas with 6,827 (eight percent), and Davao Region with 4,477 (six percent).

Continued collaboration

Health Secretary Francisco T. Duque III said that the 21 cases diagnosed daily in the country is a public health threat which needs the continued cooperation and collaboration of all local communities, civil society organizations, key populations at-risk and the whole of government.

“Despite the presence of the Covid-19 pandemic, we should all remain focused and resolute in our mandate of preventing and reducing transmission,” Duque said.

The health chief stressed that the government wil continue to provide quality HIV and AIDS-related services that are readily available including addressing conditions that aggravate the spread of HIV infection like poverty, gender inequality, marginalization and ignorance.

Delayed visits

Gilead Sciences, Inc. and the Sustained Health Initiatives of the Philippines (SHIP) announced the results of a a pulse survey conducted to evaluate the impact of the Covid-19 pandemic on the access and delivery of HIV care, which includes testing, treatment and prevention, in Asia-Pacific. 

The results show that more than 90 percent of people living with HIV as well as individuals at-risk in the Philippines reduced or delayed their visits to HIV clinics during the Covid-19 pandemic. 

Moreover, eight in 10 Filipino respondents were concerned about their long-term ability to access antiretroviral medications, one of the highest percentages amongst all respondents in the Asia-Pacific region.

With the latest and highest HIV infection rates in the region, the disruption caused by the pandemic can set back efforts in trying to reduce this incidence rate. 

The Philippines is one of 10 countries and territories in Asia-Pacific involved in the survey. A total of 1,265 respondents, including people living with HIV (PLHIV), individuals at-risk, and HIV care prescribers, were interviewed from the region; 153 of these respondents were from the Philippines. 

An analysis into the responses in the survey provided additional insights into the disruptions caused by the Covid-19 pandemic: 

Covid-19 has had the most severe impact on HIV testing in the Philippines. The Philippines reported the highest decline in the frequency of testing across all respondent groups in the region. Access to testing was reported to be most disrupted among individuals at-risk, with 64 percent of them reporting a decrease in frequency of testing. Travel restrictions (68 percent) and concerns of getting infected at point-of-care (68 percent) were the main reasons for the change in behavior. The DOH previously raised concerns over the lack of HIV testing in the country due to quarantine restrictions and travel constraints. Newly diagnosed cases in the Philippines dropped by 68 percent in the second quarter of the year compared to last year, but the DOH’s epidemiology bureau noted that there has been limited access to HIV services since March.  

Covid-19 has also disrupted preventive care. More than half of at-risk respondents in the Philippines have reported that they had either decreased or stopped their intake of preventive medications, with 100 percent of them citing travel restrictions as the cause for the disruption. 

Dr. Kate Leyritana of the Sustained Health Initiatives of the Philippines (SHIP) shared that proper routine testing as well as preventive care are important for affected populations to manage their health to avoid higher risk of health complications. 

“As such, it is crucial for us to find new ways to provide support and access to adequate HIV care when they experience such constraints,” Dr. Leyritana said.

She added that the increased adoption of telehealth services observed during the pandemic is one such mode of care delivery and “we believe that telehealth can bridge the gap in the access to HIV care in the long-term.”

As the survey results suggest, there was an uptake of telehealth services with 70 percent of the PLHIV and individuals at-risk in the Philippines saying that they utilize telehealth services to receive care, and expect to be using telehealth in the future for video consultation (45 percent) and refill of medications (32.5 percent).

“This pulse survey shows that ensuring access to critical HIV care services is an important public health priority especially when an end in sight to the pandemic remains uncertain. Gilead is committed to collaborating with the HIV community from public health authorities to HIV care prescribers, patient groups and civil societies in the Philippines and across the region to identify strategies that can close the gaps to care delivery to ensure the continuity of vital HIV care services during these challenging times and beyond,” said Boon-Leong Neo, Senior Director, Medical Affairs, Gilead Sciences, Asia-Pacific.

Source: https://businessmirror.com.ph/2020/12/10/hiv-tagged-a-public-threat-as-cases-rise-daily-doh-says/


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COVID pandemic disrupted HIV care, testing – study

ACCESS to testing and treatment for human immunodeficiency virus (HIV) have been disrupted by the coronavirus disease pandemic (COVID-19) pandemic, according to a study conducted by a non-government organization and a US-based biopharmaceutical company.

In a statement for yesterday’s celebration of World’s AIDS Day, the Gilead Sciences Inc. and the Sustained Health Initiatives of the Philippines (SHIP) said the study showed “more than 90 percent of people living with HIV as well as individuals at-risk in the Philippines reduced or delayed their visits to HIV clinics during the COVID-19 pandemic.”

It also said the disruption can set back efforts to reduce the HIV incidence rate.

The study showed that access to testing was reported to be most disrupted among individuals at-risk, with 64 percent reporting decrease in frequency of testing.

Travel restrictions (68 percent) and concerns about getting infected at point-of-care (68 percent) were the main reasons for the change in behavior.

This is in accordance with a statement of the Department of Health regarding its concerns over the lack of HIV testing in the country due to quarantine restrictions and travel constraints.

“Newly diagnosed cases in the Philippines dropped by 68 percent in the second quarter of the year compared to last year, but the DOH’s epidemiology bureau noted that there has been limited access to HIV services since March,” said Gilead and SHIP.

The study also showed that more than half of at-risk respondents in the Philippines have said they had either decreased or stopped their intake of antiretroviral medications.

“A total of 100% of them cited travel restrictions as the cause for the disruption,” said the study.

The study was conducted from October to mid-November 2020, in 10 countries/territories in the Asia Pacific, including Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam.

There were 1,265 respondents, with 153 coming from the Philippines.

According to the DOH HIV/AIDS and ART Registry of the Philippines, 81,169 HIV and AIDS cases have been reported from January 1984 to October 2020.

In October 2020 alone, there were 735 confirmed HIV-positive individuals.

In a statement, Health Secretary Francisco Duque III said the pandemic is not a reason to stop efforts to reduce HIV transmission.

“The 21 new HIV cases diagnosed every day means that the country is facing a public health threat, which needs the continuing cooperation and collaboration of all local communities, civil society organizations, key populations at risk, and the whole of government,” he said.

Source: https://malaya.com.ph/index.php/news_news/covid-pandemic-disrupted-hiv-care-testing-study/