Global HIV Prevention—Check!

by Kate McQuestion E-mail
In 2006, an article in the New England Journal of Medicine cited the substantial success of the implementation of a routine checklist on reducing catheter-related infections in the Intensive Care Unit of a Michigan Hospital. This story was shortly followed by media uptake the WHO Patient Safety Checklist, which, when utilized, reduced surgery-related mortality by almost 50%. The clinical use of checklists has become a hot topic for clinical quality improvement advocates, and as such, they been generally embraced in some areas of clinical practice.

Could this kind of tool be effective in public health?

The concept of a checklist is, intentionally, simple. The checklist serves as a mechanism to combat human failures of attention or memory—particularly in high stress or repetitive environments. The overall goal of a checklist is not only to ensure that each item is checked-off as prescribed, but to ensure an environment that promotes teamwork and professional discipline. Due to the ability of checklists to make complex systems approachable, they have already been widely used in industries such as aviation and construction, and now are advancing in medicine as well.

HIV prevention efforts, too, involve complex systems consisting of dynamic target populations, multiple programmatic efforts, and a lack of measurable quality indicators—all in all, making sustainable quality improvement challenging.

Checklists might provide a standardized method to ensure basic quality improvement and program management practices in an environment where pressing need may often lead to deficits in consistent and quality programming. Furthermore, they can be used as a tool to increase quality by improving communication, both internally within an organization, but also with the members of the target population being served.

It is a common complaint that too little emphasis falls of clinical delivery sciences, but it is fair to say that even less falls of preventative services delivery. NGOs working in HIV prevention need to keep better track of both the outcomes and impact of their programs. With out measuring results, it is hard to identify best practices and improve quality standards. HIV Quality Improvement Checklist tools could serve as a constant reminder for NGOs to monitor and evaluate results, thus improving health of communities world-wide.

Sources:

  • Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Eng J Med 2006; 355: 2725–32.
  • Gawande A. The Checklist Manifesto: How to Get Things Right. Henry Holt and Co: New York, 2009.
  • Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population [published online ahead of print January 14, 2009]. N Engl J Med. 2009; 360(5):491-499.

Kate McQueston is a Master of Public Health Student at The Dartmouth Institute for Health Policy and Clinical Practice and Intern at the WHO Regional Office for Europe Division for Communicable Diseases.

Global Health News Last Week

From March 28 to April 1, panelists working in Canada, Uganda, the United States, and Zambia will lead a discussion in GHDonline.org on ways to build sustainable partnerships to strengthen surgical and anesthesia capacity in resource-poor settings. More information can be found here.

March 22 was World Water Day. Blogger Tom Murphy has collected some interesting videos on PSI’s blog here.
Elizabeth Taylor, Hollywood icon and longtime advocate for the fight against HIV/AIDS, passed away on March 23 at age 78.
March 24 was World TB Day.

POLICY

  • China, the world’s largest tobacco producer and home to a third of all smokers, has issued a national ban on smoking in hotels, restaurants and other indoor public spaces.
  • Fears are growing among HIV/AIDS sufferers in the Ukraine amid claims from some patients that they have been denied life-saving medicines by authorities during a crackdown on drug substitution therapy.
  • The WHO has announced a list of 30 essential medicines for treating common diseases of mothers and children that can be used as the basis for procurement and supply of medicines and guide local medicine production.

RESEARCH

  • Scientists from the University of California, Berkeley (UCB), Dublin City University and Universidad de Valparaiso (Chile) have developed a self-powered, low-cost chip that can test blood samples and diagnose diseases like tuberculosis and HIV within minutes.
  • Researchers have discovered that capsaicin, the compound that makes jalapeños, red chilies, and the famous habanero pepper spicy, inhibit the production of cholera toxins.
  • Results from a recent study show that people with HIV who change antiretroviral treatment regimens due to side effects are at higher risk for developing drug resistance.
  • The Pakistan Medical Association’s 2011 annual report found that 400,000 infants die in the first year of their life each year and 1 out of 10 children die by the age of five.
  • A study by researchers from Johns Hopkins University found that child diarrhea deaths could be almost halved if currently available interventions such as breastfeeding, hand washing with soap, and improved household water treatment were widely implemented.
  • Global health and development blogger Amanda Makulec shares seven key ideas that she took home from the Global Health Metrics and Evaluation Conference in Seattle.

DISEASES AND DISASTERS

  • Despite setbacks, work continues at Japan’s Fukushima Dai-Ichi nuclear power plant. Meanwhile, in addition to radiation-contaminated vegetables, officials are now warning families to not give Tokyo tap water to infants due to elevated levels of radiation found in the water supply. The World Bank estimates that the earthquake and tsunami have caused as much as $235 billion in damage to Japan and that it will take five years for the nation to recover.
  • The crisis in Côte d’Ivoire continues as well, as the country’s healthcare system is strained by the violence.
  • Leprosy, which has been officially “eliminated” in India, still affects hundreds of thousands of people who are shunned by society. There are 130,000 new cases diagnosed in the country each year.
  • Leaders at the 26th Annual Conference of Alzheimer’s Disease International challenged the World Health Organization and countries around the world to take action on the dramatic surge in the global incidence of Alzheimer’s disease and dementia.

Global Health News Last Week

POLICY

RESEARCH

  • A paper published in Science by a research group at the University of Maryland demonstrates that a fungus, Metarhizium anisopliae, can be used to combat the malarial parasite inside the mosquito. Another promising study suggests that a compound produced by a seaweed in Fiji could be used to combat malaria.
  • A new study has shown that that Internet kiosks providing information on prenatal and postnatal care have helped reduce infant, child, and maternal mortality rates in rural India.
  • A study published by the Harvard School of Public Health last year found that the poorest third of the world’s population account for only 4% of surgeries worldwide, and that over two million people in low-income countries have no access to life-saving surgery.
  • The first phase trials of the HIV vaccine developed in India were completed with no side effects reported. Meanwhile, a three-year research trial on a vaginal anti-HIV gel has been launched in Rwanda.
  • The Trachoma Atlas, an open-access resource on the geographical distribution of trachoma, was launched by a team of collaborators from the London School of Hygiene & Tropical Medicine, the International Trachoma Initiative at The Task Force for Global Health, and the Carter Center. It is funded by a generous donation from (you guessed it!) the Bill & Melinda Gates Foundation.
  • The European Solutions Enterprise for Neglected Diseases (euSEND), a new initiative, based in the Netherlands, was launched to aid in the fight against neglected tropical diseases. The organization’s goal is to “take the role of matchmaker” to facilitate partnerships in research for NTD treatments and vaccines.

PROGRAMS

  • Swaziland has a large-scale circumcision drive in an attempt to lower HIV rates.
  • Cash-transfer programs as a means of assisting the poor are beginning to gain attention and popularity from development and economic professionals. Mexico’s and Brazil’s have captured particular attention and are credited with poverty reduction and GDP growth.
  • The first methadone maintenance program in sub-Saharan Africa recently opened in a hospital in Dar es Salaam, Tanzania. Heroin use is a growing problem in port cities, where the drug passes through en route from Afghanistan to Europe.

DISEASES