| CaReQIC expert group meetings | | Guide the overall technical direction of the collaborative. Ensure CR voices are incorporated at all levels of the collaborative. Help the collaborative maintain a patient-centered focus and culture.
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| Preparatory session for CRs | Patients associated with PLHIV advocacy organizations Key populations, such as MSM, CSWs, and transgender persons, were deliberately included to incorporate the voices of marginalized populations
| Introduce CaReQIC and an overview of QI methods, patient engagement, and patient-centered care. Equip CRs with QI skills to participate in technical learning session activities with HCPs. Empower CRs to recognize the importance of their input in all areas of their treatment and care. Prepare CRs to engage in constructive conversations about systems issues in future learning sessions by establishing safe spaces for collaboration.
| Discuss QI theory, process maps, swim lane diagrams, test changes (PDSA cycles), identify actionable systems-level issues. Establish learning session expectations, including: role of CRs, creating safe spaces, ground rules of information sharing and confidentiality, avoiding blame, how to give feedback. Explain role of CRs on QI teams.
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| Patient engagement preparatory session for HCPs | HCPs involved in CaReQIC | Give HCPs an introduction to the patient engagement strategy. Promote the value of patient input and lived experiences. Encourage providers to seek patients' perspectives to improve care. Prepare HCPs to engage in constructive conversations about systems issues in future learning sessions by establishing safe spaces for collaboration.
| Describe “patients as partners” in the QI process, benefits of patient engagement, CR roles in learning sessions and QI teams. Establish learning session expectations: creating safe spaces, ground rules of information sharing and confidentiality, avoiding blame, how to give feedback. Encourage “through the patients' eyes”: urge teams to go out and communicate with their patients and see what their experience at the clinic is really like.
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| CR engagement in learning sessions | CRs and HCPs from facility-based QI teams | Enhance CR and HCP QI technical skills. Improve CRs' and HCPs' ability to work as a team to plan and execute PDSAs at their sites. Encourage perspective-taking and greater empathy between CRs and HCPs.
| Highlight coproduction: importance of CR role in QI process, levels of community engagement in QI, co-production of outcomes. Discuss teambuilding and self-identification of strengths. Conduct “learning from the patient experience:” guided conversations between CRs and providers. Hold empathy-building sessions: interactive session to discuss challenges facing HCPs and patients; “problem prism” activity to explore a problem from multiple points of view, including discussion on issues from both patient and provider perspectives; “Ignite Talks” (selected participants share personal stories about experiences as HIV patients or providers working in HIV). Conduct technical QI sessions: setting aims, defining measures, process mapping (including maps guided by CR perspective), swim lane diagrams, run chart development, PDSA planning, change concepts for differentiated care for PLHIV, breakout sessions conducted using ideation technique, "carousel solution” brainstorming to generate a list of change concepts for teams to test for selected drivers, and sustaining changes. Present QI teams' strategies and successes.
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| CR participation in facility-based QI teams | CRs and HCPs from facility-based QI teams | Provide a mechanism for the PLHIV community, through patient representation, to be actively involved in improving their care and treatment at facilities. Ensure PDSAs aligned with PLHIV priorities.
| Team meetings commonly discuss challenges, review patient input, determine strategies, decide which ideas to test, assign tasks, report on progress, complete prework for upcoming learning sessions. |
| CAST meetings | Led by CRs and I-TECH key population group advisors
There were CAST groups in Jamaica and Trinidad and Tobago as of August 2017, with a total membership of 11 CRs | Engage PLHIV to partner with health care facilities to enhance care. Ensure that PLHIV engaged in QI have an opportunity to pass QI skills on to other members of the community. Create a mechanism to recruit new patients, learn QI, and join improvement efforts. Provide a formal conduit to share information and ideas from the PLHIV community to the treatment sites and vice versa. Provide a forum for CRs to troubleshoot challenges they may have with their QI teams.
| Conduct monthly meetings, plan and test PDSAs, collect data, present and test change ideas at the site and community level. |
| Ongoing support to facility-based QI teams | | Offer support to QI teams to engage patients and develop and implement new ideas to improve care. Achieve greater patient representation on QI teams. Provide teams with any necessary technical expertise to overcome project hurdles or with engaging patients.
| Hold in-person and distance coaching on PDSAs, conduct QI webinars, provide feedback on monthly QI reports, update materials and tools provided, provide data analysis assistance, provide CR recruitment support and related tools provided to QI teams. |