Southeast Asia Stigma Reduction QI Learning Network

Fourth Multi-Country Learning Network Meeting

The 4th Multi-Country Exchange Meeting of the Southeast Asia Stigma Reduction QI Learning Network was convened on January 14-15, 2019, in Bangkok, Thailand, with representatives from National and Provincial Ministries of Health, U.S. Centers for Disease Control and Prevention (CDC) country offices, local implementing partners, and implementing facilities in Cambodia, Lao PDR, Thailand, and Vietnam. 

The objectives of the meeting were to:

  • Present country-specific updates on implementation of S&D QI activities, with a focus on how findings from survey results are being used to target QI activities.
  • Present examples of facility-level S&D QI activities from implementing sites in Cambodia, Lao PDR, Thailand, and Vietnam.
  • Discuss challenges related to implementation of QI activities to reduce S&D.
  • Report progress on use of Network’s common suite of clinical questions to assess patient-level treatment literacy and linkages to UNAIDS’ 90-90-90 targets.
  • Present working change package of QI interventions that have been implemented by participating facilities to date, and discuss strategies for dissemination of successful interventions.
  • Begin development of Network-wide questions for assessment of patient experience, and discuss approaches to integrate routine collection of these data into ongoing QI activities.

Meeting Themes/Highlights

  • Presentations from Ministries of Health in Cambodia, Lao PDR, Thailand, and Vietnam summarized results of baseline data collection and how findings are being used to drive prioritization of QI activities. Country presentations also considered approaches to disseminating best practices and successful interventions, and how routine collection of data on patient experience, through surveys, advisory boards, exit interviews, and other fora, can be used to further inform S&D QI activities.
  • A short presentation by UCSF-HEALTHQUAL reviewed the findings of an article, recently published in Health & Place, that explored the relationship between spatial organization of service delivery and experiences of S&D among PLWH. Findings from the study highlighted the importance of addressing aspects of the institutional environment—such as facility policies, and clinic organization and flow—in efforts to reduce S&D.
  • Presentations from facilities implementing S&D QI activities in Cambodia, Lao PDR, Thailand, and Vietnam, reported baseline S&D survey results and approaches to development and evaluation of S&Dreduction interventions. Facility presentations also considered strategies for engaging hospital leadership in S&D-reduction activities, and approaches for scaling up successful interventions in other departments of the hospital.
  • A presentation from UCSF-HEALTHQUAL presented S&D QI interventions that have been implemented by participating facilities to date, and discussed strategies for disseminating these interventions to other facilities and regions.
  • A facilitated discussion among meeting attendees considered ongoing challenges, enablers, and strategies for implementing S&D QI activities. Ongoing challenges reported by attendees included translation of aspirational regional and national policy aims into implementation of concrete activities; and harmonization of HIV-specific S&D-reduction activities with efforts to address barriers to care for all patients.
  • Members of the working group tasked with development of clinical questions reported that common Network measures had been selected, and are currently being pilot-tested in Lao PDR, Thailand, and Vietnam. Results of these pilots will be reported during the Network’s 5th Multi-Country Exchange Meeting.
  • A presentation by UCSF-HEALTHQUAL and a facilitated discussion among meeting attendees considered the importance of assessing patient experience as part of S&D QI activities, and reviewed existing frameworks to guide development of Network-wide measures. A working group will be convened by UCSF-HEALTHQUAL to finalize selection of measures, which will be subsequently shared with the Network for piloting and broad implementation.

Next Steps

The 5th Multi-Country Exchange Meeting will be convened in the second quarter of CY 2019, and will focus on
strategies for engaging civil society organizations in stigma-reduction activities. In the interim, UCSFHEALTHQUAL
and participating Ministries of Health will continue implementation of S&D QI activities through
the following next steps.


  • Follow up with Ministries of Health on their implementation plans and provide technical support on S&D QI activities.
  • Convene a working group to develop common measures for assessing patient experience, and disseminate selected measures to Network for piloting.
  • Continue development and dissemination of Spotlights to showcase facility-level experiences implementing S&D QI activities.

Ministries of Health will:

  • Continue implementation of S&D QI activities according to their work plans.
  • Continue to harvest successful interventions and implementation approaches for presentation at the Network’s 5th Multi-Country Exchange Meeting.

Read the full report