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Advancing HIV Service quality through community-led monitoring system in Chiang Mai, Thailand
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BACKGROUND: People-centered HIV services that respond to the needs of clients necessitate feedback mechanisms such as Community-Led Monitoring (CLM) where stigmatized population groups can voice their concerns and perspectives on how to improve HIV testing, treatment, and Pre-Exposure Prophylaxis (PrEP).
DESCRIPTION: A group of civil society and at-risk population (including people-living-with-HIV (PLHIV)) representatives in Chiang Mai, Thailand launched a people-centered CLM system in January 2022. This CLM aims to improve HIV service delivery by collecting and analyzing data on service quality and clients' satisfaction through structured feedback tools, surveys and interviews with clients to identify gaps and formulate improvement plans. This initiative involved 17 committee members and 21 hospitals collaborating to enhance service quality per the evolving needs of at-risk populations.
LESSONS LEARNED: Data collection was conducted during March 2022 - November 2024 and yielded 3,425 responses from 21 hospitals across Chiang Mai.
In addition to CLM findings, the structured feedback tools were formalized into Standard Operating Procedures (SOPs) for data collection and analysis and subsequently scaled up to three other provinces: Chiang Rai, Phitsanulok, and Ubonratchathani.
CONCLUSIONS: CLM is vital in creating a participatory environment where at-risk populations monitor and review HIV services. Through the implementation in Chiang Mai during March 2022 - November 2024, CLM improved PrEP service availability to cover all districts in the province, reduced travel burden for ART refills for clients living with HIV, and increased awareness of U=U (Undetectable=Untransmittable) among the public, at-risk population communities, and service providers. With standardized tools and community leadership, CLM proves to be an effective and scalable process to enhance HIV service quality in multiple provinces.
DESCRIPTION: A group of civil society and at-risk population (including people-living-with-HIV (PLHIV)) representatives in Chiang Mai, Thailand launched a people-centered CLM system in January 2022. This CLM aims to improve HIV service delivery by collecting and analyzing data on service quality and clients' satisfaction through structured feedback tools, surveys and interviews with clients to identify gaps and formulate improvement plans. This initiative involved 17 committee members and 21 hospitals collaborating to enhance service quality per the evolving needs of at-risk populations.
LESSONS LEARNED: Data collection was conducted during March 2022 - November 2024 and yielded 3,425 responses from 21 hospitals across Chiang Mai.
| CLM Results | Outcomes |
| Clients reported low or no access to PrEP in many hospitals. (2022) | Expansion of PrEP facilities from 13 to 24 hospitals across all 24 districts. (2023) |
| PLHIV felt that multi-month dispensing (MMD) was not offered to them by providers (2022) | Provincial Health Office-led strategy to scale up 6-month MMD at 24 hospitals. (2024) |
| PLHIV reported that U=U was not integrated in counseling. (2023) | Provincial Health Office launched a comprehensive U=U campaign. (2024) |
In addition to CLM findings, the structured feedback tools were formalized into Standard Operating Procedures (SOPs) for data collection and analysis and subsequently scaled up to three other provinces: Chiang Rai, Phitsanulok, and Ubonratchathani.
CONCLUSIONS: CLM is vital in creating a participatory environment where at-risk populations monitor and review HIV services. Through the implementation in Chiang Mai during March 2022 - November 2024, CLM improved PrEP service availability to cover all districts in the province, reduced travel burden for ART refills for clients living with HIV, and increased awareness of U=U (Undetectable=Untransmittable) among the public, at-risk population communities, and service providers. With standardized tools and community leadership, CLM proves to be an effective and scalable process to enhance HIV service quality in multiple provinces.