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Scaling Up Universal Test & Treat (UTT) through Targeted HIV Case Finding at a
Regional Hospital in KwaZulu-Natal, South Africa
Lorna Ogle
MatCH (Maternal, Adolescent & Child Health)
School of Public Health, University of the Witwatersrand
Background
oMatCH is the PEPFAR/USAID District support partner for HIV & related programmes in eThekwini District, KwaZulu-Natal
oOur main objectives are:
• Sustainable health systems strengthening through innovative QI-based models of support
• Optimising patient pathways and the cascade of care
• Attainment of UNAIDS 90-90-90 targets
oUniversal Test and Treat (UTT) has been implemented by DOH since September 2016. There is a need to optimise facility- level implementation at priority facilities
Problem Statement
oHistorically, testing for HIV was done at Voluntary Counselling & Testing (VCT) service points by HIV Lay counsellors at health facilities
oWith roll-out of UTT, there was a need to scale-up Provider Initiated Counselling & Testing (PICT) to meet increased client load
Source: UNAIDS
Rationale
oAchievement of 90-90-90 targets is dependent on successful linkage to care and UTT
oPICT allows for Health Care Workers to identify populations ‘at risk’ as part of all routine consultation
oWe present here a focussed PICT health system strengthening QI project implemented at a regional hospital in eThekwini over a 3-month period to optimise PICT and promote active case-finding
Methodology
oEntry point analysis of PICT was conducted at the facility
oMeetings were held with relevant stakeholders to allocate space and commodities for HIV testing
oAn assessment was conducted of the staff allocation in the different departments/ ‘entry points’
oJunior categories of staff (EN’s, ENA’s) were trained on PICT & TB screening of all clients (inpatient, outpatient) and linkage to care
oRelevant systems and tools were introduced
oData was reviewed 3 months pre- and post- training
Training & Tools
oOf the 286 staff allocated to the various entry points, 201 were trained and mentored on PICT.
oHTS registers were provided at each entry point for recording and data collection.
Results: PICT Training Output
100% 100%
77% 100% 50%
100% 100% 100%
54% 64%
50% 64% 50%
61%
84%
0
10
20
30
40
50
60
70
No. of staff No. of staff Trained
Results: Impact of PICT Training on reaching HTS Target
0
500
1000
1500
2000
2500
Q1 Q2 Q3 Q4
Quarterly HTS data performance (all ages) FY17
HTS dataperformance perquarter
HTS Target = 1066 per quarter (annual target divided over four quarters).
PICT Training
Results: Pre & Post Training Comparison of PICT Output / HTS Yield / Linkage
0
500
1000
1500
2000
2500
Total Number tested Number Tested Postive Number linked to care
980
228 58
2121
249 142
RESULTS: PRE & POST TRAINING COMPARISON OF PICT OUTPUT/HTS YIELD/LINKAGE
Pre-Training Post-training
Increase in testing coverage and proportion of tested positive linked to care from 25% pre-training to 57% post training
Results: Paediatric HTS_Pos and Linkage to Care (FY17)
Q1 Q2 Q3 Q4
Tested 0 156 116 131
Positive 0 8 3 1
TX_New 4 16 11 7
0
20
40
60
80
100
120
140
160
180
Challenges
oGynaecology Clinic: routine PICT was not being offered at this site even
post- training due to insufficient staffing. MatCH has allocated staff to
assist. Results show a high positivity rate, especially in adolescents
oLinkage to care: hospitals refer patients on discharge to local clinics for
linkage to care. Tracing these patients and ensuring retention in care is
difficult
Recommendations
oQIP: All hospital admissions should have TB Screening and PICT done at the respective entry points
oPatients triaged as green and yellow code in Casualty but not admitted should be considered for PICT. Careful planning is required to identify opportunities for testing during patient waiting times
oPatients who test HIV Positive must be linked to care at Hospital level and down-referred or transferred thereafter, as appropriate. This is to limit patients becoming Lost to Follow up (LTFU)
Recommendations
oPICT training should be offered on a regular basis to relevant healthcare workers to
accommodate for staff changes and high staff turnover
oCapacitating staff will ensure stability of the programme and accountability of all
relevant staff
oMonitoring of the programme is imperative
o The use of registers for data collection and record-keeping is crucial
oCollaboration between partner organisations and facilities is essential for the
success of the programme
Key Messages
1. Identify key entry points where HIV-related disease and asymptomatic HIV
infection are more likely
2. Given that PITC is a key entry to HIV care and treatment, significant efforts need
to be made to ensure that those who test positive are effectively linked to care
and treatment.
3. To enhance successful implementation, onsite mentorship support is vital,
evidenced by the improvement in health outcomes in facilities where this was
provided.
Acknowledgements
oPEPFAR/USAID
This presentation is made possible by the support of the American people through the United States
Agency for International Development (USAID). The contents are the sole responsibility of MatCH
(Maternal Adolescent and Child Health) and do not necessary reflect the views of USAID or the United
States Government.
oKZN DOH
oMatCH:
o Dr A Ramkissoon
o MatCH Program Managers
o MatCH Facility Teams
Thank you | Ngiyabonga
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