qi activities u in savannakhet hiv unit for oi forum_1...opd, ipd, genecology, and administration...
TRANSCRIPT
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QI Activitiesin Savannakhet HIV Unit
By Mangkhalar Rasaphol | Pharmacist
Contents
•Overview of SVK HIV Unit
•Service flow at SVK HIV Unit
•Cohort of clients and transferred out
•Lost to follow-up after ART
•QI-related activities to address the lost to follow up
The Hospital• 170 beds• 290 staff (282
female)• 4 Departments:
OPD, IPD, Genecology, and Administration
• IPD: HIV Unit
Some background info of HIV Unit• 1993 found HIV+• 1998 established
VCT • 2001 established
HIV Unit (OI treatment by MSF)
• ART in 2003 -2008 (MSF)
• 2009 – now supported by GF
Services available at HIV Unit
Under National Strategy on HIV/AIDS:
To achieve 3 Zeros
Care and support:
psychological, social,
discrimination and sigma
Ois and ARVs: Adherence to the treatment
VCT (confidentiality and informed consent)
Prevention from mother to child transmission
OPD&IPD Services
Reception
MBI
CD4, VL
1
4
2
35
6
7
Cohort of Clients registered in HIV Unit during 2003-05/2016
2397
482 487387
1041
1866
399265 190
5
1007
Registerred Transferred out Death Lost Stop on follow up
Accumulative lost to follow-up since 2014-2016
1 to 6/14 7 to 12/14 1 to 6/15 7 to 12/15 1 to 5/16
on follow up 904 941 956 992 1007
lost 137 146 171 175 190
N.total 1041 1087 1127 1167 1197
0200400600800
100012001400
13,1 %15,1 % 14,9 %13,4 % 15,8 %
Transferred-out clients
In-country: 14 Outbound: 27
10 cases-{Muk Inter Hospital:2
Rasavithy Hospital: 1Sirirath: 3
Nakhanpranom Hospital: 1Traksin Hospital: 2Pattani Hospital: 1
Unknown service setting: 17
41 cases
With referral letter: 14
Name of the project: Reduce the lost of follow-up after 12-moth of ART Initiated
Implementation Timeline: 01/2015-05/2016
Implementation bodies: all team members
Target: To half percentage of the lost to follow-up (Indicator: %)
10
Issue identification
Service provider
Time consuming in providing services
Clients
Being nervous
Socio-economic factor
• Solve problem at service perovider side
Revised job description
• Solve problem at client side
Increase clients to be come PLA member
Offer comfortable choices for following-up services
Actions taken
Brainstorming meeting
Systematic follow-up approach
- CD4 Count
- VL
- Appointment
Self-evaluation1 2
43
Self-evaluation resultBefore After
Meet31%
no information
24%
Migrant to thailand
29%
dead6%
other10%
Home-based visits 2015-2016
190 186
141
43
29
0
20
40
60
80
100
120
140
160
180
200
LFU CALL HOME VISIT MEET RETURN
Issues reported
15,26%
0
44
149
177 182
151
178 184
143
121 128 125111
47
0 1 6 8 5 5 413 7 7 11
2213
2
On ARV 1 year Lot
111
193
264
231
207195
213
171
142
170 170
134 129
5744
149
177 181
150
178 184
143121 128 125 124
95
47
0 1 1 2 1 1 2 2 3 4 6 4 1 0
New Reg Start ARV Lot
Lost to follow up after 12months of ART
Lost to follow –up after ART in new cases
Results to date
- Improved client tracking system
- Established periodic monitoring (monthly basis)
- Improved counselling skills of team embers
- Reduced lost to follow-up when compared to previous year
Challenges• Frequent relocation
• Give false information
• No systematic research and analysis on service quality at SVK HIV Unit
• Financial constraints for home visits
• Continue to implement QI
• Frequently follow the lost to follow-up through better collaboration with PLA group (especially non-provincial residents)
• Improve adherence counselling skills
• Increase family involvement in providing care and support
Future Plan