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