(version november 2018) · sop tb tier.net tmc tpt top qi qip ultf vl wac wbot wphcot 10/10...

(version November 2018)

HIV and TB Supportive Supervision Toolkit (v. November 2018)

Contributors:

Jackie Smith Mildred Shabangu

Sibongile Shezi Neziswa Mdaka Stiaan Byleveld Joslyn Walker

Patricia Bartman

Editing and proofreading:

Judith King Ross Haynes

Design and layout:

Lebo Dikobe

Suggested citation:

Health Systems Trust. HIV and TB Supportive Supervision Toolkit. Durban: Health Systems Trust; 2018.

Purpose of the Toolkit; how to use this Toolkit

List of acronyms and abbreviations

Section A: Introduction

SA SURE Plus Project Approach

South Africa's health policy implementation architecture

Section B: Prevention

Options for notifying your partner about HIV testing

Steps for Index Case Contacts Testing Services

Index case contacts tracing:

Partner Information Form (in two parts)Contact Referral Slip (CDC-designed)

Partner Contact Form (other)

Outcome of Partner Testing Services FormTesting Outcome Form for HIV-exposed children

Four streams of care diagram: Ideal Clinic re-organisation of services

Process ow for IPT monitoringIPT audit tool

Process ow for community testing co-ordination

Section C: Care and treatment

Process for Provider-initiated Testing and Counselling (PITC)

PITC facility owFacility Baseline Assessment

Standard operating procedure for review of registers

Laboratory processes

Facility Improvement Plan (FIP) development processFacility Planning Cycle

Bottleneck Analysis diagram

Facility Technical Working Group (FTWG) stakeholders

Process ows for unique ID and linkage monitoring

Viral load management process

Viral load monitoring at 6 months Quality Improvement Plan (QIP) 'KwikSkwiz'

90-90-90 Strategy:

A-1

A-2

A-4

A-5

B-1

B-2Index Client Information Form B-3

Partner Elicitation Form B-4

B-7B-8

B-9

B-10

B-11Four streams facility algorithm B-12

Single facility sketch plan B-13Multi-building facility sketch plan B-14

TPT diagram B-15

B-16B-17

B-18

C-1C-2C-3

C-4

C-6C-6C-7

C-8

C-9

C-10C-11

C-12

C-5

B-5

Adherence Club data owLinkage Ofcer role and standard operating procedure

Community outreach relationshipsCommunity / Differentiated Care Model:

C-13C-14C-15

Supervision of Data CapturersData management:

C-16

Purpose of the HIV and TB Programme Toolkit:

This Toolkit has been compiled to support health managers and partners in providing on-site, supportive supervision to facility staff by standardising and focusing supervision practices, thereby increasing efciencies in the priority programmes.

The processes and algorithms contained in the Toolkit are derived from National Department of Health policies and guidelines, which should always be utilised as key source documents for deeper understanding and guidance.

This Toolkit enables any manager or supervisor to examine processes in the clinic to determine whether they are working well – and if not, to identify where the challenges lie and design Quality Improvement Plans.

This is not an exhaustive set of tools, and it will be expanded periodically on request to the project management.

How to use this Toolkit

The Toolkit has been organised into three thematic sections: Introduction; Prevention; Care and Treatment.

A good place to start is to review all the Toolkit content when you receive it. If you are familiar with the material, it will be easier during a busy day to refer quickly to a specic tool for supervision purposes. Check the Table of Content to identify items that would be especially useful to you.

As you review the contents, make notes of the particular challenges experienced in your facility with systems and processes. If you need something that is not available in the Toolkit, suggest this to HST so that a relevant tool can be developed and added to the material.

Use the Toolkit material to help organise your thoughts, map out the supervision tasks you wish to accomplish, and set timelines.

Managing supervision practice requires creativity as well as a set of learnt skills. Discussing supervision issues with your peers in the eld is a good way to gather further information and ideas.

To download a PDF of this Toolkit, go to: http://www.hst.org.za/publications/HST%20Publications/HIV%20and%20TB%20Supportive%20Supervision%20Toolkit.pdf

HIV and TB Supportive Supervision Toolkit (version November 2018) Section A - page 1 of 5


ACR

ANC

ART

BNA

CBO

CCMDD

CDC

CEO

COP

CRAG

DATIM

DatCap

DCST

DHP

DIMES

DIP

DME

DoB

DOP

DREAMS

DsD

DQA

eGFR

EMR

FIP

FOP

FTWG

HIV

HST

HTC

HTS

HPRS

ICRM

ICSM

ID

IPT

IPV

LAC

LO

LTFU

MC


ART clinical record

antenatal care

antiretroviral therapy

Bottleneck Analysis

community-based organisation

Central Chronic Medicine Dispensing and Distribution

Centers for Disease Control and Prevention

Chief Executive Ofcer

Country Operational Plan

serum cryptococcal antigen

Data for Accountability, Transparency and Impact

Data Capturer

District Clinical Specialist Team

District Health Plan

DREAMS Integrated Monitoring and Evaluation System

District Implementation Plan

District Monitoring and Evaluation Ofcer

date of birth

District Operational Plan

Determined, Resilient, Empowered, AIDS-free,

Mentored, and Safe [PEPFAR empowerment programme for

adolescent girls and young women]

direct service delivery

data quality assessment

estimated glomerular ltration rate [a blood test to measure kidney function]

emergency medical record

Facility Implementation Plan

Facility Operational Plan

Facility Technical Working Group

Human Immunodeciency Virus

Health Systems Trust

HIV testing and counselling

HIV Testing Services

Health Patient Registration System

Ideal Clinic Realisation and Maintenance

Integrated Clinical Services Management

identication

isoniazid preventive therapy

intimate partner violence

Local AIDS Council

Linkage Ofcer

lost to follow-up

maternal and child



MCWH

M&E

MDR

MMC

Mx

N/A

NC

NCD

NCS

NHLS

OM

OSS

OVC

PHC

PITC

PLHIV

PMTCT

PN

PT

Rx

SA SURE Plus

SCM

SRH

SOP

TB

TIER.Net

TMC

TPT

ToP

QI

QIP

uLTF

VL

WAC

WBOT

WPHCOT

10/10

maternal, child and women's health

monitoring and evaluation

multidrug-resistant

medical male circumcision

medicine

not applicable

Nurse Clinician

non-communicable disease

National Core Standards

National Health Laboratory Service

Operational Manager

Operation Sukuma Sakhe

orphans and vulnerable children

primary health care

provider-initiated testing and counselling

people living with HIV

prevention of mother-to-child transmission of HIV

Professional Nurse

Prociency Testing

a doctor's prescription ['recipe']

South Africa's Sustainable Response to HIV and TB Project

supply chain management

sexual and reproductive health

standard operating procedure

tuberculosis

Three Interlinked Electronic Register for TB and HIV

traditional male circumcision

TB preventive therapy [A course of isoniazid (INH) given for a period

of 12 months to HIV-positive patients who do not have active TB

to minimise the risk of them contracting it]

termination of pregnancy

quality improvement

Quality Improvement Plan

unconrmed loss to follow-up [TIER.Net abbreviation]

viral load

Ward AIDS Committee

Ward-based Outreach Team

Ward-based Primary Health Care Outreach Team

A CDC process-strengthening term, relating to a focus on 10

high-burden facilities in 10 high-burden districts, categorised

into four key activity areas; this term is likely to change but is

currently in use and is referred to in the Toolkit.

SA SURE Plus Project – Approach

Health Systems Trust (HST), through the SA SURE Plus Project, is the CDC-funded District Support Partner in four districts in South Africa's KwaZulu-Natal Province. Since district-level health facilities and community health services form the foundation of health service delivery, effective implementation of the country's health policies and strategies is dependent on well-functioning health facilities.

As illustrated in the accompanying diagram, the project's approach to supporting district health facilities covers a wide range of activities. To improve the quality of health care, SA SURE Plus focuses mainly on health systems strengthening in the areas of Ideal Clinic Realisation and Maintenance (ICRM), change management within the UNAIDS 90-90-90 initiative, expanding the roll-out of alternative access to chronic medication through the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, and the strategic placement of supplemental staff to assist facilities with HIV and TB services and data management. The community-based services include mobile outreach services, as well as the facilitation of support groups for newly diagnosed and unstable patients and adherence clubs for stable patients.

This work is aligned with the aims of and guidelines for Primary Health Care Re-Engineering, National Health Insurance, and the National Core Standards for Health Establishments in South Africa.


SA SURE Plus

Co

mm

un

ity s

erv

ices

Facilit

y-b

ased

serv

ices

Nati

on

al str

ate

gie

s

Sch

ool

He

alth

WB

PH

CO

Ts

PH

CR

e-

en

gin

ee

rin

g

Na

tiona

l

He

alth

Insu

ran

ce

TB

/HIV

in

tegra

tion

DC

ST

90

-90-9

0

Na

tio

na

l S

tra

teg

ic

Pla

n

Na

tiona

l A

dhe

ren

ce

Str

ate

gy

Dis

tric

t-b

ased

serv

ices

ICS

M

Na

tiona

l Co

re

Sta

nd

ard

s

Su

pp

ort

g

rou

ps

CC

MD

D

Ad

he

rence

cl

ub

s

Sp

ace

d

Fa

st-la

ne

ap

poin

tme

nts

Ide

al

Clin

ic

EM

R

HP

RS

Dis

tric

t H

ea

lth

Pla

n

DIP

De

ca

ntin

g

pla

n

Pro

vin

cia

l o

vers

igh

t

EM

R

Co

mm

un

ity

FO

P

So

uth

Afr

ica’s

healt

h p

olicy i

mp

lem

en

tati

on

arc

hit

ectu

re


Dete

rmin

e the p

refe

rred

meth

od o

f part

ner

noti

catio

n o

r ch

ild test

ing for

each

nam

ed

part

ner/

child

and

reco

rd o

n P

art

ner

Info

rmati

on

Fo

rmB

iolo

gic

al C

hild

ren

In

form

ati

on

a

nd/o

r F

orm

Ste

p 4

Intr

oduce

index

case

conta

cts

test

ing s

erv

ices

to th

e in

dex

clie

nt d

uring p

re-t

est

sess

ion o

r PM

TC

T/A

RT

vis

it

Ste

p 1

Obta

in a

list

of s

exu

al a

nd

needle

-sharing p

art

ners

and b

iolo

gic

al c

hild

ren <

15 w

ith u

nkn

ow

n

HIV

sta

tus

Ste

p 2

Scr

een a

ll nam

ed p

art

ners

for i

ntim

ate

part

ner vi

ole

nce

(IP

V)

Ste

p 3

Conta

ct a

ll nam

ed p

art

ners

and test

all

bio

logic

al

child

ren <

15 w

ith u

nkn

ow

n s

tatu

s usi

ng the

pre

ferr

ed a

ppro

ach

Ste

p 5

Reco

rd p

art

ner

noti

catio

n a

nd fam

ily test

ing

outc

om

es

on the O

utc

om

e o

f P

art

ner

/Ch

ild

ren

Testi

ng

Fo

rm

Ste

p 6

Pro

vide a

ppro

priate

serv

ices

for

child

ren b

ase

d

on H

IV s

tatu

s, s

ero

conco

rdant/dis

cord

ant

part

ners

, or

work

to s

upport

dis

closu

re

Ste

p 7

Use

the

to

P

art

ner/

Ch

ild

ren

In

form

ati

on

Fo

rms

docu

ment

resu

lts o

f IP

V s

creenin

g a

nd

pre

ferr

ed

pa

rtn

er

noti

catio

n a

nd/o

r ch

ild te

stin

g m

eth

od

.

Com

ple

te o

ne f

orm

for

each

na

me

d p

art

ne

r

Use

the

to

In

dex C

ase C

on

tacts

Te

sti

ng

Ta

lkin

g P

oin

ts

intr

oduce

part

ner/

fam

ily t

est

ing to

th

e in

de

x cl

ien

t a

nd

co

mple

te t

he I

nd

ex C

lien

t In

form

ati

on

Fo

rm

Use

the

to

P

art

ner/

Ch

ild

ren

* E

lic

ita

tio

nF

orm

sre

cord

part

ner(

s)’/c

hild

(ren)’s

na

me

s a

nd

co

nta

ct

info

rmatio

n

Exc

lud

e p

art

ne

rs p

osi

ng

a h

igh

ris

k o

f IP

V;

refe

r in

de

x cl

ien

t to

IP

V/O

VC

se

rvic

es

wh

ere

ava

ilab

le a

nd

dis

cuss

oth

er

op

tion

s fo

r d

iscl

osu

re.

Cli

en

t re

ferr

al:

Coach

clie

nt

on

dis

closu

re;

Pro

vide ‘T

ips

for

telli

ng y

our

part

ner

about

HIV

’ and R

efe

rral S

lipF

acil

ity-b

ased

: C

onr

m a

n

appoin

tment

to t

est

bio

logic

al

child

ren <

15

Co

ntr

act

refe

rral:

Pro

vide

refe

rral c

ard

and d

iscl

osu

re

script;

agre

e t

hat

the c

lient

will

re

fer

the p

art

ner

or

bring t

he

child

for

HT

S w

ithin

seve

n d

ays

.

Pro

vid

er

refe

rra

l: In

itia

te

pa

rtn

er

con

tact

atte

mp

ts u

sin

g

tele

ph

on

e a

nd

ho

me

vis

it

sc

rip

ts

Co

mm

un

ity

-ba

se

d:

Co

nr

m a

d

ay/

time

fo

r th

e p

rovi

de

r to

te

st

the

ch

ild(r

en

) in

th

e h

om

e.

Du

al re

ferr

al:

Co

ach

th

e c

lien

t o

n jo

int d

iscl

osu

re; m

ake

a p

lan

fo

r w

he

n a

nd

wh

ere

join

t d

iscl

osu

re w

ill ta

ke p

lace

; o

ffe

r H

TS

to

pa

rtn

er

Wa

s th

e p

art

ne

r su

cce

ssfu

lly

con

tact

ed

?W

as

the

ch

ild te

ste

d?

Reco

rd s

ucc

ess

ful p

art

ner

conta

ct o

r ch

ild t

est

(incl

udin

g H

IV s

tatu

s) o

n t

he

Ou

tco

me o

f P

art

ner/

Ch

ild

ren

Testi

ng

Fo

rm

If

, in

itia

te p

rovi

de

r re

ferr

al f

or

co

ntr

ac

t re

ferr

al

pa

rtn

ers

or

ho

me

te

stin

g fo

r ch

ildre

n a

fte

r se

ven

d

ays

; o

the

rwis

e r

eco

rd u

nsu

cce

ssfu

l co

nta

ct o

n

the

Ou

tco

me

of

Pa

rtn

er/

Ch

ild

ren

Te

sti

ng

Fo

rm

Ste

ps f

or

ind

ex c

ase c

on

tacts

testi

ng

serv

ices

*Note

: N

o B

iolo

gic

al C

hild

Elic

itation

F

orm

is a

vaila

ble

as

yet.

Yes

No

HIV and TB Supportive Supervision Toolkit (version November 2018) Section B - page 1 of 18

Op

tio

ns f

or

no

tify

ing

yo

ur

part

ner

ab

ou

t H

IV t

esti

ng

Cli

en

t re

ferr

al =

Tell

your

part

ner

about yo

ur

HIV

sta

tus

an

d e

nco

ura

ge

him

or

her to

com

e to

the h

ealth

faci

lity

for a

n H

IV te

st.

Pro

vid

er

refe

rral =

A c

ounse

llor or oth

er h

ea

lthca

re p

rovi

de

r w

ill c

all

or vi

sit y

ou

r part

ner and in

form

them

that t

hey

need to

test

for H

IV.

Co

ntr

act

refe

rral

= Y

ou a

nd t

he c

ounse

llor

will

wo

rk t

og

eth

er

to n

otif

y yo

ur

part

ner.

You w

ill h

ave

seve

n d

ays

to tell

you

r p

art

ne

r, a

fte

r w

hic

h th

e c

ou

nse

llor

will

conta

ct y

our part

ner.

Du

al

refe

rral

= T

he c

ounse

llor/

pro

vider

will

sit

with

yo

u a

nd

yo

ur

pa

rtn

er

an

d

support

you a

s yo

u te

ll yo

ur part

ner about y

ou

r H

IV s

tatu

s.


Instructions: Complete this form while interviewing the HIV-positive index clientwho has verbally agreed to receive index partner testing services.

Transgender (male to female) Transgender (male to female)Gender: Male: Female

Date form completed (dd/mm/yyyy):

Name of person completing form:

Name of health facility or HIV testing site:

INFORMATION ABOUT THE INDEX CLIENT

Index client's name (Last, First, Middle):

DoB (dd/mm/yyyy): Age: years

Marital status: Single Engaged to be married Married/cohabitating�monogamous

Divorced Widow/er Married�polygamous: #wives

*Complete one form per index client

Client's personal cell-phone number:

Alternative contact number (if available):

Address (including any landmarks, e.g. next to the church):

Date of HIV diagnosis: (dd/mm/yyyy):

Is the index client currently enrolled in an HIV treatment programme?

If yes, name of health facility:

If yes, list the index client's ART enrolment number:

For women: How many children younger than 15 years does the index client have?

How many of these children should be tested for HIV?

Index Client Information Form


Instr

ucti

on

s: A

sk the in

dex

clie

nt to

tell

you the n

am

es

of all

the p

eople

they

have

had s

ex

with

in the p

ast

12 m

onth

s,

incl

udin

g b

oth

main

/marr

ied p

art

ners

and c

asu

al/u

nm

arr

ied p

art

ners

. If the c

lient

inje

cts

dru

gs,

ask

them

to a

lso tell

you the

nam

es

of th

eir in

ject

ing d

rug u

se p

art

ners

. Y

ou m

ay

wis

h to s

tart

with

the m

ain

se

x part

ner

and then a

sk a

bout oth

er

part

ners

, or

you m

ay

wis

h to s

tart

by

ask

ing a

bout th

e m

ost

rece

nt part

ner

and w

ork

ing b

ack

ward

s in

tim

e.

Ph

on

e n

um

ber

Alt

ern

ati

ve p

ho

ne

nu

mb

er

1)

2)

3)

4)

5)

6)

7)

8)

9)

10)

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Unkn

ow

n

Lis

t n

am

es(s

) o

f p

art

ners

(Tic

kif

nam

e is

unkn

ow

n)

Co

mp

lete

on

e f

orm

fo

r each

in

dex c

lien

t

Part

ner

Elicit

ati

on

Fo

rm


Instructions: Ask the client to give you as much information as they can about each of the partners they named on the partner elicitation form. Write 'N/A' for any information that is not available. After completing a separate form for each contact, le all completed forms in the client's folder or medical chart.

Partner's DoB (dd/mm/yyyy):

Partner's name (Last, First, Middle):

Partner's nickname:

Partner's gender:

Partner's physical description:

Partner's age: years

Male Transgender Female

How would you describe your relationship to this partner?

My wife/husband/ancé/ancée We live together but are not married My girlfriend/boyfriend Someone I had sex with for fun Someone who pays me or gives me things to have sex with her/him Someone I paid to have sex with

Yes No Don’t Know Declines to answer

Yes No Don’t Know Declines to answer

Yes No Declines to answer

If known HIV-positive partner: Is this partner currently taking medications for HIV?

As far as you know, has this partner ever tested positive for HIV?

Do you currently live with this partner?

*Complete one form (two pages) for each partner named by the index client.

Partner Information Form (page 1)


Partner Information Form (page )2

1. Has [partner's name] ever hit, kicked, slapped, or otherwise physically hurt you?

2 . Has [partner's name] ever threatened to hurt you?

2 . Has [partner's name] ever forced you to do something sexually that made you feel uncomfortable?

Yes No

Yes No

Yes No

Instructions: Show the 'Options for Getting Your Partner Tested' card to the index client and review the four options.

Ask the client which option they would prefer and record their chosen option below.

If the client choses 'Contract referral', record the date (7 days from today's date) by which the partner should come for HIV testing services.

Contract Referral: Both the index client and healthcare provider will notify the partner. The index client will rst try to notify the partner no later than [date] _____/_____/_______, after which the provider will contact the partner (with permission from the index client).

Dual Referral: The index client and healthcare provider will jointly notify the partner. This joint session will occur on _____/_____/________

Index client's plan for notifying this partner:

Client Referral: Index client will notify the partner

Provider Referral: Healthcare providers will notify the partner

No partner testing is needed; the partner is known to be HIV-positive.

Partner testing is not recommended at this time due to safety concerns.

Because your safety is very important to us, we ask all clients the following questions:


HIV is very common in our community. It is important that you come for an HIV test at [name of health facility] _________________________________________ so that you can learn your HIV status. If you are HIV-negative, we can give you information on how you can remain free from HIV. If you are HIV-positive, we can give you medicines to treat your HIV. These medicines will help you live a long life and reduce your chance of passing HIV onto others.

HIV testing services are available from Monday to Friday from 8:30 in the morning until 5:00 in the evening. We hope you will come for an HIV test at your earliest convenience.

HIV is very common in our community. It is important that you come for an HIV test at [name of health facility] _________________________________________ so that you can learn your HIV status. If you are HIV-negative, we can give you information on how you can remain free from HIV. If you are HIV-positive, we can give you medicines to treat your HIV. These medicines will help you live a long life and reduce your chance of passing HIV onto others.

HIV testing services are available from Monday to Friday from 8:30 in the morning until 5:00 in the evening. We hope you will come for an HIV test at your earliest convenience.

Please bring this referral slip with you.

Signature of healthcare provider:

Date:

Please bring this referral slip with you.

Signature of healthcare provider:

Date:

REFERRAL SLIP

REFERRAL SLIP


Client name:

ID number:

Alternative contact number (if available):

Date of visit: Form completed by:

File number

Personal cell number:

Name:

Partner invitation letter given:

Male Female

Diagnoses: HIV TB HIV&TB

(If 'No', reason:

PART A: To be completed by counsellor for all clients testing positive at their clinic visit or during outreach:

Contact code Contact cell number: Contact tested at booking

Full physical address:

Would like home-based HIV testing for partner: Yes No (If 'Yes', complete the rest of this form.)

I hereby confirm that the details are correct and that I agree to have a community health worker call me to schedule a home visit to offer HIV counselling and testing services to my partner.

The best time to call me is:

Client's signature:

Staff member's name:

Agreed time and date:

Date:

Staff signature:

Protection of confidentiality

Yes No

PART B: To be completed by the health worker doing home testing

No (If 'No', reason):

Diagnoses: HIV-neg TB-neg HIV-pos HIV&TB TB-pos

Testing done:

Number of other people/contacts tested:

Initiated same day on: ART TB IPT Referred to

Yes

Date of referral/appointment: Facility staff name: Number:

Clinic for initiation (if 'Yes')

PART C: To be completed by NC/PN initiating Rx

Date partner/contact initiated on Rx:

Initiated by:

Signature:

PART D: To be completed by Data Capturer

File number:

Date file captured on TIER.Net:

File captured by:

Signature:


IND

EX

CL

IEN

T IN

FO

RM

AT

ION

Nam

e:

HT

S/A

RT

Clin

ic N

um

ber:

Gen

der:

□

Male

□ F

em

ale

□ T

ransg

ender

Date

of

bir

th:

/ /

*Co

mp

lete

ad

dit

ion

al fo

rms if

ind

ex c

lien

t h

as m

ore

th

an

TH

RE

E p

art

ners

.

G

en

der:

□ M

ale

□ F

em

ale

□

Tra

nsg

ender

Date

of

bir

th:

Typ

e o

f p

art

ner

testi

ng

: □

Clie

nt □

Pro

vider

□ C

ontr

act, d

ate

_

D

ate

/Meth

od

of

1s

t co

nta

ct

att

em

pt:

/ /

P

hone

Hom

e

Date

/Meth

od

of

2n

d c

on

tact

att

em

pt:

/ /

P

hone

Hom

e

Date

/Meth

od

of

3rd

co

nta

ct

att

em

pt:

/ /

P

hone

Hom

e

Was

part

ner

co

nta

cte

d?

□

Yes □

N

o

If y

es, w

ho

co

nta

cte

d p

art

ner?

□

Clie

nt □

Pro

vider

□ C

lient +

Pro

vider

Ou

tco

me o

f P

art

ne

r Testi

ng

Serv

ices:

□ P

art

ner

rece

ived a

n H

IV test

□

Part

ner

refu

sed a

n H

IV test

□

Part

ner

know

n to b

e H

IV-p

osi

tive

□ O

ther:

Part

ner’

s H

IV s

tatu

s (

if t

este

d):

□

HIV

-posi

tive

□ H

IV-n

egativ

e

Is t

he p

art

ner

on

AR

T (

if H

IV-p

osit

ive)?

□

Yes

□

No

/ /

PA

RT

NE

R 1

G

en

der:

□ M

ale

□ F

em

ale

□

Tra

nsg

ender

Date

of

bir

th:

Typ

e o

f p

art

ner

testi

ng

: □

Clie

nt □

Pro

vider

□ C

ontr

act, d

ate

_

D

ate

/Meth

od

of

1s

t co

nta

ct

att

em

pt:

/ /

P

hone

Hom

e

Date

/Meth

od

of

2n

d c

on

tact

att

em

pt:

/ /

P

hone

Hom

e

Date

/Meth

od

of

3rd

co

nta

ct

att

em

pt:

/ /

P

hone

Hom

e

Was

part

ner

co

nta

cte

d?

□

Yes

□

No

If y

es, w

ho

co

nta

cte

d p

art

ner?

□

Clie

nt □

Pro

vider

□ C

lient +

Pro

vider

Ou

tco

me o

f P

art

ne

r Testi

ng

Serv

ices:

□ P

art

ner

rece

ived a

n H

IV test

□

Part

ner

refu

sed a

n H

IV test

□

Part

ner

know

n to b

e H

IV-p

osi

tive

□ O

ther:

Part

ner’

s H

IV s

tatu

s (

if t

este

d):

□

HIV

-posi

tive

□ H

IV-n

egativ

e

Is t

he p

art

ner

on

AR

T (

if H

IV-p

osit

ive)?

□

Yes

□

No

/ /

PA

RT

NE

R 2

G

en

der:

□ M

ale

□ F

em

ale

□

Tra

nsg

ender

Date

of

bir

th:

Typ

e o

f p

art

ner

testi

ng

: □

Clie

nt □

Pro

vider

□ C

ontr

act, d

ate

_

D

ate

/Meth

od

of

1s

t co

nta

ct

att

em

pt:

/ /

P

hone

Hom

e

Date

/Meth

od

of

2n

d c

on

tact

att

em

pt:

/ /

P

hone

Hom

e

Date

/Meth

od

of

3rd

co

nta

ct

att

em

pt:

/ /

P

hone

Hom

e

Was

part

ner

co

nta

cte

d?

□

Yes

□

No

If y

es, w

ho

co

nta

cte

d p

art

ner?

□

Clie

nt □

Pro

vider

□ C

lient +

Pro

vider

Ou

tco

me o

f P

art

ne

r Testi

ng

Serv

ices:

□ P

art

ner

rece

ived a

n H

IV test

□

Part

ner

refu

sed a

n H

IV test

□

Part

ner

know

n to b

e H

IV-p

osi

tive

□ O

ther:

Part

ner’

s H

IV s

tatu

s (

if t

este

d):

□

HIV

-posi

tive

□ H

IV-n

egativ

e

Is t

he p

art

ner

on

AR

T (

if H

IV-p

osit

ive)?

□

Yes

□

No

/ /

PA

RT

NE

R 3

Ou

tco

me

of

Part

ner

Tes

tin

g S

erv

ice

s

Fo

rm


IND

EX

CL

IEN

T IN

FO

RM

AT

ION

Nam

e:

HT

S/A

RT

Clin

ic N

um

ber:

Gen

der:

□

Male

□ F

em

ale

□ T

ransg

ender

D

ate

of

bir

th:

/ /

No

. o

f ch

ild

ren

:

Testi

ng

Ou

tco

me F

orm

fo

r H

IV-e

xp

osed

ch

ild

ren

N

am

e:

Gen

de

r:

□ M

ale

□

Fem

ale

Date

of

bir

th:

Ch

ild

’s H

IV s

tatu

s:

□ H

IV-p

osi

tive □

HIV

-negativ

e

□ U

nkn

ow

n

If t

este

d H

IV-p

osit

ive:

AR

T s

tart

da

te

/ /

AR

T C

lient N

um

ber

__

__

__

__

_

/ /

Ch

ild

1

Na

me:

Gen

de

r:

□ M

ale

□

Fem

ale

Date

of

bir

th:

Ch

ild

’s H

IV s

tatu

s:

□ H

IV-p

osi

tive □

HIV

-negativ

e

□ U

nkn

ow

n

If t

este

d H

IV-p

osit

ive:

AR

T s

tart

da

te

/ /

AR

T C

lient N

um

ber

_

_________

/ /

Ch

ild

1

Na

me:

Gen

de

r:

□ M

ale

□

Fem

ale

Date

of

bir

th:

Ch

ild

’s H

IV s

tatu

s:

□ H

IV-p

osi

tive □

HIV

-negativ

e

□ U

nkn

ow

n

If t

este

d H

IV-p

osit

ive:

AR

T s

tart

da

te

/ /

AR

T C

lient N

um

ber

_

_________

/ /

Ch

ild

1

Na

me:

Gen

de

r:

□ M

ale

□

Fem

ale

Date

of

bir

th:

Ch

ild

’s H

IV s

tatu

s:

□ H

IV-p

osi

tive □

HIV

-negativ

e

□ U

nkn

ow

n

If t

este

d H

IV-p

osit

ive:

AR

T s

tart

da

te

/ /

AR

T C

lient N

um

ber

__

__

__

__

_

/ /

Ch

ild

1

In

st

ns

ructi

o

• • • •

Com

ple

te t

his

test

ing f

orm

for

all

bio

logic

al c

hild

ren

of

the

ind

ex

clie

nt.

If

the

ind

ex

pa

tien

t h

as

mo

re t

ha

n f

ou

r ch

ildre

n,

com

ple

te a

dd

itio

na

l fo

rms

as

needed s

o t

hat

all

child

ren a

re r

eco

rde

d.

If the in

dex

HIV

patie

nt

is a

child

, co

mp

lete

th

e f

orm

fo

r a

ll th

e c

hild

's s

iblin

gs

an

d b

iolo

gic

al p

are

nts

.C

hild

ren o

f m

ale

index

clie

nts

do n

ot

ne

ed

HIV

te

stin

g,

un

less

th

eir b

iolo

gic

al m

oth

er

is H

IV-p

osi

tive

, d

ece

ase

d,

or

he

r H

IV s

tatu

s is

un

kno

wn

/no

tdocu

mente

d.

This

form

should

be r

evi

ew

ed a

nd u

pd

ate

d a

t le

ast

an

nu

ally

.


ILLUSTRATION OF FOUR STREAMS OF CARE

PREVENTIVE /

PROMOTIVE

CARE STREAM

– MCWH

(by appointment)

Well adults and well

children

Maternal health

• Antenatal

• Post natal

Reproductive

health

• ToP

• Family

Planning

• Sterilisation

• MMC

Child health

• Well Baby Clinic

• Immunisation

SERVICES

(Allied health

services)

STREAM

(by appointment)

Oral Health

Physical Therapy

• Physiotherapist

• Occupational Therapist

Podiatry

Speech and

Hearing Therapy

Mental Health team

• Psychiatrist

• Psychologists

• Mental health

nurse

st 1 visit

support services

Eye Care

ACUTE / MINOR

AILMENTS

STREAM

(unplanned

visits)

Adults and children

daily visits

Episodic care

Minor ailment

Access to MC & SRH

st for the 1 time Conrmationof pregnancy

and family planning

Universal

test and treat (UTT)

Medical

emergency

Referral from

community screening

including index case

contact testing

CHRONIC

STREAM

(by appointment)

Adults and children

with known chronic

conditions

HIV • Pre-ART

• ART initiation

TB

NCDs

• Diabetes

• Hypertension

• Cardio vascular

• Asthma

• Epilepsy

• Other

Mental health

ST 1 visit chronic

conditions

• IPT

Drug-sensitive

• MDR down -

referral

•



Recep

tio

n

Clinical algorithm to scale up TB Preventive

Therapy (TPT) for adolescents and adults (15+ years of age)


IPT Monitoring Process


• Know 90-90-90 Strategy and target-setting toolkit

• Individual must know HTS policy

• Know facility targets and COP targets

• Know performance of facility (DHIS)

• Agree on process

• Discuss tools for implementing and monitoring

(conrm HTS and pre-ART modules in use)

• Conduct skills audit >> training plan (including prociency testing

(PT) for all testers)

• Potential missed opportunities (from headcount)

• Review current workload of testers

• Review facility HTS Barometer

• Discuss PITC targets and target-setting

• Discuss SCM regarding HTS (test-kits and consumables)

• Discuss intra-facility and community data ow process

• Map current service points in facility

• Create current patient ow

• Map potential PITC patient ow

• Engage all stakeholders (including Clinic Committee and CBOs)

• Map new PITC process ow

• Orientate all testers on tools and processes,

and on daily reporting requirements

• Brief all facility team members, including security staff

• Inform Clinic Committee if not part of the new process activity

• Arrange signage

• Review appointment system

• Toolkit in each room

• Patient stationery

• Job aids

• Ensure a friendly environment for under-5s

• Ensure a youth-friendly environment

• For Operational Manager

• For facility testers (Nurse Clinicians and Lay Counsellors)

• For Data Capturers

• For Information Teams

Review PITC performance through:

• daily HTS Register review;

• daily individual performances against individual targets;

• weekly facility performance against facility target;

• bi-weekly review of dashboard data.

HIV and TB Supportive Supervision Toolkit (version November 2018) Section C - page 1 of 16

• B

eco

me

fa

mili

ar

with

th

e P

ha

rma

cy N

CS

to

ol,

Ide

al C

linic

ass

ess

ment to

ol,

and L

ab a

ssess

ment to

ol.

• R

evi

ew

/sca

n th

e c

urr

en

t D

HP, D

IP/D

OP, F

aci

lity

Pro

le

, F

IP/F

OP, base

line r

eport

, F

aci

lity

QIP

and

D

QA

R

ep

ort

s, 1

0/1

0 to

ols

an

d r

ep

ort

s, P

HC

an

d P

rog

ram

me r

evi

ew

tools

and r

eport

s.•

Fa

cilit

ate

ide

nti

catio

n o

f a

nd

en

ga

ge

me

nt w

ith r

ele

van

t st

ake

hold

ers

. •

An

aly

se th

e c

olle

cte

d in

form

atio

n a

nd

co

mp

ile th

e r

ep

ort

and p

rese

nta

tion.

• D

en

e th

e in

ten

tion

of th

e b

ase

line

ass

ess

me

nt.

• A

gre

e o

n th

e d

ate

an

d tim

e fo

r a

sse

ssm

en

t.•

Ag

ree

on

th

e p

eo

ple

/te

am

invo

lve

d.

• C

om

ple

te a

ll to

ols

as

ab

ove

.•

Orie

nta

te th

e F

aci

lity

Tea

m o

n th

e to

ols

an

d p

roce

ss.

• R

evi

ew

oth

er

rep

ort

s (ite

ms

2.2

to

2.8

in th

e F

aci

lity

Ba

selin

e R

eport

tem

pla

te).

• C

on

du

ct th

e b

ase

line

ass

ess

me

nt.

• C

he

ck p

rog

ress

on

all

QIP

s a

nd

ide

ntif

y g

oo

d p

ract

ice

s a

nd g

aps

• G

ive

fe

ed

ba

ck o

n th

e b

ase

line

ass

ess

me

nt.

• D

eve

lop

th

e Q

IP b

ase

d o

n g

ap

s id

en

tie

d (

usi

ng

th

e B

ottle

ne

ck A

na

lysi

s te

mp

late

s).

• D

eve

lop

th

e Q

IP b

ase

d o

n g

ap

s id

en

tie

d (

usi

ng

th

e B

ottle

ne

ck A

na

lysi

s te

mp

late

s).


PHC Area Manager mentors the OM

OM/CEOleads the

team

School Health representative

Ward-based Outreach Team representative

Ward AIDS Committee

Chairperson

Facility staff (both clinical

and data)

Clinic Committee / Hospital Board representative

Facility Technical

Working Group

Implementing Partner

representatives

Facility Technical Working Group (FTWG) stakeholders

Facility Planning Cycle


How do we know if we have arrived?

How do we get there?

Measure and evaluate

Where are we now?

Conduct baseline assessment of current performance

on all four pillars

Where are we going?

Setting of targets

Develop QIP with interventions

Introduction

• Purpose of developing FIP• Steps for FIP development• Patient Management Cascades• Data needed to complete the FIP• The core participants are the facility staff (check the DIP).

SMART AIM

• Set out an aim statement for each cascade pillar• Identify priority population groups to focus your aim statement

Facility Implementation Plan (FIP) development process

Map stakeholders

• Map stakeholders for each of the cascade pillars• Include CBOs, LAC, WAC, PLWHIV, etc.

Review current situation

• Review performance data for each pillar using run-charts, performance dashboard and cascades• Review previous plan (reect on the activities implemented successfully)

Bottleneck and Root Cause Analysis

• Brainstorm bottlenecks and issues leading to poor performance for each cascade as seen in the 2X4 Matrix

• Prioritise three bottlenecks• Use the BNA guiding

questions or • Place these in the Fishbone• Apply '5 Whys’ to get to the

root causes (whether using the guiding questions or the Fishbone)

Design interventions

Brainstorm possible solutions to address the identied root causes from the bottleneck analysis:• Prioritise high-impact

activities using the Prioritisation Matrix

• Populate the FIP template • Review implementation of

the plan in 90 days and develop a QIP


Introduce the 2x4 Matrix

Brainstorm bottlenecks for each cascade pillar

Prioritise 3 bottlenecks per cascade and place these on the Fishbone

Respond to the guiding questions for each prioritised bottleneck

Get to the root causes using the '5 Why’


Do

cu

men

t H

IV r

esu

lts

• R

egis

trat

ion

Cle

rk:

Cap

ture

pat

ient

’s fu

ll ID

Num

ber

in H

PR

S a

nd p

atie

nt r

ecor

d du

ring

patie

nt r

egis

trat

ion

• P

N:

Writ

e ID

Num

ber

in H

TS

Reg

iste

r an

d cl

inic

al s

tatio

nery

as

the

uniq

ue id

entifi

er

• D

atC

ap:

Ent

er H

TS

res

ults

from

HT

S R

egis

ter

into

TIE

R.N

et H

TS

mod

ule

• D

atC

ap:

Ent

er c

lient

s in

itiat

ed o

n A

RT

resu

lts fr

om c

linic

al s

tatio

nery

into

TIE

R.N

et A

RT

mod

ule

• D

atC

ap:

Use

sea

rch

func

tion

(ID

; nam

e; d

ate

of b

irth;

fold

er n

umbe

r) in

to T

IER

.Net

to p

reve

nt d

uplic

ate

entr

ies

Iden

tify

H

IV+

no

t o

n

AR

T

• D

atC

ap:

Run

‘Wai

ting

for A

RT

List

’ rep

ort o

n cl

ient

s w

ho a

re H

IV-p

ositi

ve b

ut n

ot in

itiat

ed o

n A

RT

• D

atC

ap:

Run

‘HIV

Mis

sed

App

oint

men

ts /

uLT

F S

elec

tion’

rep

ort

on c

lient

s w

ho a

re H

IV-p

ositi

ve a

nd o

n

AR

T w

ho m

isse

d an

app

oint

men

t

• D

atC

ap:

Pro

vide

OM

with

list

of H

IV-p

ositi

ve p

atie

nts

not o

n A

RT

who

wer

e ne

ver

initi

ated

and

/or

m

isse

d ap

poin

tmen

ts

Tra

cin

g

an

d lin

kag

e

OM

: P

rovi

de L

inka

ge O

ffice

r/tr

acin

g te

am w

ith li

st o

f HIV

-pos

itive

pat

ient

s no

t on

AR

T w

ho w

ere

neve

r

ini

tiate

d an

d/or

mis

sed

appo

intm

ents

Lin

kag

e O

ffice

rs: T

race

HIV

-pos

itive

pat

ient

s no

t on

AR

T

PN

: In

itiat

e H

IV-p

ositi

ve p

atie

nt o

n A

RT

Pro

cess

ow

s f

or

un

iqu

e ID

an

d lin

kag

e m

on

ito

rin

g


Linkage Ofcer:(90-90-90):

mobilisation, tracing, retention in care

Community Mobiliser:Clinician support and

community mobilisation –st nd 1 and 2 90

FACILITY:Nurse Clinician and

Data Capturer

WBOTs:

Professional Nurse

Enrolled Nurse

Community caregivers

CBOs

Professional Nurse

Data Capturer

Administrators

Facilitatorsnd rd2 and 3 90

Active referrals

Community Dialogues

Health education

Tracking and tracing

Community events

TMC and MMC

Referrals toOutreach Teams

Traditional CouncilsWar Rooms

AIDS CouncilsWard AIDS Committees

Stakeholder engagement

and participation between

community and facility

LTFU and H

TC lists

Missed appointments

Referrals

Testi

ng and

scre

ening gaps

Referrals

Stable and adherent

Return to treatment


Purpose:

Liaises between Nurse Clinician and Data Capturer at facility level to mobilise community through outreach teams, links with CBOs and delivery of services into the community

Role:

1. Community engagement through stakeholder structures: � Ward AIDS Committee � War Rooms � CBOs � Traditional Councils

2. Support the 90-90-90 Strategy3. Link clients to facility for care and treatment4. Index case contact testing and tracing5. Health Education

Tools used:

Referral forms

Track and Trace tool

Early/Late Missed Appointment Register

Guidance for LTFU engagement

LTFU lists

Index case contact tracing tools

Data–client file and TIER.Net

Flipchart tools

HTC Registers

CBO community mobilisation schedules

Adherence Club schedule

Support Group schedule

Co-infected Client Case ID Register

Data ow

Facility:

Client data held by community ‒ TIER.Net, patient les, Early / Late /

Missed Appointment Registers and LTFU Lists

Nurse ClinicianFacility Data Capturer

Linkage Ofcer: Stakeholder engagement

Civil society / CBOsWard AIDS CommitteesWBOTsOperation Sukuma Sakhe

Client referral /data returned for capture

Household assessmentsCommunity testing/initiationHealth EducationDecanting: Adherence clubs CCMDD external pick-up points Spaced Fast-laneSupport groups

Community members provided with services:Community stakeholders:


Patients attend the club every two months

Patient details are entered into the Adherence Club Register at attendance of the meeting

CBO Club Facilitator completes the tally sheet using the Adherence Club Register

CBO Data Capturer extracts data from the Adherence Club

Register and reports to DME by stthe 1 of each month

CBO Club Facilitator submits the Adherence Club Register to the

Facility Manager for capturing within 5 days of club meeting

1. Facility Manager receives the Register2. Facility Manager signs off the tally sheet3. Facility Manager gives the facility Data Capturer the Adherence Club Register for capturing in TIER.Net

1. Facility Data Capturer captures the data from the Adherence Club Register into TIER.Net system within 2 days2. Facility Data Capturer hands the Adherence Club Register to the Facility Manager

CBO Club Facilitator fetches the Adherence Club Register from the facility for the next

adherence club meeting

CBO Manager updates facility calendar with club dates

CBO Facilitator noties the HST Nurse Clinician of blood dates 2 months in advance

CCMDD TA checks the manifests returned

HST Data Capturer ensures that the process is completed and data are captured

HST Data Nurse Clinician reviews Adherence Club Registers for accuracy against client le notes, and refers errors


TIER.Net (key focus)Reporting and utilising

information for decision-making

Data quality assurance

• Signed off, no backlogs, and maintenance

• HTS Module implementation with all HTS results captured

• ART Module: All required results entered from clinical stationery daily

• Capture ID numbers daily as unique identication in the absence of folder number; correct name, date of birth or physical address to prevent duplication

• ART clients decanted to CCMDD and adherence clubs are correctly captured in TIER.Net daily

• IPT start- and end-dates and outcomes correctly captured daily

• VL and CD4 results entered into and

• Generate Early Warning Indicators (EWI), 90-90-90 Tracer Indicators and QIP Indicators to monitor the HIV programme effectiveness at facility level: bi-weekly, monthly and quarterly

• Generate TIER.Net reports to trace and link clients to care weekly and monthly

• DATIM and DIMES: report monthly results; ensure that results reported match results in source documents

• DsD results: collect and report weekly

• Verify data daily• Weekly Registers / clinical

stationery review• Conduct TIER.Net audit

monthly

Supervision of Data Capturers SOP


For more information, contact one of our offices:

Durban (Head Office): 34 Essex Terrace, Westville, 3630

Tel: +27 (0)31 266 9090

Johannesburg: 1st Floor, Block J, Central Park,

400 16th Road, Midrand, 1682Tel: +27 (0)11 312 4524

Cape Town: Block B, Aintree Office Park, Doncaster Road,

Kenilworth, 7700 Tel: +27 (0)21 762 0700

Email: [email protected]: 086 588 0394

Web: http://www.hst.org.za

(version november 2018) · sop tb tier.net tmc tpt top qi qip ultf vl wac wbot wphcot 10/10...

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