QUALITY IMPROVEMENT LEARNING SESSION 3 DOCUMENTATION PERIOD: JUNE 2011- DECEMBER 2011 Experience gained by Kitovu Mobile AIDS Organization (Kitovu Mobile) in South West Uganda. Presenter; Nsamba Joseph Presenter; Nsamba Joseph Kitovu Mobile AIDS Organisation-Uganda 1 Ministry of Health WHAT DRIVES KITOVU MOBILE? Mission: To improve the quality of life of people infected and affected by HIV and AIDS through working in and with communities focusing on the areas of Prevention; Care, and Support and Capacity Building thus fulfilling the words of Christ : • “ I have come that they may have life, life in its fullness” (John 10:10) Vision: “An empowered community with the ability to cope with HIV and AIDS and its impacts ”. Kitovu Mobile AIDS Organisation-Uganda 2 1
About QI in Kitovu Mobile AIDs • Kitovu Mobile AIDs Organization has a QI QI team team consisting consisting of of 8 8 members members including: 1- ART Physician, 2-clinicians, 3-nurses, 1-Data personnel and 1-HIV Medic. 1 member went to school and another retired from work • • We have one clinician under mentorship. Improvement objectives 5 and 6 Improvement objective 5 Patient on ART Retained in Care, Target 100% P ti t ART R t i d i C T t 100% Indicator for the Objective % of patients on ART who are retained in care every month. Improvement objective 6 Patients on ART who kept appointment (Target 100%) p pp ( g ) Indicator for the Objective % of patients on ART who kept appointments every month 4 2
DESCRIPTION OF THE PROBLEM, GAPS Gaps exist due to ; Self transfer by clients. Some clients develop severe illnesses-Admissions Inaccessibility to CD4 count testing following stop for CD4 support by Rakai Project (RHSP) Staff Staff 5 Improvement objectives 7 and 8 Improvement objective 7 Adherence Adh % of Patients on ART with adherence level above 95% (Target=95%) Improvement objective 8 TB assessment TB t % of Patients in general care who were assessed for TB every month. % of clients in general care who were assessed, suspected and treated for TB every month 6 3
DESCRIPTION OF THE PROBLEM, GAPS Despite good ARVs supply from MoH-NMS since December 2010-September 2011, We still have 3.7% adherence gap below the indicator objective. j Over 90% poor adherence is Registered among old-clients(On ARVs 3-4 years and more) Despite improvement in TB assessment at Kitovu Mobile from 63.7% in 2009 to relatively stable range of 97.8-100% in 2011, TB detection rate is still low. Laboratory investigation of TB in the villages is a challenge, L b t i ti ti f TB i th ill i h ll No continuous phase of AntiTBs TB Suspicion rate was very low (1.05%) 7 EFFECTIVE TESTED CHANGES AND STEPS All staff to document clients adherence level, assessment and suspect for TB on the HIV/ART card assessment and suspect for TB on the HIV/ART card every day. Regular feedback and CMEs to staff to increase vigilance for TB management. Intensifying treatment and adherence counseling by peers and staff. 8 4
% of patients who demostrated adherence level above 95% between June-December 2011 100 89.9 88.5 90 89.3 83.3 77.6 75.9 80 77.8 70 vel % of patients Adherence lev 60 50 40 Adherence gap Over 90% observed in old patients. 30 nn 20 10 0 June July Aug Sept Oct Nov Dec 2011 Numerator 712 625 649 692 802 755 396 Denominator 854 823 836 890 892 853 443 Percentage (%) 83.3 75.9 77.6 77.8 89.9 88.5 89.3 Data source: Kitovu Mobile AIDs Org. Data Base 5
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GOOD CLINICAL OUT COME Improvement objective % of Patients on ART with good clinical outcome (Target=80%) Indicator for the Objective % of Patients on ART with good clinical outcome g Kitovu Mobile AIDS Organisation- 13 Uganda DESCRIPTION OF THE PROBLEM, GAPS Data by sampling technique revealed that on average 55 5% of total patients on ART had good clinical 55.5% of total patients on ART had good clinical outcome. In the last one year, patients weight has not been consistently taken due to depreciated weighing scales that are un repaired. p Documentation without differentiating between OIs and other problems Kitovu Mobile AIDS Organisation- 14 Uganda 7
Kitovu Mobile AIDS Organisation- Uganda EFFECTIVE TESTED CHANGES AND STEPS New weighing scales have been bought with protective coition boxes for safe protective coition boxes for safe transportation while in field Ensure electronic tracking of individual patients data in the database. Held CME about OIs and differentiate them Held CME about OIs and differentiate them from other problems. 15 % of clients who demostrated good clinical outcome between June-December 2011 100 95 93 nical outcome 90 89 87 80 70 70 age of clients with good clin 63 60 55 50 50 40 30 Percenta 20 10 0 June July Aug Sept Oct Nov Dec 2011 Denominator 146 146 146 146 146 146 146 Percentage % 50 63 55 87 95 93 89 8
Kitovu Mobile AIDS Organisation- Uganda BABY MARIA BROUGHT BY HER GRAND AT MOBILE OFFICE FOR REVIEW. Weight monitoring is very vital in assessing patient clinical outcome OTHER ISSUES IN KITOVU MOBILE Through collaboration with other local organizations; organizations; 287 clients were able to access follow up CD4 counts done through the COSTOP study by MRC. Over 1687 people in communities of Bukakkata sub-county were tested for HIV through the Test b t t t d f HIV th h th T t and Treat project. 197 turned Positive 9
SUSTAINING QI EFFORTS All Quality Improvement efforts depend on the continuous supply and availability of th ti l d il bilit f Medicines Empowering site teams through trainings and feedback. Kitovu Mobile AIDS Organisation- Uganda 19 Kitovu Mobile AIDS Organisation- Uganda OTHER CHALLENGES Only 85 clients have been initiated on ART since the beginning of the year, because of limited accessibility to CD4 count. Biggest number started basing on C WHO clinical staging Solution. Refurnishing of laboratory premise is already done at Kitovu mobile and the CD4 machine arrived in t Kit bil d th CD4 hi i d i Kampala yesterday. 20 10
Kitovu Mobile AIDS Organisation- Uganda BLESSINGS 21 CONT CONTACTS; TS; KITOVU MOBILE AIDS ORGANISATION Plot 4 Delhi Road, P.O Box 207 Masaka, Uganda, East Africa www.kitovumobile.org E-mail; director@kitovumobile.org T l 0481 20113 Tel: 0481-20113 Fax: 0481-20275/20514 F 0481 20275/20514 Nsamba Joseph Nassanga Shibah QI Team Leader Ass. Team Leaders Mob; +256782275596 Mob; +256776928810 quality.art@kitovumobile.org nashibah10@gmail.com nsambajoseph@gmail.com Kitovu Mobile AIDS Organisation-Uganda 22 11
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