{{ {{--

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