Quality Improvement Updates
Katutura Health Center, NAMIBIA
Prevention Education
Katutura Health Center, located in a suburb of the Windhoek district, is staffed by two doctors, five nurses, one pharmacist, two pharmacy technicians, one pharmacy assistant, two data clerks, four counselors, one revenue clerk, one maintenance person, and three expert patients.
Health Center staff chose prevention education as their QI focus, because of low performance demonstrated in this area.
Investigation of data revealed that patients starting treatment were not receiving required prevention education at the time of initiation because of poor scheduling. For example, one day 40 patients arrived, and on another day only five showed up.
During this analysis, staff also identified a link between poor patient adherence and prevention education deficits. Additional obstacles included perceived patient disinterest in counseling, and delays between adherence counseling and ARV initiation.
Katutura staff decided on a two phase improvement strategy.
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The AIDS Support Organization (TASO Mbarara), UGANDA
CD4 Monitoring
The AIDS Support Organization (TASO) is currently the largest non-governmental organization providing HIV/AIDS services in Uganda. The TASO Mbarara Center is an HIV clinic located ajacent to the Mbarara Hospital, Mbarara municipality of south western Uganda. The Mbarara HIV clinic was established in 1989 by eight volunteers in a one room office of the Mbarara hospital, and in 1991 became a formal and semi-autonomous TASO Center. TASO Mbarara now runs six outreach clinics covering 16 communities over seven districts. The TASO Mbarara clinic also sees patients from the neighboring countries of Congo, Rwanda, and Tanzania.
After receipt of baseline data, the quality improvement team identified low performance (17%) in CD4 monitoring, prioritized this area and developed a systematic approach to improving their performance.
First, they analyzed methods to optimize the use of their existing scheduling system to track patients based on type of visit needed.
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Al Nouri Specialist Hospital, NIGERIA
CD4 Monitoring
Al Nouri Specialist Hospital, a treatment partner of AIDS Relief, is located in Kano, northern Nigeria. As of July 2009, approximately 2288 patients had received HIV care services, of which 1188 received ART.
To jump start their improvement program, Al Nouri established a quality management committee comprised of five staff, including the ART physician, three nurses, and a pre-existing M&E representative. Through facility partner AIDS relief, a June 2009 quality training provided valuable educational support for a member of the QI team. Monthly meetings were established to review QI activities.
When baseline data revealed low performance in CD4 monitoring (% of patients from chart reviews with CD4 repeat at 6 months within the month), hospital staff chose that aspect of care as their QI focus.
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Grace Children's Hospital, HAITI
Cotrimoxazole Prophylaxis
Grace Children’s Hospital, founded in 1967, is located in western Haiti just outside the capital of Port-au-Prince. The hospital serves a region with a population of approximately 67,000 people, including 3500 people living with HIV. Of the HIV+ population, 1142 are currently on HAART. The hospital’s HIV program is open 8:00AM until 4:00PM, Monday through Friday.
The hospital is staffed by 16 doctors, five counselors, one psychologist, one technician, 20 nurses, 13 lab techs, two data clerks, five outreach workers, one pharmacist, two adherence counselors, one nursing coordinator, and 18 auxiliary staff.
After baseline data revealed a low performance score of 32.4% in administration of CTX prophylaxis, defined as the proportion of HIV-positive adolescents who received cotrimoxazole prophylaxis in the preceding 6 months, staff determined to prioritize improvements in this area. In December 2008, Grace established a formal quality committee composed of staff from the hospital’s HIV clinic.
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