1
ONE STOP SERVICE
SAVANNAKHET PROVINCIAL HOSPITALHIV CARE UNIT
PRESENT BY : KHAMPHANG SOURINPHOMY, MD
• N. Blood tested : 50.961•• N. HIV test positive N. HIV test positive : : 22..131131• N. AIDS Case : 1.358• N. AIDS dead : 691• N. PHA group : 318
• N. Impact to Child : 139
Overall pictures of HIV Overall pictures of HIV 1993 1993 to to 20142014
1993 - 2013 2014
HIV HIV positive positive by Genderby Gender1993 1993 to to 20142014
55%45%
Male Female
57%43%
Male Female
Blood Tested: 50.961; HIV +: 2.131 Female: 940
0
100
200
300
400
500
600
6937 12 34
260
557
386345
184
10071
Numbers
HIV HIV positive by Age positive by Age 1993 1993 to to 20142014
Blood Tested: 50.961; HIV +: 2.131 Female: 940
93%
5% 2% 0%0%
HeterosexualMTCHomosexualIDUBlood
HIV transmissionHIV transmission1993 1993 to to 20142014
Challenges during the implementation
• From mother-to-child infection remains found
• Late admission of clients (almost come with OIs)
• Limited engagement of family members in providing care
• Insufficient number of human resources at the ARV clinic
Team meeting to discuss on the Late admission of clients
• Service provider - Limited number of medical
doctors/nurses, unable to handle broad services
- Nurses receive new roles (replacement)
- Lack skills of new staff .• Client - Being intolerant to sickness- Facing unsupportive family
(due to inability to disclose themselves)
- Hesitate to come due to familiarity with current service provider
Participatory planning and actions
• Service provider
- Modify roles and responsibilities of nurses so that PL+ could support
- Discuss with nursing technical team on proper replacement process
- Provide on-job training for new nurses who are not familiar with their tasks
• Client
- Propose group activities for new cases to share experiences with peers( meditation)
- Support self-disclosure of clients to trusted family members (shared roles in providing care)
• Extra visit at Doctor’s compound
One stop service activities for HIV/AIDS One stop service activities for HIV/AIDS
Concerted effort:
- Leader of all levels.- Mass organizations and religion organizations .- Health authorities of al levels- Governmental and non governmental organisations- Community, families and PHA
To Improve go long life and lively hood To Improve go long life and lively hood
Involve social and economic developingInvolve social and economic developing
Involve in HIV prevention processingInvolve in HIV prevention processing
II. II. Care and treatmentCare and treatment-OIs prophylaxis and treat-ART management-Adherence care
I. VCT/PICT-Op In and Op out case-Counseling-confidentiality-Blood test
III. Care and III. Care and PreventionsPreventions--Condom use >Condom use >9595%%--PMTCTPMTCT--Standard precautionsStandard precautions
IV. Care and support--Chico’s counselingChico’s counseling--Sisal Economic supportSisal Economic support--Nutrition supportNutrition support--Description and stigmaDescription and stigma
Reception
Adherence counseling
Consultation’s
Medicine Activity
Adherence counselingBefore go home
OPD Activities
CD4, VL,…
Go home
Patients Register
BMIBMI
IPD Activities
Diagnosis and treated .
Patients monitoringLab Activities
Round ward
Case study discuses
13/08/2015 13
Implemented activities: group discussion during the meeting with family members
Meditation
13/08/2015 15
Adherence Counselingis responsibility of all staff
PLACE TO OPEN DISCUSSION ON DAILY LIFE
Care, Treatment and Support
Activities
SOCIO-ECONOMICPROBLEMS are
discussed
TREATMENT COMPLIANCESARE EXPLORED
HOW TO TAKE DRUGS
THIS IS FOR
PLWAs BETTER LIFE
MEDICAL ISSUES ARE ADDRESED
MEET WITH ADHERENCE COUNSELOR
HIV positive access to care1993-2014
17
0
20
40
60
80
100
120
140
160
180
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
HIV+ 6 0 25 30 55 57 72 67 79 60 75 13 16 13 17 13 15 14 14 14 13 13
Acc.to care 0 0 0 0 0 0 0 0 0 0 75 13 16 13 17 13 15 14 14 14 13 13
Cumulative of HIV Patient Registered Since 2003-06/2015
total transferred out death lost of follow up on follow up
2132
434 442347
941
10334 8 15 48
2235
468 450362
989
adualt Child total
Cumulative of HIV Patient Registered on ART Since 2003-06/2015
1666
366242
166
909
7825 2 5 47
1744
391
244171
956
total transferred out death lost of follow up on follow up
adualt Child total
Current ARV regimen 2003-06/2015
0
50
100
150
200
250
300
350
400
450
500
adualt Child total
First line 461 32 493
alternative First line 372 3 375
Second line 76 12 88
CD4 Monitoring
21
0
500
1000
1500
2000
2500 2218
1875
1244
381250
136 13615 104 17
20032003--20142014 20142014
VL Monitoring 2014
N.p.on ART VL test VL Und VL Detact VL>1000
Series1 959 935 881 54 36
0
200
400
600
800
1000
1200
MDR Monitoring MDR Monitoring 2014 2014
78
27
10
13
7
2726
10
0
5
10
15
20
25
30
AZT DDI 3TC/FTC D4T ABC TDF NVP EFV ETV
VL>VL>10001000 copiescopies MDR test MDR test
3636 3636
ນົດນົດ ຮຽຘຮຽຘ ທ ີ່ທ ີ່ ຖອດຖອດ ຖອຘຖອຘ(Lesson learn)(Lesson learn)
• ທ ຳຄຳຘ ເບັຘທ ມ (Team work)
• ມ ກຳຘ ຖອດຖອຘນົດຮຽຘ (lesson learned )
• ມ ເ ີ່ ອີ່ ຳຍບະສຳຘຄຳຘ (Network )
• ປ ູ້ ຮັນນ ລິ ກຳຘ ເບັຘສ ຘກຳຄ (Clients center)
• ທ ຳຄຳຘ ດູ້ ວຍໃ (Work from Heart )
– ທ ມດຽວກັຘ (One team)
– ໃດຽວກັຘ (One Heart )• ກູ້ ຳວໄບ ດູ້ ວຍກັຘເພ ີ່ ອສູ້ ຳຄສັຘຸຘ ຘະ ພຳນ!!