Increasing the Proportion of

Counseled Clients Testing for HIV at

RHU Outreaches in Hoima District

Kyarimpa Annet

Reproductive Health Uganda (RHU)

Supervisors: Dr. Maina Wamuyu Gakenia

Mr. Jackson Chekweko

Dissemination workshop for SPH-CDC HIV/AIDS Fellowship programme- projects

August 20, 2010

Introduction RHU is a non-government and not for profit organization that

provides sexual and reproductive health services (SRH).

RHU currently has 16 branches, located in the districts of

Lira, Mityana, Gulu, Hoima, Mbale, Apac, Kapchorwa, Fort

portal, Tororo, Iganga, Arua, Luweero, Kampala, Kabale,

Mbarara, and Bushenyi.

RHU-Hoima branch is located in Western Uganda. The

facility runs 9 outreaches in the parishes of Central ward,

Western ward, Northern ward, Bugema, Kitoba, Buhanika and

Town Council. These outreaches are visited monthly.

Problem identification Brain storming

Fish bone analysis of the problem › Inadequate skills of service providers in HCT, Inadequate

VCT kits, Lack of Privacy at outreaches, Small staffing

Multi-voting

Theme selection matrix Rating

› Inadequate skills of Service Providers 18.4

› Lack of privacy at outreaches 20

› Small staffing 19.3

Problem statement, justification › Problem

only 19% of the clients counseled for HIV

testing, took an HIV test at the RHU Hoima

outreaches.

› Justification

The continuous quality improvement (CQI)

project, was set to address privacy and Service

provider counseling skills for effective HCT, and

hence increase the number of clients testing for

HIV at the outreaches.

Baseline situation • Clients counseled in a vehicle while others are

catching

A pre-test counseling session during an outreach in Katerega Village

A client being bled during an outreach in Katerega Village

Baseline situation-continued Number of People Pre-couselled for HIV and

Number of People tested for HIV at RHU Hoima

Outreached May - July 2008

0

100

200

300

400

500

600

700

Months of the Year

No.

of P

eopl

e P

re-c

ouns

elle

d/ T

este

d fo

r HIV

No. of people pre-

counselled for HIV at

Outreaches

Total Testing for HIV at

Outreaches

No. of people pre-

counselled for HIV

at Outreaches

405 513 612

Total Testing for

HIV at Outreaches

108 98 94

May June July

19% Current

Situtaion

Project objectives General Objective

To increase the proportion of clients testing

for HIV at RHU Outreaches in Hoima

District.

Specific Objective

By the end of January 2009, at least 30% of

clients pre-counseled for HIV at the RHU

Hoima outreaches, taking an HIV test.

Project counter measures/ implementation

• Sensitization of management on CQI

• Selection of CQI team

• Held on-job training for staff and peer educators

on quality improvement

• RHU trained service providers in HCT

• Procurement and equipping the outreach sites

with outreach kit to address privacy.

• Monitoring and evaluation

• support supervision to RHU Hoima.

Project implementation-2

Results/project outcomes CQI team established and functional

CQI is integrated in RHU-Hoima interventions (quarterly client exit interviews and quality of care assessment checklist developed by IPPF).

Five Service providers and 12 peer educators trained in CQI

RHU service providers trained in HCT

RHU-Hoima secured free working space from the community to improve privacy during outreaches (KCB bank, kitoba SACCO, central ward shed, northern ward space in the shop)

Increased client load (see next slide).

No of people counselled for HIV testing at outreaches, Oct,

605 No of people counselled for HIV testing at outreaches, Nov,

556

No of people counselled for HIV testing at outreaches, Dec,

624

total testing for HIV at outreaches, Oct, 268

total testing for HIV at outreaches, Nov, 282

total testing for HIV at outreaches, Dec, 362

Percentage testing for HIV at outreaches, Oct, 44

Percentage testing for HIV at outreaches, Nov, 51

Percentage testing for HIV at outreaches, Dec, 58

No

. of

pe

op

le c

ou

nse

lled

/te

ste

d

Months of the year (2008)

Number of people counseled and tested for HIV at RHU Hoima Oct-Dec 2008

No of peoplecounselled forHIV testing atoutreaches

total testing forHIV atoutreaches

Percentagetesting for HIV atoutreaches

Lessons learnt

• Team work is a Key aspect in implementation

and sustainability of CQI.

• Progressive quality assessment should be

institutionalized for CQI to be realized.

• Emerging issues (effects) following CQI

interventions should be closely analyzed,

monitored and possible solutions drawn.

Challenges

• Stock out of HIV test kits

• Over whelming clients for limited

counselors/service providers

• Limited funds to address emerging quality of

care issues/gaps

Way forward

Integrate emerging issues in RHU annual

work plan and budget (procurement of HCT

kits)

Partnership with Hoima- District Health

officer and other organizations such as TASO

for joint outreaches, HCT kits, client referral

Advocacy and proposal writing for increased

funding – (sustainability of achievements)

Routine –CQI assessment

Acknowledge

• Makerere University school of Public health and CDC

• Reproductive Health Uganda

• Supervisors

• Facilitators

• Programme coordinators