what drives kitovu mobile? · 4 description of the problem, gaps despite good arvs supply from...

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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

Kitovu Mobile AIDS Organisation-Uganda1

Presenter; Nsamba Joseph

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”.


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About QI in Kitovu Mobile AIDs

• Kitovu Mobile AIDs Organization has aQI team consisting of 8 membersQI team consisting of 8 membersincluding: 1- ART Physician, 2-clinicians,3-nurses, 1-Data personnel and 1-HIVMedic.

• 1 member went to school and another retired from work• We have one clinician under mentorship.

Improvement objective 5

P ti t ART R t i d i C T t 100%

Improvement objectives 5 and 6

Patient on ART Retained in Care, Target 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

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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 CD4support by Rakai Project (RHSP)

Staff Staff

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Improvement objective 7Adh

Improvement objectives 7 and 8

Adherence % of Patients on ART with adherence level above

95% (Target=95%)

Improvement objective 8TB t TB assessment % 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 month6

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Despite good ARVs supply from MoH-NMS since December2010-September 2011, We still have 3.7% adherence gapbelow 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 from63.7% in 2009 to relatively stable range of 97.8-100% in2011, TB detection rate is still low.

L b t i ti ti f TB i th ill i h ll Laboratory investigation of TB in the villages is a challenge,No continuous phase of AntiTBs

TB Suspicion rate was very low (1.05%)

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EFFECTIVE TESTED CHANGES AND STEPS

All staff to document clients adherence level,assessment and suspect for TB on the HIV/ART cardassessment and suspect for TB on the HIV/ART cardevery day.

Regular feedback and CMEs to staff to increasevigilance for TB management.

Intensifying treatment and adherence counseling bypeers and staff.

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5

83.375.9

77.6

77.8

89.988.5

89.3

70

80

90

100

vel

% of patients who demostrated adherence level above 95% between June-December 2011

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30

40

50

60

% o

f p

atie

nts

Ad

her

ence

le

v

nn

Adherence gapOver 90% observed in old patients.

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

0

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Data source: Kitovu Mobile AIDs Org. Data Base

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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 outcomeg

Kitovu Mobile AIDS Organisation-Uganda

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Data by sampling technique revealed that on average55 5% of total patients on ART had good clinical55.5% of total patients on ART had good clinicaloutcome.

In the last one year, patients weight has not beenconsistently taken due to depreciated weighing scalesthat are un repaired.p

Documentation without differentiating between OIs andother problems

Kitovu Mobile AIDS Organisation-Uganda 14

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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 themHeld CME about OIs and differentiate them from other problems.

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87

9593

89

70

80

90

100

nic

al o

utc

om

e

% of clients who demostrated good clinical outcome between June-December 2011

50

63

55

30

40

50

60

70

age

of

clie

nts

wit

h g

oo

d c

lin

June July Aug Sept Oct Nov Dec

2011

Denominator 146 146 146 146 146 146 146

Percentage % 50 63 55 87 95 93 89

0

10

20

Per

cen

ta

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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 Bukakkatab t t t d f HIV th h th T tsub-county were tested for HIV through the Test

and Treat project. 197 turned Positive

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SUSTAINING QI EFFORTS

All Quality Improvement efforts depend on th ti l d il bilit fthe continuous supply and availability of Medicines

Empowering site teams through trainings and feedback.


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OTHER CHALLENGES Only 85 clients have been initiated on ART since the

beginning of the year, because of limited C


accessibility to CD4 count. Biggest number started basing on WHO clinical staging

Solution.

Refurnishing of laboratory premise is already done t Kit bil d th CD4 hi i d iat Kitovu mobile and the CD4 machine arrived in

Kampala yesterday.

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BLESSINGS

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CONTACTS;KITOVU MOBILE AIDS ORGANISATION

Plot 4 Delhi Road, P.O Box 207 Masaka, Uganda, East Africa www.kitovumobile.org

E-mail; [email protected] l 0481 20113 F 0481 20275/20514Tel: 0481-20113 Fax: 0481-20275/20514

Nsamba JosephQI Team LeaderMob; [email protected]@gmail.com

Nassanga ShibahAss. Team LeadersMob; [email protected]


what drives kitovu mobile? · 4 description of the problem, gaps despite good arvs supply from...

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