WHAT DRIVES KITOVU MOBILE? Mission: To improve the quality of life - - PDF document

1

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-Uganda 1

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”.

Kitovu Mobile AIDS Organisation-Uganda 2

2

About QI in Kitovu Mobile AIDs

• Kitovu Mobile AIDs Organization has a

QI team consisting

• f

8 members QI team consisting

• f

8 members including: 1- ART Physician, 2-clinicians, 3-nurses, 1-Data personnel and 1-HIV Medic.

• 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

4

3

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 CD4

support by Rakai Project (RHSP)

• Staff
• Staff

5

Improvement objective 7

Adh

Improvement objectives 7 and 8

• Adherence
• % of Patients on ART with adherence level above

95% (Target=95%)

Improvement objective 8

TB 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 month

6

4

DESCRIPTION OF THE PROBLEM, GAPS

• Despite good ARVs supply from MoH-NMS since December

2010-September 2011, We still have 3.7% adherence gap below 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 from

63.7% in 2009 to relatively stable range of 97.8-100% in 2011, 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%)

7

EFFECTIVE TESTED CHANGES AND STEPS

• All staff to document clients adherence level,

assessment and suspect for TB on the HIV/ART card assessment and suspect for TB on the HIV/ART card every day.

• Regular feedback and CMEs to staff to increase

vigilance for TB management.

• Intensifying treatment and adherence counseling by

peers and staff.

8

5

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

nn Adherence gap Over 90% observed in old patients.

Data source: Kitovu Mobile AIDs Org. Data Base

6

7

GOOD CLINICAL OUT COME

Improvement objective

• % of Patients on ART with good clinical
• utcome (Target=80%)

Indicator for the Objective

• % of Patients on ART with good clinical outcome

g

Kitovu Mobile AIDS Organisation- Uganda 13

DESCRIPTION OF THE PROBLEM, GAPS

• Data by sampling technique revealed that on average

55 5% of total patients on ART had good clinical 55.5% of total patients on ART had good clinical

• utcome.
• In the last one year, patients weight has not been

consistently taken due to depreciated weighing scales that are un repaired. p

• Documentation without differentiating between OIs and
• ther problems

Kitovu Mobile AIDS Organisation- Uganda 14

8

EFFECTIVE TESTED CHANGES AND STEPS

• New weighing scales have been bought with

protective coition boxes for safe

Kitovu Mobile AIDS Organisation- Uganda

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 them

Held CME about OIs and differentiate them from other problems.

15

nical outcome

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

age of clients with good clin

Percenta

9

BABY MARIA BROUGHT BY HER GRAND AT MOBILE OFFICE FOR REVIEW.

Kitovu Mobile AIDS Organisation- Uganda Weight monitoring is very vital in assessing patient clinical outcome

OTHER ISSUES IN KITOVU MOBILE

• Through collaboration with other local
• rganizations;
• rganizations;
• 287 clients were able to access follow up CD4

counts done through the COSTOP study by MRC.

• Over 1687 people in communities of Bukakkata

b t t t d f HIV th h th T t sub-county were tested for HIV through the Test and Treat project. 197 turned Positive

10

SUSTAINING QI EFFORTS

• All Quality Improvement efforts depend on

th ti l d il bilit f the continuous supply and availability of Medicines

• Empowering site teams through trainings and

feedback.

Kitovu Mobile AIDS Organisation- Uganda 19

OTHER CHALLENGES

• Only 85 clients have been initiated on ART since the

beginning of the year, because of limited C

Kitovu Mobile AIDS Organisation- Uganda

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 i at Kitovu mobile and the CD4 machine arrived in Kampala yesterday.

20

11

Kitovu Mobile AIDS Organisation- Uganda

BLESSINGS

21

CONT CONTACTS; TS;

KITOVU MOBILE AIDS ORGANISATION Plot 4 Delhi Road, P.O Box 207 Masaka, Uganda, East Africa www.kitovumobile.org E-mail; director@kitovumobile.org T l 0481 20113 F 0481 20275/20514 Tel: 0481-20113 Fax: 0481-20275/20514 Nsamba Joseph QI Team Leader Mob; +256782275596 quality.art@kitovumobile.org nsambajoseph@gmail.com Nassanga Shibah

• Ass. Team Leaders

Mob; +256776928810 nashibah10@gmail.com

Kitovu Mobile AIDS Organisation-Uganda 22