From the HIVQUAL International Update

The AIDS Support Organization (TASO Mbarara): 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.  The team then worked with hospital staff to reinforce scheduling of appointments for CD4 counts, with particular emphasis on follow-up for patients who do not return. To encourage patients to keep appointments, staff developed education sessions, with CD4 testing available on the spot. As a way to ensure patient completion of all necessary screenings and tests, the QI team developed a guided and systematic process to accompany patients from station to station within the clinic. The team also worked with staff to strengthen documentation of CD4 results in all patient files. Staff was sensitized to the importance of consistent filing of patient forms, and an effort was made to locate and organize all loose records.

For patients lost to follow-up, the team engaged fieldworkers (community outreach staff) to help identify those patients within their communities and schedule patient appointments.

The team scheduled monthly meetings to review improvement activities.

Follow-up data demonstrated an increase in CD4 monitoring from 17% at baseline to 47% at round two.

These innovations have provided the TASO Mbarara improvement team with valuable insights. Using community outreach as a means to reach patients and schedule appointments has produced notable results in the area of adherence. To improve documentation, staff enlisted a volunteer filing clerk, while reinforcing existing systems and strategies to improve patient appointments.

These notable successes have paved the way to undertaking additional improvement activities. Missing charts, documentation issues, and a high volume of testing samples continue to challenge TASO staff. Hiring of a full time data clerk is a priority, and staff plan to engage other teams at the national level to share experiences across facilities.

Uganda Completes First Round of Data Collection at 20 Pediatric Sites

After a successful first round of data collection in late 2006, plans began to form for a large expansion of HIVQUAL-Uganda beyond the original 20 sites of the first phase.  Among the 80 expansion sites ultimately chosen, 20 were pediatric care facilities in the Northern part of Uganda, an area that had until recently been ravaged by a decades-long civil war.  With the addition of these sites in the North and a new pediatric component supported by UNICEF, HIVQUAL-Uganda is an example of a major donor collaboration between PEPFAR and UNICEF.
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