HTS | Relying only on patient requests or referrals for HIV testing. | Introduced strategies to enhance provider-initiated testing:
Offered group pretest counseling in all patients’ waiting areas Implemented a daily roster system of staff to conduct pre-test counseling Nurse in charge or designee to check accountability log daily
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Missed opportunities to offer HTS to all patients
| Redesigned clinic patient flow
Ensure that acute patients are directed to lay counselors after vitals assessmentsa are conducted If above not possible, then staff caring for acute patients were (i) trained in HIV testing and counseling and (ii) provided with the appropriate HTS stationery
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HTS data inaccuracies caused by:
| Daily data quality control checks
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Overdependence on lay counselors
| Increasing the accountability and responsibility for the HTS program
On-site HTS refresher training was held which addressed: pre- and post-test counseling messages, conducting HIV rapid tests, and data recording Awareness of clinic target set by the district health office was disseminated
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TB screening among PHC clinic attendees | Missed opportunities to offer TB screening to all clinic attendees | Centralized TB screening
Made TB screening mandatory at an identified strategic point visited by all patients, such as, vitals assessmenta station Visual prompts and reminders to conduct TB screening included large and colorful TB posters, printed and easily accessible signs, and symptoms checklists Made TB screening mandatory for acute patients
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Inaccurate TB screening data | Data quality control checks
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IPT initiation among new ART patients | Ambiguity in IPT initiation guidelines
| Clarify IPT initiation timing and arrive at mutually agreed upon timing for initiation
Each clinic team arrived at a common time to start IPT (e.g., 7,14, or 30 days after starting ART) Agreed upon timing was documented and standardized for entire clinic
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Confusion about roles and responsibilities of clinic staff | Enhancing accountability and responsibility for IPT program
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No system for identifying patients eligible for IPT | Strategies to identify patients returning at the agreed upon time for IPT
The “box system” -eligible patients’ files placed in a decorated box for easy identification, OR Tagged files of eligible patients with stickers or red ink OR The “diary system” reminder note in clinic diary to initiate IPT at next visit and note attached to patient file
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Poor recording of IPT initiation date in clinic chart notes | Refresher training on clinic stationery to document IPT
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Nurses lack confidence to rule out TB | Host a training for nurses, lay counselors, and data capturers highlighting the importance and potential benefit of IPT for HIV-infected patients
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ART initiation among HIV-TB coinfected patients | Patient chart notes for TB and ART kept separately
| Combining ART and TB files
For HIV-TB coinfected patients, ART and TB chart notes were physically combined The district health office agreed upon a common unique identifier to be used The TB module on the electronic ART database was activated to accommodate TB and ART data
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Poor coordination between NIMART and TB nurses regarding ART and TB treatment initiation | Refresher training for nurses
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VL monitoring at month 12 after ART initiation | No system to identify patients eligible for month 12 VL tests | Generate report from electronic system of patients due for VL
Address the data capturing backlog of VL results and ART initiation Draw on the assistance of local nongovernmental organizations and support partners for assistance with data capture Generate VL reports from the data system to determine which patients have not had or are due for VL test (filter out deceased and transferred-out patients) Tag/mark the files of patients due for VL for easy identification Trace patients who were missed for a VL test
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