HIV

New filing system has massive impact on clinic waiting times, reporting and retention in care

The ‘Siyenza Sprint’ campaign (building on the momentum of February Frenzy and March Madness) in Amathole, aimed to increase testing (‘Know Your Status’), strengthen linkage to care (universal test and treat) and support retention in care (to ensure viral suppression).

There was unprecedented support for the Siyenza Sprint (including a provincial road show across all Siyenza districts) and TB HIV Care’s Care and Treatment and HTS teams worked extended hours to ensure that we reached more people with health  care services.

A notable success from the campaign was the complete overhaul of the clinical records filing system at facilities across the Eastern Cape.

Poor records management and inadequate filing infrastructure has negatively impacted on accurately accounting for clinical interventions, as well as on patient waiting times –  given the administrative bottleneck at the start of each clinic visit. Many instances of patient file duplication, missing files and pronounced delays in retrieving records have been noted, especially in high volume facilities.

TB HIV Care undertook an overhaul  of the system and since February 2019 has implemented this key intervention at 35 facilities across three districts over a period of three months.

Waiting times experienced by clients have reduced significantly and the standardised approach has led to more accurate reporting interventions, improving the TX_CURR indicator (number of adults and children currently receiving antiretroviral therapy) by up to 40% in some cases.

The aim is to rapidly scale the intervention to a further 70 facilities in due course as the new system has had a significant impact on clinic waiting times, accurate reporting and, ultimately, retention in care.

 

BMSF project: The Eastern Cape Community Collaborative Cancer Initiative

On Tuesday, 05 March, TB HIV Care (THC) received a notification of award for an exciting new community project to be implemented in the Eastern Cape from 01 April 2019. 

The Eastern Cape Community Collaborative Cancer Initiative, as the project is known, is the second THC project to be funded by Bristol Myers Squibb Foundation (BMSF) and marks a notable diversification of the scope of services offered by THC. The overarching goal of the project is to support improved patient outcomes for lung cancer and other common cancers affecting people living in the catchment area of the Nelson Mandela Academic Hospital, by raising community awareness of lung cancer, promoting and linking people to screening, supporting navigation through the health system as well as supporting palliative and survivorship activities.

This community-based project will link with and support the activities of the Nelson Mandela Academic Hospital Oncology Centre of Excellence, which is being supported through a separate funding agreement with BMSF. 

You may be wondering why THC, an organisation that has historically focused on two of the most prevalent infectious diseases impacting South Africans (TB and HIV) would be branching out into lung cancer, so here are some interesting facts:

  • Lung cancer is the leading cause of cancer-related deaths in South Africa, accounting for around 16% of all cancer deaths, followed by cervix, breast and prostate cancer.
  • Lung cancer is the second most common cancer affecting South African men and the fourth most common in women.
  • People living with HIV who have access to effective antiretrovirals are living longer lives and co-morbid non-communicable diseases such as diabetes, heart disease and cancers are becoming an increasing health burden to this group and others. Yet many South Africans have limited awareness of cancer.
  • There is evidence that TB, either active TB or successfully treated TB with resultant lung scarring, is a risk factor for the development of lung cancer.
  • Lung cancer can present with similar clinical symptoms and X-ray changes to TB (incl. unexplained weight loss, a persistent cough, blood-stained sputum) and diagnosis may be delayed if health workers are not aware of the possibility of an alternate diagnosis to TB.

In light of this, we believe that it is important that links between TB and cancer service providers are strengthened and community awareness raised. TB HIV Care is therefore partnering with four community-based organisations (CBOs) in OR Tambo and Alfred Nzo districts to raise community awareness and support endeavours to equip community-based and primary health care providers with the necessary knowledge and skills to assess risks for lung cancer and refer patients for early screening.


Benchmarking Best Practices in Viral Load Monitoring

TB HIV Care, led by Mandisa Mona (Advanced Clinical Care Facilitator), joined a team of ten delegates, including representatives from TB HIV Care’s Chris Hani district office, SEAD and the Chris Hani District Department of Health (DOH), on a four-day visit (26 February – 01 March) to Durban. The trip was organised by CAPRISA.

The purpose of the visit was to benchmark best practices in viral load monitoring and recognition of treatment failure; learn strategies to increase viral load coverage in ART clients; share Advanced Clinical Care (ACC) tools utilised for improved patient outcomes and share M&E tools for reporting purposes. All of which contribute to moving closer to achieving the third target of UNAIDS’ 90-90-90 goals (that by 2020, 90% of all people receiving antiretroviral therapy will have viral suppression).

The best practices will be piloted in the Chris Hani health district, with relevant stakeholders prioritising 10×10 facilities and escalated to other facilities supported by TB HIV Care in Amathole and OR Tambo.

The team also visited Clairwood Hospital (Thusong ARV Clinic) where ART patients with complications are managed.  They were taken step-by-step through the management process of these patients.

Thanks so much to all involved.