OVERVIEW OF HIV/AIDS & TB IN NAMIBIAOVERVIEW OF HIV/AIDS & TB IN NAMIBIA

The 9The 9thth Advanced HIV COURSE-AIX-EN- Advanced HIV COURSE-AIX-EN-PROVENCE-FRANCEPROVENCE-FRANCE

0707thth-9-9thth september 2011 september 2011

Dr. Mgori,NK-(MD,FMMED cand)Dr. Mgori,NK-(MD,FMMED cand)

SUMMARYSUMMARY

Population 1.8 millionPopulation 1.8 million

70% of the world’s estimated 70% of the world’s estimated 40 million people living with 40 million people living with HIV/AIDS are located in HIV/AIDS are located in Sub-Saharan AfricaSub-Saharan AfricaOverall HIV prevalence in Overall HIV prevalence in Namibia stands at 17.8%.Namibia stands at 17.8%.In 2007, Namibia’s estimated In 2007, Namibia’s estimated tuberculosis (TB) incidence tuberculosis (TB) incidence rate of 767 cases per rate of 767 cases per 100,000 population was the 100,000 population was the fourth highest in Africa, and fourth highest in Africa, and more than twice the African more than twice the African regional averageregional averageThe TB prevalence of 532 The TB prevalence of 532 cases per 100,000 population cases per 100,000 population and TB mortality of 102 and TB mortality of 102 cases per 100,000 population cases per 100,000 population are also above average for are also above average for the regionthe regionAbout 67 percent of newly About 67 percent of newly registered TB patients are registered TB patients are HIV positiveHIV positive

AIM Statement

2.Assembling the Team

5.Develop and Improvement Theory

6.Test the Improvement TheoryThe interventions were tried on patients registering with the ARV clinic over one month from January 15 to February 15 2010Data was collected over the intervention period to monitor for number of patients:

•Eligible for IPT•Eligible for IPT commenced on IPT during the intervention period•From previous cohort who returned to pick up IPT refills•From previous cohort who failed to come for refills•Stopped by providers due to side effects•Cumulative number of patients on IPT at the clinic

1.Getting Started

3.Investigate the current Process

To improve the provision of TB Isoniazid Preventive Therapy to eligible patients from a baseline of 22% in December2009 to at least 50% by June 2010

A QI Project team was established :•Medical Officer. Team lead and chair•Registered Nurse-Project Secretary Team members:

•Sister -In-Charge•Pharmacist•Data Clerk•Community Counselor•Expert Patient

4.Identify Potential Solutions

•July to December 09 performance data were presented at a weekly departmental meeting.•Data for all previous quality indicator performance scores was reviewed•Staff members were asked to comment on the data•It was agreed that “IPT “ be taken up as a QI project•A team was selected to spearhead the project.

• The doctor gave a presentation to all the clinic nurses on screening for IPT eligibility and how to prescribe IPT

• A screening tool for TB was made available in all consulting rooms• A screening tool for IPT was availed for all providers• Data clerk gave a presentation on documentation in the patient’s file to improve

documentation• Expert patient provided intensified Health Education to patients on IPT and TB in

order to clear the thematic myths and misconceptions on IPT identified in the Focus Group Discussions

•If the all nursing staff are educated about the need for providing IPT, then they are likely to provide it•If the screening tools for IPT are provided in all the consulting rooms, then providers (doctors and all nurses) are more likely to screen for IPT•If the screening tools for TB are made available, then the providers are likely to screen for TB and identify those eligible for IPT•If the data clerk provides information on the correct recording of IPT data, then providers are more likely to document IPT when they provide it

• 94 patients were newly registered for HIV care for between Jan 15 and Feb 15 2010

• 80 patients were started on IPT in that period• This translated to a performance of 85%• From Feb15 2010 IPT was now offered to all eligible pre-HAART patients

by all the nurses• Given the success of the pilot phase, the project was further expanded to

include the patients on HAART as from 15 March 2010

PERIOD

ELIGIBLE PATIENTS SEEN in

the period

Number of patients

commenced on IPT

during the period

Percentage of eligible patients

commenced on IPT in the

period

Of previous month’s cohort,

came for IPT refill

Did not come for

refill

Stopped due to

side effects

Cumulative number of

patients commenced

on IPT

Jan 15 to Feb 15 2010 94 80 85 7 11 2 80

PERIODELIGIBLE PATIENTS

SEEN

Monthly number of patients commenced

on IPT-Janu09 to June 10

Percentage of eligible patients

commenced on IPT

Of previous month’s cohort, came for IPT

refill

Did not come for

refill

Stopped due to side effects

Cumulative number of

patients commenced on

IPTJan 15 to Feb 15 94 80 85 7 11 2 80

Feb 16 to march 15 173 127 73.4 55 23 1 207

March 16 to April 15 450 237 52.6 198 9 0 444

April 16 to May 15 534 420 78.6 646 11 0 864

May 16 to June 15 486 317 65.2 1061 31 0 1181

9.Establish Future Plans• A red sticker was stuck on passports of patients on IPT for ease of

identification and follow up on adherence and monitor completion rates

• During H/E patients were shown samples of IPT and CPT for differentiation• Staff were encourage to record on the TB column in the file if IPT had been

taken prior (e.g. IPT 2006)• Pharmacist on the QI team will continue updating the team regularly on

IPT progress during staff meetings

FOR FURTHER INFO CONTACT:hivqualnam@nacop.netwww.healthqual.org

Start of QI project

THANK YOUTHANK YOU