Improving TB assessment among HIV/AIDS patients attending Mengo Hospital, an urban hospital in Uganda

Author(s):

Suubi Henry Mubiru

Topics: HIV-TB

Region and Country: Uganda

Organization: Mengo Hospital

The Report

Problem:

Mengo Hospital is a Non Government faith based private not for Profit hospital and the pioneer of modern medical practices in Uganda and has existed for a hundred and thirteen (113) years thus far. It was established by Dr. Sir Albert Ruskin Cook of the Church Missionary Society in 1897. It has four main clinical disciplines of medicine; surgery, paediatrics and obstetrics & gynaecology, along with the specialised services in; eye care (ophthalmology), optometry, dentistry and HIV clinic with state of the art facilities and services.

Mengo hospital exists with a Mission; “To provide excellent sustainable health care services that bear witness to Christ”.

The Vision “ to attempt to heal the suffering is much, to carry the water of salvation to thirsty souls is more, but to combine the two is the greatest work a man can hope.”

The HIV/AIDS, Counselling and Home Care Department started its activities in 1988 with approximately 69 patients. Since its inception, the services at the department have greatly grown in scope and size registering several land marks, from just 69 clients to over 5000 registered in the clinic currently, having over 2,300 clients receiving ART. The clinic also caters for children infected with HIV and to-date there are approximately 240 child clients, of whom 130 are receiving ART.

Problem statement: Low assessment for TB among HIV positive client at the facility.

By 2005 the TB assessment among HIV positive patients was between 10-15% and this was attributed to a number of factors which were stipulated in one of the QI core staff meeting date 24 August 2006.

§ Member noted that inadequate documentation was a big barrier to ascertain actual HIV positive patients assessed.

§ Absence of a simple and appropriate tool for assessment of TB at every clinic visit.

§ Low staff orientation especially new staff

§ Low involvement of administrators in the running of HIV clinic.

§ Separate and independent TB clinic from the other related clinical setting e.g the HIV/AIDS facility.

Intervention:

§ Integration of TB/HIV services under one clinic, and setting up internal departmental linkages between OPD, Laboratory, wards and HIV/AIDS Clinic.

§ Involvement of hospital administration for support and easy implementation.

§ CMEs, staff training and regular schedule review meetings were adopted to review progress.

§ Accurate, complete documentation and regular feedback established to different parties including Administors and hospital staff.

§ Free TB tests for HIV positive clients.

§ Sharing experiences with other treatment centres especially those with quality Improvement structures for French matching.

§ Identifying a TB focal person in the HIV/AIDS clinic to cordinate the departments and follow up the TB suspected HIV/AIDS patient an Mengo Hospital.

§ Team work and task shifting which made assessment of TB at various stations possible hence increase coverage.

§ Introduction of TB suspect clinic register for easy follow up of those HIV positive patients with a high index of TB suspicion and to increase TB case detection level at 100% in the Hospital.

§ Introduction of Intensified Case Finding tool for TB to assess all HIV positive patients to, easy documentation and to have 100% of HIV/AIDS patient assessed for TB.

Results:

Tremendous percentage increase of HIV positive patients assessed for TB at every clinic visit from (15%-100%).
Drastic percentage increase in TB case detection among HIV positive patients.
Percentage increase in the patients’ retention ratios which resulted to increased TB treatment success.
Reduction in the TB treatment coverage gap among HIV positive clients.
Scaling up of TB/HIV care.
Improved quality and quantity of life of HIV/AIDS patients in HIV clinic.

Lessons:

§ Co-management of TB/HIV is core for the increase in case detection of TB among HIV positive patients, increased coverage and results in a good TB treatment success rate.

§ Using the Intensified Case Finding (ICF) tool in the assessment of TB is very paramount to establish TB suspects which increases TB case detection hence reduction in TB treatment coverage gap.

§ Developing a vibrant M&E frame work internally is cardinal in quality improvement project as it systematically identifies what level of quality the system currently producing, which helps to identify the gaps with proof periodically, monitors the effectiveness of the change introduced and evaluate critically the progress in line with the desired standard.

§ Using TB suspect register increases TB dictation rates by about 30%

§ Involvement of top administration facilitates the implementation of a specific change but team work is paramount for the effectiveness of the introduced change.

§ Proper, accurate and complete recording is a key factor in quality improvement for it provides information (statistical inference) which is based on to move for a change and to ascertain the effectiveness of every change as introduced.

§ Non monetary motivation approach i.e by acknowledging a least contribution for quality improvement by a team member through feedback, reports on progress,praise and appreciations, in relation to the desires standard.

§ Sharing experiences is a practical approach for quality improvement for “a problem shared is a problem solved” and changes come when you do a common thing in an uncommon way.

In quality improvement, there is urgency of doing, knowing what do to is not enough, we must apply. Being willing in not enough, we must do. And anything which has not been documented, did not happen, so documentation is a key practise for quality improvement.

Year:

2010

Improvement Report

By Henry Suubi

We appreciate the HCI activities, it has helped our facilite to register tremedours in various areas varying from clinical, administrative especially in taking decisions, getting logistics with the information we gather and put to use and for the benifit of our patients and staff. Thx