FRAMEWORK FOR IMPROVING CONTINUUM OF CARE FOR VCT IN KZN

NDLANGUBO CLINIC UNDER ESHOWE HOSPITAL

The goal of Uthungulu District is optimal health for all hence Ndlangubo Clinic’s main aim is scaling up of VCT in order to facilitate early diagnosis and early treatment for all clients at risk. In these times of escalating HIV and AIDS, it is the reason why the clinic is scaling up VCT especially the vulnerable group such STI, TB, and cancer. Ndlangubo Clinic has been moved from NgwelezaneHospital to fall under EshoweHospital according to dermacation of the district.

The clinic is supported by the technical advisor Mrs P.B. Harrison is a very enthusstic and passionate about HIV and Aids clients being treated timeouly. When the programme started the staff were not trained, attitudes were poor for some members of staff, poor understanding of guidelines. The numbers of counsellors were few after loosing one counsellor and on clinic days some clients had to wait. Sometimes clients were given appointments avoiding long ques.

Having conducted QA Awareness Workshop, the Quality Assurance team began to have quality as an eye opener, awarenes of guidelines, identification of gaps, skills were given to analyse the data, intepret the data, gaps were analysed and solutions were sought. Regular visits gave a better chance to discuss gaps and learning sessions taking place. The team was reviewed if all trained fom time to time. New staff was sent for QA workshop trainings to improve their understanding of quality. During visits staff took interest and always looking forward to discuss the analysed data for the benefit of the clinic hence staff began to feel the need to scale up VCT

STRATEGIES USED

How continuous of care is being achieved by:

  1. Intergration of services rather than separate service delivery system.
  2. Ensuring the continuum of care model to better focus on needs of the clients
  3. Fostering of leadership, skills and to ensure change and improvement.
  4. Group counselling followed by the individual counselling of each and every client visiting the clinic.
  5. Use of guidelines to bring about compliance.
  6. Ensuring of continuous training of all staff to provide knowledge and skills was done.
  7. Discussion/feedback on graph done for the VCT data.
  8. Emphasis on TB and HIV integration to staff working with the clinics
  9. Conducting awarenesses to in the community has increased numbers
  10. CD4 done for all HIV+ clients.

IMPROVEMENT

The numbers gradually began to increase. The staff became enthusiastic to visits by the Technical Coordinator. VCT uptake also remained high. The data began to show improvement as noted on graph below:

  1. Pretest counselling has increased.

2Testing rate has shown an improvement.

3Early detection has led to early referrall for Haart.

4Clients are beginning to come forward HIV testing voluntarily.

FIGURE 1 # OF VCT FIGURE 2 VCT UPTAKE

CHALLENGES

  1. Rotation of staff.
  2. Clients found HIV+ are found to be from very remote areas.
  3. Clients suspected to be co-infection are found to be amongst the early deaths who have not tested for HIV.
  4. Ignorance about the delay in testing for HIV and consequences of such action result in death.
  5. Social stigma is still predominant in remote areasespecially where there are no CHW or HBC workers.

The improved VCT uptake has resulted in improving CD4 numbers

FIGURE 3. # TESTING HIV+ and # OF CD4

Improved # has shown the best efforts by staff who has learnt from the information delivered to them by HCI/QAP. Increased enthusiasm amongst staff. # of clients on Haart have increased in the area.