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TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

To

30/6/2014

DATE OF ASSESSMENT

1/8/2014

SITE INFORMATION

Dien Chau OPC, Dien Chau district, Nghe An province


SERVICES PROVIDED

ARV for adults


ARV for children

HTC

MMT

PMTCT

C&S

Out-reach

TB

STI

AREA

City

Rural

Mountainous

OTHERS

Clients in prison

% total clients)

Ethnic group clients

% total clients)

Total clients under management:


HUMAN RESOURCES
Full-time: 7
Part-time: 2
Total: 9

Name

Position

Quy

OPC chief,
doctor
Doctor
Doctor
Counselor
Pharmacist
Nurse
C&S
Peer

Hue
Ha
Lien, Hien
Nga
Ha
Gia
Tuong

Name of USAID/SMART
TA provincial site
monitor
Dr. Nguyen Thanh Ha

285 (14 Pre-ART/ 271 ART)

Contracted
Part-time
Full time
X
X

Gov
Part-time Full-time
X
X

X
X
X
x
X
x

Name of OPC chief

Name of PAC
representative

Dr. Dau Trong Quy

Ms. Luong Thi Thu

File assessment data

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TA PLAN FORM (v 4.8.14.0)


USAID/SMART TA

TA Assessment
Summary Results

Result

HUMAN RESOURCES

50%

STRUCTURE AND
ACCESS

49%

DRUG SUPPLY

90%

LABORATORY
CAPACITY

60%

DATA MANAGEMENT

60%

CASE MANAGEMENT

33%

ART/Pre-ART
DELIVERY

90%

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USAID/SMART TA
SUMMARY RESULT OF HIVQUAL AND SMART TA INDICATORS
SMART TA
Standard

No Indicator

1
2

4
5
6

8
9
10

Proportion of medical record is more than 80%


of score used the patient chart review tool
Proportion of patients who newly registered at
the OPC in last 6 months are tested for CD4
within 15 days of enrolment
Proportion of pre-ARV patients who visit the
OPC regularly (according the national guideline
every 3 months and per appointment with
doctor)
Proportion of patients who were newly
registered at OPC was prescribed INH
Proportion of ARV patients visiting the OPC for
medication pick-up according to scheduled
appointment in the last visit
Proportion of ARV patients who are assessed
for medication adherence in the last visit
Proportion of patients were initiated ART within
15 days after qualification in last 6 months
Proportion of qualified HIV patients are
prescribed for Cotrimoxazole or DAPSONE for
the last visit
Proportion of patients are screened for TB in
the last medical visit
Proportion of patients are tested CD 4 at least 1
in last 6 months

Proportion of patients who still alive and on


treatment after 12 months on ART (NGI ID)
Proportion of patients retained in care after 12
12 months of registration (SMART TA
recommended ID)
11

Last round result

Present result

Difference

Score

Pass or fail

80%

60%

60%

Fail

75%

74%

74%

Fail

75%

81%

81%

Pass

80%

31%

31%

Fail

85%

68%

68%

Fail

90%

100%

100%

Pass

65%

59%

59%

Fail

90%

59%

59%

Fail

80%

100%

100%

Pass

85%

74%

-3%

Fail

85%

77%

81%

3%

Fail

80%

78%

84%

6%

Pass

SMART monitoring score

SMART TA classification

Improving

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TA PLAN FORM (v 4.8.14.0)


USAID/SMART TA

No

Issue

HUMAN RESOURCES
Staff Integration: Before 2014 July,
OPC Dien Chau staff was fully on
contract paid. However, since 15
July 2014, Drs. Quy and Hue from
the Infectious Department of Dien
Chau Hospital started involving in
treatment activities of the OPC.
The challenge is that OPC doctors
have not been trained on ARV
treatment and have limited
knowledge on HIV care
STRUCTURE AND ACCESS

1.

1.

2.

TB Infection Control: Medical


mask available but not welldelivered to needed patients (TB
suspected/ coughing patients)

IEC materials on Universal


Precaution: not available

Solution

Person in
charge

Supporter

Other
sources

Deadline

Actual
date of
completio
n

Note

Dr. Tien
Director of
Dien Chau OPC
Hand-on training for OPC Dien
Chaus doctors with support from
FHI 360 and PAC clinical experts

Dr. Dinh
Director of
Nghe An PAC

Bi-monthly

Dr. Bich Thuy FHI 360


QI PDSA Activity #1
Plan: Implement TB infection control
Do:
- Triage nurse distributes medical
mask for needed patient (TB
suspected/coughing patients)
- Counselor provides counseling
session for the TB
suspected/coughing patients to
understand the importance of
medical mask wearing.
See: After 1 month, the OPC counts
how many medical masks have been
distributed and if they are provided
appropriately for the TB
suspected/coughing patients.
Act: Triage nurse leads discussion of
data and team provides feedback,
solutions, and plan for ongoing
monitoring.
SMART TA, PAC to send UP IEC
materials to OPC including hand
washing procedure, safe coughing
guidelines

Triage nurse,
counselor

Thanh Ha, Mai


Phuong FHI
360

OPC Chief

OPC Chief

Nghe An
PAC

December
2014

September
2014

Thu Binh - PAC

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USAID/SMART TA
C

DRUG SUPPLY
Itraconazole: not available

LABORATORY CAPACITY

There was an interruption of CD4


test in the two recent months

Viral Load has not been


implemented in Dien Chau OPC
for more than 3 years which dues
to the capacity of OPC doctors in
determining suspected failure
cases as well as lack of monitoring
from PAC

Not only OPC staff but also PAC


staff has very limited knowledge
on GeneXpert, which may lead to
difficulties in scaling up ICF and
enhancing the collaboration
between PAC and provincial TB
program

PAC support Dien Chau to purchase


all necessary OIs drugs as per
guidance, including Itraconazole

Dr. Dinh - PAC


Dr. Tien - Dien
Chau Hospital

September
2014

PAC reports the issue to their


supplier and avoid running out of
CD4 test kit in future

Dr. Dinh - PAC

September
2014

Dr. Dinh - PAC


Hand on training for OPC doctors
about criteria for VL test, supported
by FHI 360 and PAC clinical experts

Hand on training for OPC doctors on


GeneXpert
Sending OPC and PAC staff to attend
advanced trainings of ICF if possible
Promoting and encouraging the
exchange activities between PAC and
provincial TB program

October
2014

Drs. Thanh Ha,


Bich Thuy - FHI
360

Drs. Dinh, Dr.


Tien - PAC
PHS

December
2014

Triage nurse,
counselor,
C&S

PAC

Monthly

Triage nurse

PAC

Sept, 2014

Dr. Lam Provincial TB


Hospital

DATA MANAGEMENT

Documentation: paper work,


lacking of e-logbook. Contact
information of patients have not
been updated regularly

Documentation: Three logbooks:


ART, pre-ART, daily medical checkup are updated, but not regularly.
There is no logbook to follow up
with transfer out patients.

E-logbook will be issued very soon.


In the meantime, the triage nurse is
encouraged to use the Excel file of
HIVQUAL to manage and update all
OPC patients
Triage nurse, counsellor, C&S team
to talk to patients and their
supporters to update their contact
information regularly
All the key logbooks of OPCs should
be updated at least on weekly basis
for better management and reducing
the workload in the last minute.
The transfer out logbook should be

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USAID/SMART TA

1.

2.
G

1.

2.

All the patient charts are grouped


by ART initial groups which takes
time and creates some difficulties
for OPC doctors to pick up the
right chart of a certain patient
when (s)he comes for health
check
CASE MANAGEMENT

Patient Follow-up: Follow-up of


referral cases, patients late reexamination, poor treatment
adherence must be improved.

developed and used regularly


All the charts should be organized by
ID number order which will allow
OPC staff easily find out any chart of
any patient at any time. For those
who died, LTFU or transferred out
there should be a note replacing for
the physical chart.
QI PDSA Activity #2
Plan: Increase the rate of retention
in care of the all the patients
including Pre-ART and ART
Do: Triage nurse records late reexamination, referral cases, phone
to them to remind for reexamination, confirm the successful
referral. Counselor provide
counseling session to the patients on
benefits of early treatment,
significance of treatment adherence,
etc; implementation of LTFU SOP
See: Check with the number of
patients who show late reexamination and poor treatment
adherence and see the records at
the record books.
Act: Continue with the action above
or change as appropriate.

OPC nurse and


doctors

PAC

September
2014

Triage nurse,
counselor,
Care and
support team

PAC to
monitor

December
2014

Dr. Dinh - PAC


OPC doctors

Dr. Lam
Provincial TB
Hospital

September
2014

ART/ Pre-ARTDELIVERY

HIV Qual # 3: proportion of newly


registered patients and eligible for
IPT are prescribed INH in the last 6
months is low (31%)

HIVQual # 1: Proportion of
patients were initiated ART within

In case having no INH available for


prescription, OPC doctors should
advise patients to purchase INH
themselves to prevent TB (this could
be noted in medical chart)
PAC should discuss with the
provincial TB program to deliver INH
to OPCs or find a purchase channel
QI PDSA Activity #3
Plan: Increase the proportion of

OPC doctors
Thu Binh - PAC

December
2014

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USAID/SMART TA
15 days after qualification in last 6
months was not high as expected
(77%), which dues to some
reasons:
- OPC receives CD4 results after 810 days since the date of sample
sending
- 1 week on Cotrim treatment
before initiating ARV to avoid
allergies risks.

3.

HIVQual # 10: Proportion of


patients are tested CD 4 at least 1
in last 6 months is not high as
expected (74%), which dues to
some reasons:
- The test date is not the same as
the health check-up date, which
duplicate effort of patients to
come to OPC
- OPC schedule CD4 test for all
clients every 6 months so when
the patient is busy or sick, he/she
will be missing the 6 month CD4
test date.
- Follow-up of patients for CD4
test must be improved

patients who were initiated ART


within 15 days after qualification in
last 6 months.
Do: PAC to discuss with the
provincial hospital to send CD4 test
results via e-mail, fax or phone call
See: PAC to check if there is any
difficulties of sending CD4 test
results via e-mail, fax or phone call
Act: Continue to send the CD4 test
results via e-mail, fax or phone call
or other alternatives as appropriate
based on the factual situation
QI Activity #4:
Plan: Increase the proportion of
patients are tested CD 4 at least 1 in
last 6 months.
Do:
Chief of Cam Pha OPC to organize
weekly meeting to review all
patients to avoid omitting patients
that are eligible for treatment, need
CD4 and other routine tests.
Doctor to appoint the test date
earlier than 6 months.
Triage nurse to check who will have
CD4 test and remind the doctor on
that by sticking a yellow sticker on
the medical record.

OPC nurse,
counselors
and doctors

PAC to
monitor

Monthly

Counselor to provide patients the


importance of CD4 and other routine
laboratory tests before the regular
test date;
Doctor to discuss with patients the
appointment date for CD4 and other
routine tests,
The appointment date for testing
and re-examination should be the

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USAID/SMART TA
same to facilitate the patients
travelling;
Counselor to call to remind patients
before testing date.
See and Act: PAC to check with the
above practice and see it works or
should be changed if needed

4.

HIV Qual # 8: Proportion of


qualified HIV patients are
prescribed for Cotrimoxazole or
DAPSONE for the last visit is low
(60%) because the doctor forgets
to prescribe the cotrim

Doctor to comply with guidelines on


prescribing Cotrim or Dapsone.
Triage nurse to check with CD4
results and clinical stage to remind
the doctor if needed.

Doctor
Triage nurse

PAC to
monitor

Monthly

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