TECHNICAL ASSISTANCE OF CARE & TREATMENT PROGRAME

USAID/SMART TA
Technical Assistance
Period
Date of assessment
Site information

Oct, 01, 2013

To

June, 30, 2014

21/8/2014
Tnh Bin
SERVICE PROVIDED

ARV on Adult
ARV on Pediatrics

Home base care

SERVICE PROVIDED

MMT

PMTCT

Out-reach

TB

City

Rural

HIV testing

Patients in Prison
Others

Mountainous

% Percentages estimated)

( % Percentages estimated)
Total patients under management: 568 ( 66 pre-ARV/502 ARV)
Ethnics people

Human resource

Name

Part-Time: 04

Full Time: 09

Chau Du Tha
Chau Chanh

Total: 13

Name of USAID/SMART TA site

monitor
Nguy n Nht Quang, FHI360

Position

Contracted

Medical doctor,
Chief of OPC
Medical doctor
Medical doctor
laboratory technician
laboratory technician
Administrative/counselor
Data management
Pharmacist
Counsellor 1
Counsellor 2
support group
support group
support group
Name of OPC chief

1. Dr. Kh ng Minh Chu

2. Mrs.Tr n Th Tuy t H ng
3. Ms. L Th Tm

Gov

X
X
X
X
X
x
x
X
X
X
X
X
X

Name of PAC representative

1.Ms.L Th Thanh vn

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TECHNICAL ASSISTANCE OF CARE & TREATMENT PROGRAME

USAID/SMART TA
Result of HIVQual and SMART TA C&T Monitoring indicators.
Round: from 1 /10/ 2013 to 31 / 3 / 2014

Assessment items
A
B
C
D
E
F
G

HUMAN
RESOURCES
STRUCTURE AND
ACCESS
DRUG SUPPLY
LABORATORY
CAPACITY
DATA
MANAGEMENT
CASE
MANAGEMENT
ART/PRE-ART
DELIVERY ART

Rate of
achievement
88%
97%
100%
100%
70%
83%
40%

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USAID/SMART TA

No

1
2
3
4
5
6
7
8
9
10
11
12

Name of indicators

The rate of medical records achieved over 80%

assess by SMART TA 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
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 eligible ART 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
months of registration (SMART TA
recommended ID)

Results at
the time
SMART TA Previuos
The
of
standard
result
difference
evaluatio
n

Achieve
SMARTTA
standard

80%

45%

75%

30%

No

75%

84%

61.29%

-22%

No

75%

23%

78.00%

55%

Yes

36.00%

36%

No

80%
85%

85.07%

90.63%

6%

Yes

95%

98.48%

99.19%

1%

Yes

75%

67%

69.44%

3%

No

90%

68%

88.41%

20%

No

80%

93%

96.95%

4%

Yes

85%

58%

79.29%

21%

No

85%

83.18%

76.79%

-6%

No

80%

0%

71.42%

71%

No

SMART monitoring TA Score

SMART TA site Classification

Improving

File of data assessment (see the attachment Excel file below)

File nh gi d n
USAID/ SMART TA

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TECHNICAL ASSISTANCE OF CARE & TREATMENT PROGRAME

USAID/SMART TA

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TECHNICAL ASSISTANCE OF CARE & TREATMENT PROGRAME

USAID/SMART TA

No

Situations

HUMAN RESOURCE 88%

There is a new data management
staff that as bee a ed o
data management.

1
3
B

STRUCTURE AND ACCESS 97%

TB Infection Control: Medical
mask available but not welldelivered to needed patients
(TB suspected/ coughing
patients)

Other
resources

Date to
complete

Ms.
Tm/Ms.H ng

Dr.Chu

Fhi 360
AG PAC

30/09/2014

Receptionist
Mrs. H ng/Mrs.
B y

Dr. Chu

T nh Bin
Hospital

To start on
30/8/2014

Who in charge

Coaching by doing on Data

management for new staff.
Experienced staff support and
guide for new staff.

QI PDSA Activity #1
Plan: Implement active TB
infection control and prevention
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.

Date
actual
completion

Notes

DRUG SUPPLY
To maintain quantity of available
OIs drug supply though OPC.

Who
support

Solution

QI PDSA Activity #2
Plan Implement advanced
isoniazid and other OI drug
procurement planning between
OPC and PAC to meet shortfall of

Drug warehouse

Dr. Chu
hospital
/An Giang
PAC

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TECHNICAL ASSISTANCE OF CARE & TREATMENT PROGRAME

USAID/SMART TA
health insurance program
Do
OPC make the OIs drug plan
and send it to PAC AG at the
end of each month.
Enroll all eligible patients in
health insurance
For drugs not available
through PAC, Assist patients
in accessing drugs through
Health Insurance.
See:
Percentage of patients
covered under health
insurance
Number (%) of patients who
have OI symptoms and
received treatment through
PAC
Number (%) of patients who
have OI symptoms and
received treatment through
health insurance Number (%)
of patients with OIS without
access to medications
(Gap)
Act:
Nurse and pharmacist report
Gap in OIs coverage and make
plan with PAC to fill gap.
D

LABORATORY CAPACITY 100%

No current issues

To maintain the quality of

laboratory services from Tinh
Bien Hospital

Dr. Chu/ Lab

staff

Hospital

PAC AG/FHI
360

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TECHNICAL ASSISTANCE OF CARE & TREATMENT PROGRAME

USAID/SMART TA
E

DATA MANAGEMENT 70%

Patient folders stored to follows
the code, not follows by the time
and group of patients _ so difficult
to find or track records including
transfers / dropout / death cases

Mr.Chau
Chanh/Ms.Tm

Mrs.H ng

Administration
and C&T support
team

Commune
health
station

To start on
30/8/2014

CASE MANAGEMENT 83%

Patient Follow-up: Follow-up of
efe al ases, pa e s la e eexamination, and poor treatment
adherence must be improved.

Arrange patient profiles

follows time (years) and group
for inactive patients
To compare data regularly
(monthly).
Will implement e-log book
QI PDSA Activity #3
Plan: Increase the rate of alive
and retention in care of the all the
patients including Pre-ART and
ART
Do:
Triage nurse make a book
records for lost follows up,
death, late re-examination,
referral cases, and make a plan
for contacting to patients and
their families: phone to them
to remind for re-examination,
confirm the successful referral.
Counselor provide counseling
session to the patients on
benefits of early treatment,
significance of treatment
adherence, etc.;
Coordinate with the commune
health station / community
support groups to find cases
lost to follow / un-treated.
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.
Result of successful contacting
with them.
Act:
Continue with the action above

PAC AG/Fhi
360

to start on
30/8/2014

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USAID/SMART TA

e e was a monitoring books

to follows up the ART case
transferred to other OPC

Administration
and C&T support
team

Commune
health
station

PAC AG/Fhi
360

To start on
30/8/2014

Early warning screening on lostfollow up, drop out cases for

current Pre-ARV/ARV patients
There was a pla o s ppo
the patients who were at risk of
loss of follow up / dropout...

Administration
and C&T support
team

Commune
health
station

PAC AG/Fhi
360

To start on
30/8/2014

Make a transfer book / list of

OPCs
Updated information about
the results of transferal cases
regularly. Include
confirmation status and
method of confirmation
(phone call to receiving OPC
and patient)
QI PDSA Activity #4
Plan: Increase the rate of
retention in care of the all the
patients including Pre-ART and
ART
Do:
Using an early warning
screening tool for patients to
re-examination.
Plan to monitor and support
the cases at risk of dropout.
See:
Review implementation of LTFU
SOP
Check with the number of
patients who show support
cases at risk of dropout and
see the records at the record
books.
Act: Readdress necessary actions
above

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USAID/SMART TA
G

ART/PRE-ART DELIVERY ART 40%

HIVQUAL Indicators
Indicator 02 Proportion of preARV patients who visit the OPC
regularly (according the national
guideline every 3 months and per
appointment with doctor) from
78% to 90%

QI PDSA Activity #5
Plan: pre-ARV patients who visit
the OPC regularly will be achieve
to 90%
Do:
Counselors need to provide
technical advice on the
benefits of the package of
care and treatment for preART patients.
Doctors should discuss with
patients schedule for
appointments to suit with
patients.
Reception staff and C&T
support team make a book
monitor immediately for PreART patients, call to remind
patients before reexamination.

OPC

Dr. Chu

AG PAC /
FHI 360

To start on
30/8/2014

1
See: Number of pre-ARV patients
who return OPC for regularly reexamination on time
Act: Continue with the action
above

Indicator 06: Increase the

proportion of patients on ART in
15 days after ART eligible at Tinh
Bien OPC from 69.44% to 75%

QI PDSA Activity #6
Plan: Proportion of patients were
initiated ART within 15 days after
eligible ART in last 6

The patients usually returned to

receive CD4 result late:
Patients d d want to
ART for fear of disclosure
of HIV status
Patients still felt strong

Do:

Counselor: Enhancing
counseling for patients on
benefits of early

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USAID/SMART TA

so they were subjective

Patients work a long
distance, so d d want
treatment

antiretroviral therapy so
encourage them returned to
get CD4 result follows the
appointment schedule when
take blood of the patients for
CD4 count testing.
Triage nurse to check who
will have CD4 test and
sticking a yellow sticker on
the medical records.
Nurse call the new eligible
patients for remind them
back OPC before
appointment day.
OPC Doctors review all newly
eligible patients d d ba k
to OPC for re-examination
and inform to Nurse.
Nurse/support team
continue to call the eligible
patients to encourage them
back OPC to receive CD4
results and should start ART
early.

See:
Number of receiving ARV in
15 days after ART eligible
Act: Continue with the action
above
SMART TA indicators
Survival rate after 12 months
on ART from 76.79% to 85%
2

Retention rate after 12

months from 71.42% to 80%

Plan: Increase the rate of alive

and retention in care of the all the
patients including Pre-ART and
ART
Do : as activity # 3
See: as activity # 3
Act : as activity # 3

Dr.Chu

AG PAC /
FHI 360

To start on
30/8/2014

C&T
support
team

Treatment
doctors

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