KCCB-KARP STANDARD OPERATING PROCEDURE

SOP Title: Operation triple zero

SOP Category: Viral suppression & retention
SOP Function: Quality improvement
SOP Number: 002
SOP Implementation date: 1st October 2017
SOP Review date: 1st October 2018

Name Title Signature Date

Author Esther Vurigwa TA-Paediatrics & 1st/10/2017
Adolescents
Reviewer
Authoriser

Purpose

The purpose of this SOP describes the initiation into OTZ, operationalization of OTZ, transition to stable clinics and later to adulthood where they
remain an alumni of OTZ.

Scope

This SOP will only be utilized under KCCB-KARP supported sites (57) in western and Nyanza region.

Responsibility
While the technical team is responsible for activities identified in this procedure, the HSLs have to ensure staff at the health facilities adhere to
these procedures, understand the SOPs objectives and other inter-related activities.

Definitions

SOP: Standard operating procedures

OTZ: Operation triple zero

Stable: A patient as defined by the new 2016 HIV guidelines (virally suppressed, been on ART more than 12 months, no history of O.Is like TB in
the last 6 months, no adherence issues, not on IPT(completed IPT) in addition; Z score > -1 & < 2,completed immunization schedule, the
child/Adolescent and the care giver are virally suppressed or in cases where the care giver is HIV negative and the child/Adolescent is virally
suppressed.

Unstable patient: Opposite of above

Pair: Caregiver and the child or Adolescent

Stable pairs: Care giver virally suppressed & child suppressed plus other characteristics of stability above

: Child/Adolescent virally suppressed & care giver is HIV negative plus other characteristics of

Stability above

Unstable pairs: Care giver not virally suppressed & child/Adolescent suppressed plus or minus the other

Characteristics of unstable child/Adolescents above

: Care giver virally suppressed & child/Adolescents not suppressed plus or minus the

Other Characteristics of unstable child/Adolescents above

: Child/Adolescents virally suppressed & caregiver not suppressed plus or minus the other

Characteristics of unstable child/Adolescents above

: Child/Adolescents not virally suppressed & Care giver not virally suppressed plus or

Minus Other Characteristics of unstable child/Adolescents above

 : Child/Adolescents not virally suppressed and caregiver HIV negative plus or minus the

other characteristics of unstable child/Adolescents above

Suppressed: Viral load <1,000copies/ml

Not suppressed: Viral load >1,000copies/ml

MMP: Multi-month prescription

Procedure

INITIATION INTO OTZ

The ALHIV 10-19 years in HIV prevention, care and treatment attends support group
In the support group, they are introduced to OTZ motto and it's initiatives
The ALHIV 10-19 years who accept to join sign OTZ commitment forms
They are then enrolled in the OTZ register for monitoring regimen, VL, communication and transition to stable and adult clinic
,

SERVICE PROVISION
Provide clinical services (history taking, physical examination, ARVs, (MDTs on ARV treatment failure, mortality, LTFU), Opportunistic infection treatment)
Facilitate adherence support (treatment preparation, adherence assessment, booster adherence and interventional adherence support)
Facilitate ART treatment literacy for ALHIV and care givers
Provide psychosocial support (OTZ therapy club meetings with topics and documentation)this to be done within the usual PSSG and OTZ champions
meet after the general support group separately to reinforce on their motto, pledge and values.
Conduct home visits to address adherence issues and take appropriate actions, soliciting for social support in cases of unstable guardian and other need
Provide laboratory services: initial, follow up and diagnostic tests
Peer led intervention
Map the referral institutions, assess the ALHIV needs and refer appropriately
Documentation of voices of champions
TRANSTION INTO STABLE CLINIC

Categorize the ALHIV and care givers into stable and unstable groupings as above
Considered the stable ALHIV for multi-month prescription in OTZ clubs but are reverted back to shorter TCAs when they become unstable
Give the unstable ALHIV shorter TCAs for closer monitoring but they can be shifted to multi-month prescription when they stabilize

TRANSITION INTO ADULT CLINIC

Prepare AYP from age 18 years for transition into adult clinic (share the similarities, differences in service provision and address their concerns)
Pick a line list of all ALHIV in the clinic
Segregate those who have attained 20 years and above from the rest
Transfer the 20 years and above to adult clinic
Despite exiting the OTZ therapy club courtesy of age factor, discuss with them that they remain OTZ alumni and can be called up on to mentor and suppo
Orientate and inculcate them into the adult clinic

MINIMUM PACKAGE OF CARE FOR OTZ (PRE-REQUISITE)

IN ADDITION TO THE MINIMUM PACKAGE OF CARE FOR AYP, THE FOLLOWING ARE INCLUDED:

1 Coordination of OTZ activities by an OTZ champion

2 Enrollment into the OTZ register
3 Follow of AYP with VL > 1000 c/m L by use of a longitudinal register
4 Support group
5 e-communication through whatssap, text messaging, phone calls
6 Adherence assessment using MMAS 4&8
7 Documentation of all adherence sessions including intervention adherence

References

Kenya 2016 ART Guidelines