ST. CAMILLUS MISSION HOSPITAL

ART CLINIC

P.O. BOX 119-40401 KARUNGU

KCCB-KENYA AIDS RESPONSE PROGRAM (KARP)

ART PROJECT

YEAR 12 ANNUAL REPORT

January – December 2015.

1. INTRODUCTION

1.1. Background:

St Camillus Mission Hospital-Karungu has been a beneficiary of US-Presidential Emergency Program for AIDS Relief (PEPFAR)grant since 2004. The core mandate being offering Treatment, Care and Support to the people living with HIV AIDS in Nyatike, Suba and Ndhiwa Sub-Counties where HIV prevalence rate still stands at 15.1% in Nyanza (KAIS 2012). The program is referred as Kenya AIDS Response Program (KARP) with Kenya Conference of Catholic Bishops as the prime recipient.St Camillus serves a catchment population of 300,000 spanning a radius of 32 km. It partners with four other dispensaries for decentralization of services.Cumulative patient enrollment by December2015 stood at 11,698 with Active on HAART being 6,097.

Fig.1: A.R.T Project Task Force.

2. YEAR 12GOALS & OBJECTIVES.

2.1. Clinical:

  1. Achieve 95% Septrin (CTX) Prophylaxis.
  2. Enrol 78 new clients each month.
  3. Initiate ARTs on 54 clients per month.
  4. Provide Post-Pharmacy Counselling (PPC) on a daily basis.
  5. Treatment Preparation Sessions on the first 3 Fridays of every month.
  6. Retain 85% of the patients.
  7. All patients on HAART for more than six months are done Viral Load monitoring.
  8. Intensive Case Finding (ICF) for TB screening to all patients.
  1. Prevention of Mother-to-Child Transmission (PMTCT) intervention.
  2. Early Infant Diagnosis to all exposed children.
  3. Baseline CD4 count to all new enrolments.
  4. Adhere to Kenya National (NASCOP) Guidelines.
  5. Adverse Drug Reaction Reporting(ADR) at 100%.

  6. Embracing Kenya HIV Quality Improvement Framework (KHQIF).

Fig.3: An ARV drug side effect‘Buffalo hump’ before (A) and after (B) successful management.

2.2. Psycho-Social/Community Based Treatment Based Support (CBTS):

1. Health Education every morning at the waiting bay.

2. Querying of Data base (IQ-Care/MSH) for patients missing appointments daily.

4. Link newly enrolled/initiated clients to Patient Support Groups(PSGs) and CHVs.

5. Maintain TB-DOT and defaulter tracking.

6. Enhanced HIV Testing at OPD, IPD, Maternity and other points of patients care.

7. Participate at all International Health Days e.g. World AIDS Day.

9. CHV mentorships during monthly co-ordination meetings.

10. Empower Youth Friendly Services.

11. Support Quarterly Adolescent and Paediatric Psychosocial Days.

2.3. Programme Administration:

  1. Facilitate Human Resource development through Continuous Medical Education.
  2. Monitoring and Evaluation through donor and Government tools.
  3. Timely generation of periodical reports to relevant consumers.
  4. Networking and Collaborations with stakeholders.
  5. Health Systems Strengthening for sustainability.
  6. Joint Supervisions with the County and Sub –County Health Management Teams.
  7. Resource mobilization for enhanced capacity in service delivery.

3. PERFORMANCE ANALYSIS

3.1. Clinical:

High retention in treatment is the primary aim of every effort towards clinical intervention while observing WHO strategic goal of 90:90:90. To achieve this, Provider initiated HIV Tests, Early Diagnosis of suspected OIs, Early ARVs Initiation, Early Infant Diagnosis, Quality enrollments and generating defaulter lists daily are some of the pillars behindour performance. We also acknowledge CDC, Ministry of Health and our partner KCCB-KARP support in provision of updates and guidelines in HIV care and management.

Fig 4:St. Camillus A.R.T. Team attending to clients.

Fig.9:St. Camillus A.R.T Health Records & information Officers at work.

The table below analyses indicator based performance during the year:

Table 1: Clinical Performance

CLINICAL INDICATOR / TARGETS FOR THE YEAR / OUTCOME / COMMENTS
New Enrollments / 956 / 1,113 / Additional HTCs helped in Testing RRI during quarter 4.
Initiation to ARVs. / 648 / 773 / Surpassed target due to high enrollments and increased initiation baseline from CD4 of 350 to 500.
CD4 at baseline enrollment % / >90% / 81% / Revised guidelines on viral load monitoring.
CTX uptake % / >95% / 97.7% / Enhanced monitoring by clinicians.
Started on second line treatment / All patients failing on 1st line. / 102 / The number has reduced from 150 in the previous year due to close follow up on non-adherent clients with home visits.
Patient retention % / >85% / 85% / Reduced transfer outs, LTFUs and mortality.
DNA-PCR Sample Collection & Testing of exposed children / All Exposed Children / 97done / Only 4 turned HIV positive & enrolled, an indicator of strong PMTCT.
Viral Load Audit / All patients on ART / Detectable=10%
Undetectable=90% / Represents strong adherence
TB-ICF. / Continuous for all patients. / 100% / Screening on going
Treatment Preparation Sessions. / 9 patients per week. / 11 per week averagely / Allqualifying patients put on HAART.
Adverse Drug Reaction (ADR) / OPEN / 18patients / This is Low, clinicians under reported the ADRs.

Table 2: Opportunistic Infection(OI) Incidence & Case Management:

MAJOR OPPORTUNISTIC INFECTION / INCIDENCE (% of Active on HAART) / OI MANAGEMENT AND OUTCOME
PTB / 73(1%) / Majority are on treatment and follow up as some have completed the treatment course
Kaposi Sarcoma / 5(0.1%) / Clients report lack of funds for the biopsies to make the diagnosis.
Cervical Cancer / 0(0%) / Screening not in the programme,therefore sporadic screening if done can produce a prevalence.
Cryptococcal Meningitis / 7(0.2%). / Cases are reducing due to early diagnosis and initiation.

Fig.5: World AIDS Celebration on 01/12/2015 in Sindo, Suba Sub-County.

3.2. Psychosocial/CBTS:

This is the Psychosocial, Political and Economic wellbeing of patient care. It is aimed at linking the clinic and the patient at the place of the patient’s residence and/or daily life. Cadres withthis responsibility are Social Workers, Community Nurses and Counselors. At the community level, CHVscomplement staff capacity. Performance evaluation can be tabulated as under:

Table 3: CBTS Evaluation:

STRATEGY/ACTIVITY / TARGET / OUTCOME
Link newly enrolled clients to Patient Support Groups (PSGs) and CHVs. / >90% to be enrolled and eligible are linked to any of 51 PSGs across the catchment area. / ART adherence and retention achieved at 90% and 85% respectively.
Health Talk every morning at the waiting bay. / A 30 minute health talk for 5 days a week at all our 5 sites. / 80% schedules done.
Querying of Data base (IQ-Care/MSH) for patients missing appointments. / All patients missing appointments. / Patient ‘lost to follow ups’ reduced to 1.8% from 2.1% in year 11.
Participate at all International Health Days. /
  • World AIDS Day at 3 Sub-counties & St. Camillus DalaKiye.
  • TB Day at 3 Sub-counties.
/ 100% Participations and recognition by County Health Departments in Homa Bay and Migori.
CHV mentorships during monthly co-ordination meetings / 12 Monthly CHV meetings at 5 St. Camillus and 4 affiliate sites. / Empowered CHVs translating to reduced defaulter rate by patients.
Empower Youth Friendly Services. / Biannual sessions planned at the 5 sites. / >75% adherence rate among the Youths.
Support Quarterly Adolescent and Peds Psychosocial Days. / Quarterly sessions planned at the 5 sites. / Adolescent friendly Clinics.
Enhanced HIV Testing at OPD, IPD, Maternity and other points of patients care within the Health facilities. / 100% Testing at all points of care / 148% achieved at close of the year. Thanks to KARP for additional staff for testing (HTCs).

Fig.6:ART Adolescents in a psychosocialtalent field day at Kadem TB & Clinic

Fig.7: Community unit participate in World TB Day 2015, Ndhiwa Sub-County.

3.4. Program Management:

Program management is done by the Project Coordinator. The officer oversees planning, budgeting, controlling, implementation, monitoring and evaluation Project Activities.Below is the analysis of outcome for the period:

  • Narrative, Data and Financial Liquidation reports were submitted to respective destinations at 90% within the first five days of every month.
  • The ART Project was awarded another funding for Acceleration of Child Treatment(ACT) by KARP. A total of 14 qualified staff 14 CHVs were hired under this fundin
  • We are partnering with RCTP-SEARCH program in as study dubbed; TEST & TREAT for early initiation to ARVs at a CD4 count of 500cc.
  • Numerous Ministry of Health, NASCOP and donor Supportive Supervisions were hosted and benefitted facility staff.
  • Fund transfer by KARP was consistent throughout the year

Fig 8: Migori County Government officials preside over World TB Day in Kuria Sub-County.

Fig.11: Traditional dancers entertain attendees during a Community dialogue Day

IN REGARD TO HUMAN RESOURCES, we can report that:

An average of 31staff benefitted from various internal and external training programs supported by both County Governments and KARP.

  • Staff stood at 16.7%.
  • TwoCollege students benefited from industrial attachments during the year.
  • Leaves were broken as desired with minimal off duties towards the end of the year

Fig.12: A mother and her daughter being weighed at St. Camillus Clinic.

CONCLUSION:

To achieve the WHOs goal of 90% of the population knowing there HIV status, 90% put on ARTs and 90% Adherence to treatment come the year 2020, the walk must start now with innovative approach and inclusivity of all stakeholders. Infection among the new borns can still be eliminated when access to EMTCT is widened where all pregnant mothers are encouraged to pursue skilled delivery at recognized healthcare facilities.

Report Compiled by ObilloMeshack.

Coordinator

KCCB-KARP

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