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HIV/AIDS

Building Sustainable Systems to Deliver Quality Services

Facility Results in South Africa

Barberton Hospital in Mpumalanga Province

Barberton Hospital is a small district hospital situated in the Ehlanzeni district in Mpumalanga province, serving a community of approximately 64,000 people. Mrs. Agness Mdawe, the URC QAP provincial coordinator, has been working with the Barberton Hospital quality assurance team since 2003, in collaboration with the PDOH district QA Coordinator. As a result of QA training and coaching during monthly quality assurance meetings and quality improvement interventions, facility staff have stepped up their efforts to promote HIV testing and to integrate counseling and testing and ART services with maternal and child health, primary healthcare, tuberculosis care, and home-based care services.

They have also improved in their follow-up of HIV-infected clients with clinical staging and CD4 counts. However, as the hospital was not accredited to provide ART, those clients requiring ART had to be referred to Rob Ferreira Hospital, 45 km away. This was very trying both for clients, most of whom could not afford to travel so far for monthly refills of their medication, and staff, who felt frustrated and helpless in this situation. However, buoyed by ongoing support from QAP, staff at Barberton Hospital continued to improve their care for HIV-infected individuals and began renovating rooms and garages for an ART site. On November 17th 2005, their efforts were rewarded with the accreditation of Barberton Hospital as an ART site.

Hospital staff has also improved in screening for and treatment of opportunistic infections, including TB, amongst People Living with HIV/AIDS (PLWHA). The number of patients screened for opportunistic infections has increased from zero in October 2005 to 75 in March 2006. At the same time, screening of HIV-infected clients for TB has increased from zero to 38 and screening of TB patients for HIV has improved from zero to 41. The quality of care provided to HIV-TB co-infected patients has also improved significantly, with an increase in the provision of opportunistic infection prophylaxis from zero in the last quarter of 2005 to 24 clients at the end of March 2006. In addition, the number of adult clients on ART has increased rapidly from 34 in November 2005 to 143 in March 2006. In order to improve adherence, all these clients are linked to treatment supporters and are receiving ongoing counseling and nutritional support.

Driefontein Health Center in Mpumalanga Province

Driefontein Health Center is situated in the Gert Sibande district, within Mpumalanga province, serving a community of approximately 50,000 people. Within the province, the HIV sero-prevalence rate amongst pregnant women is 30.8%, indicating a dire need for improvement and strengthening of the PMTCT program. Through the leadership of Mrs. Maria Fakude, the provincial QAP Coordinator, in collaboration with the DOH QA Coordinator, the quality of the PMTCT program has improved significantly. By promoting counseling and testing for HIV for all pregnant women at their first antenatal visit, the HIV testing rate has improved from 23% to 78% in the period October 2005 through March 2006. In addition, the emphasis on compliance with guidelines for facility staff has led to an increase in the administration of Nevirapine to all HIV-infected pregnant women and their babies from 151 to 207 in the first two quarters of 2006, a 25% increase. According to data collected from registers and from patient record audits, all babies born to HIV-infected mothers are now receiving Nevirapine prophylaxis at the health center.

In line with the national PMTCT guidelines, facility staff has been educated about the need to perform clinical staging and CD4 counts on all HIV-infected pregnant women and to refer for ART when appropriate. Through ongoing support and mentoring, the compliance with clinical staging of HIV infected pregnant women has increased from zero at the end of 2005 to 67% in the 2nd quarter of 2006. CD4 count testing has increased from 33% to 100% in the same time period. Facility staff has also been educated about the need to provide opportunistic infection prophylaxis to all HIV-exposed babies at six weeks and to inform mothers about PCR testing of their babies. The initiation of this service has shown some improvement from 8 to 28 infants in the first two quarters of 2006.

During a recent assessment of the value added by QAP, the Driefontein Health Center manager said, “Through the monthly support visits QAP has provided guidance, information, and training on national guidelines. This has resulted in improved record keeping, improved compliance with national guidelines, improved management and care of mothers and children and better insight into the care of HIV/AIDS clients and the correlation between TB and HIV. QAP has also influenced improvement in all programs at the facility such as chronic care, family planning and minor ailments.”

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