Improving adherence to ART for better ART Clinical outcome at Bujubuli HC III, Kyegegwa District, Western Uganda

 

Problem: 

Bujubuli Health center III is a government aided health facility located in Kyaka II refugee settlement, Kyegegwa District in western Uganda. The health center also receives financial support from UNHCR and serves an estimated catchment population of 75000 people majority of which are refugees. By June 2011, 202 patients were receiving ART at Bujubuli health center with about 41% of them taking more than 95% of their prescribed ARV medicines and a similar proportion (40.5%) were clinically well as defined by body weight, absence of new opportunist infections and functional status.

Intervention: 
Following a quality improvement coaching session in August 2011 the HIV care team at Bujubuli HC reviewed the HIV care records and discovered that a big proportion of the clients were taking less than 95% of the prescribed medicines based on self reports and pill counts. The team decided to initiate quality improvement efforts targeted towards adherence to ART. During the month of august 2011 the team started issuing of adherence cards to all ART clients and taught them how to use them for self monitoring of adherence. Individualized ART adherence counseling sessions for poorly adherent clients were introduced to solve client specific also adherence problems. Clients were encouraged to share testimonies about their adherence problems during health education sessions held during clinic days.
 
Table 1, trend of patient who have 95% adherence to ARVs since June 2011 to December 2011.
 

Months

 

June

July

August

September

October

November

December

No of adherent client as seen from the sampled HIV care cards

Num

39

49

39

69

81

86

79

Sampled HIV care cards

Den

94

78

78

82

94

94

94

%

 

41

63

29

84

86

91

84

 
 
Results: 
With the introduction of the above mention changes, the proportion of patients adherent to ART doubled, increasing from 41% in June 2011 to 84% by the end of 2011, similarly the proportion of clients clinically well raised by more than 100% in the same period. While working on improving the process of adherence to ARVs for ART clients the team discovered that appointment keeping was a problem to some of the clients who were not adhering well to medicines.
 
 
ART clients seen to have good Clinical outcome due to client’s adherence to ART treatment since June 2011 up to December 2011.

Month

 

June

July

August

September

October

November

December

Patients seen with good clinical out come from the sampled HIV care cards

Num

39

49

23

77

88

91

93

Sampled HIV care cards from the patients who were to attend the clinic that month

Den

94

78

82

94

94

94

94

%

 

41.5

62.8

29.5

93.9

93.6

96.8

98.9

 

Key: Num= Numerator.  Den= Denominator.

Lessons: 
Applying QI approaches to a particular process of HIV care is helpful in identifying problems with other related processes of care.

 

Countries: 
Report Author(s): 
Byamukama Polycarp, Mutegiki Constantine
Organization(s): 
By Byamukama Polycarp suported by Bujubuli Health Centre III
Facebook icon
Twitter icon
LinkedIn icon
e-mail icon