The Story of establishing an HIV/AIDS clinic in Tiriri HC IV, Soroti district in Uganda
In the year 2008, we started seeing HIV+ clients in Tiriri Health Centre (HC) who had been diagnosed through voluntary HIV Counseling and Testing. This presented a problem because the HIV clinic was not established at the facility. Patients could be given septrin tablets and very brief counseling. There was no central register for these patients and no scheduled day for seeing them. All the HIV patients were being registered as Out-Patients in the Out-Patients Department (OPD). The staffs did not know how to clinically stage patients using the WHO staging criteria, there was only one clinical officer who had had some training in HIV/AIDS care. At that time, we would refer our clients to get CD4 tests, care and support from other local service providers like TASO and Uganda Cares. This was because the staffs at Tiriri could not fully handle them.
Early in 2009 as the clients increased, we thought of introducing a septrin register where clients could be registered each time they came to the clinic. We were trained in HIV counseling by AIDS Information Centre (AIC), PREFA and AMREF, which are local NGOs. This made the task of caring for HIV patients a bit easier. Then in mid 2009, the USAID Health Care Improvement project (HCI) trained the staffs in Quality Improvement (QI). HCI also conducted coaching visits at the unit and established a site QI team. The QI team was established in July 2009, and we set aside one clinic day in a month on which to see HIV patients.Through the District QI Team, the HIV clinic received the MoH standard HIV patient monitoring tools. Records of HIV patients were then transferred from the OPD and Ante-natal care (ANC) register to the pre-ART register. However, even though we had 50 patients ever enrolled in care only 20 were actively seeking care at that time. Most of our patients had self-transfered to local NGOs that provide them with foodstuffs in addition to HIV care.
There are now 44 active patients in the HIV clinic. Those patients who consistently adhere to treatment have shown significant clinical improvement. Septrin is now available to our clients most of the time. Staffs are able to counsel patients and conduct clinical assessments on clinic days, as a result all our patients are clinically staging using the WHO criteria at every clinic visit. TB screening is also done for all our patients. There is on-going support supervision by the district QI team who are occasionally accompanied by HCI coaches. We have now also started to provide ARVs, and 2 people have already been started on ART. Where we have reached is all because of the support of the HCI project.
For health workers: you should work as a team to improve the quality of service delivery to your HIV+ patients and all the other patients. You should also keep records of whatever you do as it is good for accountability, future planning and references.
For other people: you should test for HIV, know your status and seek for help from qualified health workers. We also advise couples to test and know their status together.
To HIV+ patients: you should disclose your status to avoid or reduce stigma, and you should also adhere to treatment
To care-takers of HIV+ patients: you should show your patients love and care.
Finally, if you are HIV negative stay negative by taking the ABC strategy, that is Abstain from sex, Be faithful to your partner or always use a Condom.