A District Response to HIV Klipfontein/Mitchells Plain Substructure 18 April Neshaan Peton

Transcription

1 A District Response to HIV Klipfontein/Mitchells Plain Substructure 18 April 2012 Neshaan Peton

2 Metro District

3 Geographic Service Area Platform. Metro= East and West Metro West is divided into Southern /Western substructure and Klipfontein/Mitchells Plain substructures Metro East is divided into Northern /Tygerberg substructure and Khayelitsha/Eastern Plain substructures Each substructure = two municipal sub-districts Both authorities render PHC services Provincial DoH has a SLA with Coct, in this respect.

4 Klipfontein/Mitchells Plain Substructure

5 Population data for the KMP substructure Klipfontein SD has a population of of which 16% insured Klipfontein SD had between 9-11% of patients accessing HCT in 2011, testing HIV + (positive). For the year the SD tested +/ patients. Mitchells Plain SD has a population of of which 12 % insured Mitchells Plain SD had 7-9% of patients accessing HCT, test HIV + for 2011 For the year the SD tested +/ patients. ACTS fully implemented.all counselors are trained in the finger prick procedure. We have identified the need to expand our HAST Program to include all our facilities render ARV services. Link to care. Each year we roll out more sites to reach this goal. Planned new sites for 12/13 Phumlani ; Masincdane; Westridge Clinics

6 NUMBER OF FACILITIES IN THE KLIPFONTEIN / MITCHELL S PLAIN SUBSTRUCTURE Of these facilities, there are 7 BANC sites and 11 ARV sites, of the 11 ART 4 offer paeds services. Health district Facility type No. Community Health Centres (CHC s) 3 Community Day Centres (CDC s) 6 Maternity & Obstetric Units (MOU s) 3 Clinics 18 Satellite Clinics 6 KLIPFONTEIN / MITCHELL S PLAIN Mobile Clinics 0 District Hospitals 2 Associated Psychiatric Hospitals (APH s) 1 Rehabilitation Hospitals 1 Palliative Care In-patient facilities 1 Sub-acute care In-patient facilities 1

7 CHC CDC CLINIC SATELITE CLINIC DISTRICT MOU RHC Guguletu CHC Hanover Park CHC Dr. Abdurahman CDC Heideveld CDC Nyanga CDC Silvertown Lansdowne Manenberg Vuyani Heideveld Hazendal Honeyside Ruimte road GF Jooste Mitchells Plain MOU Nyanga Junction RHC Masicedane Nyanga Guguletu Hanover Park

8 CHC CDC CLINIC SATELITE CLINIC DISTRICT MOU RHC Mitchells Plain CHC Crossroads CDC Browns Farm (Inzame Zabantu) Crossroads 1 Crossroads 2 Phumlani Mzamomhle Tafelsig Mandalay Satellite Clinic Westridge satelite Rocklands satelite New Mitchells Plain District Hospital Mitchells Plain MOU Mitchells Plain Youth Health Eastridge Lentegeur Weltevreden Valley Rocklands

9 MDHS Facilities : CoCt Clinic: The two sub-districts has support systems CHC *Guguletu ; Hanover Park; *Mitchells Plain Hanover Park; Heideveld; Manenberg;Lansdowne;Silvertown; Guguletu;Nyanga; Vuyani and Masincedane;* Mzamomhle;Phumlani;Cross roads;weltevreden Valley;Eastridge; Westridge;Lentegeur;Rocklands and Tafelsig CDC- *Heideveld (combined facility); Dr Abduragman ;*Nyanga (combined facility); Inzame Zabantu and *Cross Roads (combined facility) RHC-Nyanga; Mitchells Plain MOU- Guguletu; Hanover Park and Mitchells Plain

10 Rank Leading causes of YLLs: Western Cape Districts 2009 City of Cape Town Cape Winelands Central Karoo Eden Overberg West Coast 1 HIV 13.1% TB 11.3% HIV 13.7% TB 12.6% TB 10.6% TB 12.2% 2 Homicide 9.8% HIV 11.0% Road injuries 13.1% HIV 9.3% HIV 9.3% HIV 8.9% 3 TB 9.6% Homicide 6.6% TB 10.9% Homicide 6.7% Homicide 8.2% Road injuries 7.6% 4 Road injuries 5.6% Road injuries 6.5% COPD 6.5% Ischaemic heart disease 5.9% Road injuries 7.3% Ischaemic heart disease 7.0% 5 Ischaemic heart disease 4.8% Stroke 5.2% Homicide 6.4% Stroke 5.5% Ischaemic heart disease 5.1% Homicide 7.0% 6 Diabetes mellitus 4.4% COPD 4.9% Stroke 5.5% COPD 4.8% Stroke 4.7% Stroke 5.9% 7 Stroke 3.8% Ischaemic heart disease 4.5% Ischaemic heart disease 4.1% Pneumonia 4.7% Pneumonia 4.4% Diabetes mellitus 4.1% 8 Pneumonia 3.8% Pneumonia 4.1% Diarrhoea 3.0% Road injuries 4.5% Lung cancer 3.9% COPD 3.9% 9 Lung cancer 3.0% Lung cancer 3.7% Lung cancer 2.8% Lung cancer 4.1% Suicide 3.5% Lung cancer 3.7% 10 Hypertensive disease 2.7% Diabetes mellitus 3.4% Hypertensive diseases 2.6% Source: Western Cape BOD reduction project Diabetes mellitus 3.8% COPD 3.1% Pneumonia 3.5%

11 Klipfontein/Mitchells Plain Substructure BOD Klipfontein Sub-district HIV;TB Mitchells Plain Sub-district - Homicide; HIV and TB With the aim of reducing new infections and linking those in need to the appropriate level of care. Nurse driven services ; Paeds; ACTS; NIMART; Adherence clubs ; CDU;TB/HIV Integration project; PMTCT and developed strategic partnerships.

12 Program Staff and Roles and Responsibilities Substructure HAST team: HAST Manager; HAST Medical Officer ; TB/HIV Integration Coordinator ; PMTCT Coordinator; HAST Clerk; HAST Info Clerk; NPO Partners/NMS Program management policy implementation, technical and clinical support, project management, Quality Assurance, M&E.

13 Framework for ART Units Appointment system Triage system MDT meetings Operational meetings HOD

14 Nurse Driven ART Services 2011 move to Nurse driven services, followed HF2 processes to create CNP post Linked with tertiary Hospital GSH, RXH and NPO partners for support of rolling out paeds ART services Heideveld clinic started their paeds service with the support of the RXH team in May 2011.

15 Paeds and Adolescent services Well established paeds services Guguletu Mitchells Plain GSH Cross Roads GSH/Kidz positive Vuyani KI Heideveld RXH Adolescent services Guguletu and soon Cross Roads

16 RAP Project Hanover Park Started in Feb 2011 in partnership with DTHF Pilot project for one year with the aim of assessing the impact this will have on birthing outcomes (PCR negative) Services are rendered in a Park Home R for equipment Staff compliment Medical Officer; CNP X1 and Professional Nurse x1 (NIMART trained) MOU-Nurse render both ANC and ART services, before referring the patient to the ART service for f/up. This improves patient experience. Engage the provincial office Viral loads done in a MOU.

17 Adherence Clubs Do decrease current workload and improve the patient experience (taking time off work/school) Criteria 18yrs older; adherent client ; stable on regimen; virally suppressed Club managed by Pn, club register and Meds prepacked (CDU)

18 CDU. Non- clinical visits, patient comes to collect meds only, pre-packed via service provider

19 Comprehensive, integrated BOD focused POC Population-based bed norm Revised CBS policy: i. Dehospitalised care: Long-term care Inter-mediate care Supported self-care ii. Adherence support i. Prevention/ Promotion CBS Gate-keepers to rest of system Acute PHC hospitals Care pathways approach FPS Comprehensive death scene investigation Service responsive to BOD What should we do differently because of our 2020 principles? Integrated BOD focused POC in GSA EMS Proper care pathway Integrated ICT and CAD solution Specialised hospitals Psych: Review IDS policy WCRC: Integrated Rehab services TB Hospitals: Revise projected TB cases Decentralise DR Mx

20 NIMART Rolled out 2010, full day Saturday work shop Facility Manger buy in and Management commitment Developed M&E tools Training coordination done via substructure office All ART sites have one Medical Officer who is a trained Mentor Provide Locum support Authorization management sign off process

21 TB/HIV Integration strategy implementation. CCW (TB/HIV Integration) project rolled out in 2011 Policy decision taken in 2010 by the provincial office H 172/2010 TB/HIV Integrated Adherence policy Framework

22 Integrating TB Services at ART Sites Gugueltu ART (Hanaan Crusade) started TB services on the 3 rd May 2011 as part of the strategic move towards offering integrated services Phased in approach, as of April 2012 also offering DR TB services, supported by the CoCt

23 PMTCT system strenghtening May 2010 PMTCT Coordinators were appointed as part of the PMTCT System strengthening initiative Global Fund Training conducted by DTHF PMTCT Baseline audits were conducted GAPS IDENTIFIED the current PMTCT KEY EVENT SCHEDULE WITH THE IMPLEMENTATION OF IMPROVEMENT STRATEGIES 2010 Oct new PMTCT policy implemented, triple theraphy, NVP for Baby on discharge

24 Developing Partnerships Identified our partners Kidz positive;gsh and RXH Linked with partners to discuss support for the ART program at an operational level Visited RXH ART clinic and attended ward rounds capacity building and transfer of skills Exit Plans developed for sites which RXH team would support and new sites identified for support

25 Information Systems devlopments Tier.net installed in the ART Services Involved the district hospitals in the project, developed ART indicators for level 1 / 2 care Data flow policy influenced substructure accountability for HAST data 2011 employed Information clerk Program staff attended Sinjani training to aid the above

26 Partnered with UCT to support the project roll out, technical support and back capturing Improved on HCT Data management by using the facility diary stats as a correlation PMTCT - All PCR positive babies traced and mothers interviewed to identify gaps and improve system TB suspect Register implemented, all patients tested for HIV District Hospital ART indicators developed

27 Conclusion A collaborative approach is key to success Build relationships Building capacity by empowerment Continuously communicate Diverse local need

28 Thank you