www.khethimpilo.org

Innovation in Identifying and Managing Unsuppressed Viral Load – Strategies/Processes

for the Early Identification of Patients with Unsuppressed Viral Loads using Tier.net

Presentation By: Chazanga Tembo

Reaching 90-90-90 in South Africa Part III: Best Practices

and Innovations in Linkage, Treatment and Viral Suppression

May 31 - June 1, 2016

Pretoria, Southern Sun Hotel

Project Goal/AIM

Data Methods

Key Results

What are the Issues?

Conclusions & Recommendations

Presentation Outline

The overall goal is to support advanced clinical care for patients failing, or

with complications to antiretroviral therapy (ART), including other conditions

related to HIV, as well as Drug Resistant TB (DR-TB).

CoAg: Strengthen Capacity of the South African Government’s

Department of Health to provide quality and sustainable care for HIV-

infected patients with complicated HIV and HIV/TB treatment

management, including 2nd and 3rd line and other antiretroviral therapyunder the President’s Emergency Plan for AIDS Relief.

1. Establish and/or strengthen three Regional Centres for

Advanced Clinical management of HIV/TB in adults and

paeds in FS province – Including failure to 2nd and 3rd line.

2. Establish and or strengthen up- and down-referral systems

from PHCs and district hospitals to these referral centres

3. Build and support the capacity of DoH facility staff at district

and PHC level to manage pts –through training, mentoring

and coaching.

4. Engage SA DoH around project transition by the end of

project

Project Objectives

Data Methods

Data

Generation

Kheth’Impilo (KI) collects TIER.Net

Dispatches monthly- Export to Excel

for further analysis; Run Viral Load

(VL) Due and 2 Consecutive

Unsuppressed VL Reports from

TIER.Net;

Tier.Net Site

Tier.NET SOP

Weekly

coaching to

OMs & DCs

to draw tier

reports

Weekly

Patient File

audits by

QNM

Interpretation & capturing of results

Feedback Reports by QNM

to Facility Clinicians

Coach and Mentor

Facility Clinicians on how

to better manage these

patients

Partnerships with District

Support Partners and FS DoH

Facilities

Coaching Plans

Facility feedback

meetings by Clinicians

Routine Data capturing of

results

Trend Analysis&

Data Quality checks

Facilitators

OSDV & QA/QC

KEY RESULTS

Viral Load Completion: 6 month cohort (2014)

50%

90%

Baseline, 2014

2015, Q3 implementation

Target, by end of project

42.6%

50%

7.4%

Khethimpilo Period

(2015) Q3, Tier.Net

Targeting weak

performing

facilities

Collaboration with

DSPs/FS DoH

Data

harmonization/

information

meetings

KEY RESULTS

Viral Load Completion: 12month cohort (2014)

55%

90%

Baseline, 2014

2015, Q3 implementation

Target, by end of project

40.8%

55%

14.2%

Khethimpilo Period

(2015) Q3, Tier.Net

Targeting weak

performing

facilities

Collaboration with

DSPs/FS DoH

Data

harmonization/

information

meetings

KEY RESULTS

Viral Load Suppression: 6 month cohort (2014)

87%

90%

Baseline, 2014

2015, Q3 implementation

Target, by end of project

87.8%

92%

Khethimpilo Period

(2014) Q3, Tier.Net

90% Target

4.2%

KEY RESULTS

Viral Load Suppression: 12 month cohort (2014)

79.7%

90%

Baseline, 2014

2015, Q3 implementation

Target, by end of project

79.7%

89%

Khethimpilo Period

(2014) Q3, Tier.Net

90% Target

9.3%

Weak booking systems for drawing of VL bloods

Viral loads are either not being taken on time or recorded

Failing patients are kept on the same regimen

Last viral load results not timely captured and/ or acted upon

by clinicians

Poor adherence to clinical and data management guidelines

THE ISSUES ARE KNOWN:

CONCLUSION & RECOMMENDATIONS

• Scaling up this approach can help to achieve early VL suppression

and should be considered as the next phase.

• 90% Viral Load suppression rate in patients on ART is the last of

the 90-90-90 targets to be attained by 2020, early identification

allows us to reach this goal.

• Regular routine file audits can help sustain patients VL

suppressed

• Mentoring and coaching on effective use of guidelines/ SOPs for

VL testing and result interpretation

• Clinicians are responsible for performing these tests and reviewing

and acting on results of patients on ART.

• Maintaining a system of recalling and booking of patients through

the referral process for management of these patients at all levels

of the system

Proper data management improves early identification of VL

Unsuppressed patients

Full patient history report, appropriate recording and filing of

all blood results; correctly filled in referral forms is important

Extensive coaching on proper use of SOPs and patient

management guidelines is important

Routine feedback on monitoring of capturing of patient blood

and correct interpretation is critical

LESSONS LEARNT

SPECIAL THANKS TO:

ENTIRE KI PROJECT TEAM

FS DOH, PROVINCIAL & DISTRICTs

PEPFAR DSPs IN FREE STATE

FS HOSPITAL MANAGEMENT TEAMS

FS PHC FACILITY MANAGERS & TEAMS

Authors: Tembo C, Shembe S, Mothibi E, Pursey K, Sikweyiya L, Khumalo T,

Fekema Z, Mothibi J

This presentation was supported by the South Africa office of the United States Centers for

Disease Control and Prevention (CDC).Its contents are solely the responsibility of

Kheth’Impilo and do not necessarily represent the official views of CDC, USAID or the United States

Government