Quality improvement cycle in Opuwo district hospital HIV/AIDS clinic, Kunene region, Namibia
Thesis (MMED)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: The study aimed to assess and improve the quality of care for Opuwo District Hospital HIV/AIDS clinic in Namibia. Currently, there is no literature available on the quality of care for the HIV/AIDS clinic at primary level in Namibia. Opuwo District has one of the lowest prevalence rates of HIV/AIDS in Namibia with 8.8% among ANC patients. A total of 1714 HIV positive patients are enrolled at Opuwo District Hospital HIV/AIDS clinic and 109 (6.36%) of them are defaulting treatment. Based on these statistics, I decided to do a quality improvement cycle of the HIV clinic system to see if it would improve adherence. Adherence will improve if the quality of care rendered to patients is standard (18). Aim and Objectives The aim of the research is to improve the quality of care for patients on ARVs, with concern for factors influencing adherence in Opuwo district Hospital. The objectives are as follow: 1) To evaluate the quality of care that was given to patient registered at Opuwo HIV/AIDS clinic since 2007 2) To correct inadequacies discovered during initial evaluation of the clinic to improve the quality of care 3) To evaluate if corrected inadequacies have led to improved quality Method The study design is a quality improvement cycle The quality improvement cycle done was a teamwork that involved trained nurses in HIV, data clerk, counsellors, trained pharmacist in ARV therapy and a doctor. This team audited care rendered by looking at the structure, process and outcome of the care given at the clinic; then inadequacies discovered were corrected and the whole system was re-audited to see if there is improvement. The study population was patients attending HIV/AIDS clinic since 2007 until date and the sample size was fifty with selection made by random sample using simple proportion (HIVQUAL system that was automatically programmed to calculate sample size based on the population of patients entered into the system). Data on structure was carried out prospectively by observing what is on the ground in term of equipment, staff, tools etc. Data for proper documentation, weight checked at every visit, clinical staging at every visit, counselling at every visit, TB screening etc and outcome (regular in clinic attendance, viral load below 1000 after 6months on HAART, etc) were audited retrospectively using patient’s file. Results Using chi-square test to analyse the data, the intervention was successful because the P-values were less than 0.05 in most of the indicators audited for process and outcome. It was found that after the intervention (in-service training, re-enforce proper documentation, re-enforce health education by all staff not limit it to counsellors alone, wall poster to remind staff on ordering investigation for CD4, viral load when due and follow up results by doctor or nurses, weigh check for all patients before starting consultation, doctor and nurses should prescribe IPT, Co-trimoxazole and multivitamins) was made, adherence improved from 46% to 82% and opportunistic infection declined below 15%. Conclusion The quality improvement cycle enabled simple changes like in-service training, re-enforcement of health education by all staff, etc to be made at the clinic, which lead to appreciable quality improvement over a short period.