Sub Partner Name(s)
(No data provided.)
Overview Narrative
Witkoppen Health and Welfare Centre (WHWC) is an integrated comprehensive health and welfare facility in the Northern Suburbs of Johannesburg, which offers many different programs in response to the needs of our beneficiaries, most of whom live in the informal settlements in our catchment area.
The HIV/AIDS program at WHWC started in 1996 in response to a need of our beneficiaries who were very ill and dying in the communities we serve. USAID funding for this program was first received in 2004, through Right to Care. This program, entitled: “Innovative Approaches to Integrated Primary Health Care for Marginalized, At-Risk Populations in Informal Settlements in Urban South Africa”, has two goals: to build capacity and support for scale-up of effective and efficient models for HIV-related services in line with SAG priorities; and to develop, evaluate, scale up, and institutionalize innovations to inform SAG strategies for improving treatment outcomes among key populations such as pregnant women, infants, children and adolescents, people residing in informal settlements, and those who are HIV/TB co-infected. The objectives of the program are: to provide interim primary care, support, and referral services to residents of informal settlements, targeting an under-serviced population; to increase DoH service delivery capacity in the WHWC catchment area; to implement effective innovative approaches to integrated primary care for HIV and TB/HIV and inform DoH on the evaluation findings; and to inform SAG Policy towards the introduction of National Health Insurance.
Cross-Cutting Budget Attribution(s)
(No data provided.)
TBD Details
(No data provided.)
Key Issues
Implement activities to change harmful gender norms & promote positive gender norms
Increase gender equity in HIV prevention, care, treatment and support
Child Survival Activities
Mobile Population
Safe Motherhood
TB
Family Planning
Budget Code Information
Mechanism ID:
Mechanism Name:
Prime Partner Name:
|
17029
HIV Innovations for Improved Patient Outcomes in South Africa (Innovation Clinic)
Witkoppen Health & Welfare Centre (WHWC)
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Care
|
HBHC
|
806,272
|
0
|
Narrative:
|
WHWC provides clinical care using doctors and trained primary health care nurses (PHCN’s), psychological care using the services of our Counselling Psychologist and Professional Counsellor. Social needs are met by 3 social workers and 2 social auxiliary workers. All these services are both facility and community based. The target audience is adolescents, adults, women living in informal settlements in regions A, B and C of Johannesburg.
Coverage WHWC’s program provides adult care and support to the key populations such as adolescents, people residing in informal settlements, and those who are HIV/TB co-infected as aligned with PEPFAR and SAG National Strategic Plan 2012 – 2016, strategic objective 3
Mechanisms Ongoing counselling and support is key to addressing retention in care however if a patient does miss an appointment he/she is phoned the same or next day and is encouraged to accept another booking date. If the patient still does not attend the clinic or cannot be contacted via telephone, CHWs do home visits to these patients after a period of 1 week of not attending his/her appointment. WHWC works with other CBOs and faith based organizations that also assist in tracing patients. Referral of patients from Witkoppen is managed via contacting the clinic to which the patient will be referred to ensure that arrangements are in place to accept the patient and the referring facility has the capacity to accept the patient. Ideally this process is reversed for transfer in of patients.
Linkages WHWC provides a comprehensive service delivery model incorporating social services which includes the provision of food parcels as part of a poverty alleviation program so the inter referral between HIV and Non HIV services works well
Monitoring and evaluation WHWC uses Therapy Edge – HIV software system as a patient monitoring system. This system provides information on defaulters, lost to follow up, transfers, patients who have died or stopped treatment as well as individual patient monitoring information such as CD4C and viral load values to determine patient outcomes and cohort information.
Research studies will be commenced to evaluate adherence clubs and also retention in care in adolescent. In addition, psychosocial/psychometric evaluations will be done at baseline and repeated in year 3. Qualitative data will be collected assessing stigma, mental health/well-being, school enrolment and achievement and social support.
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Care
|
HVTB
|
433,562
|
0
|
Narrative:
|
Alignment SAG National Strategic Plan 2012 – 2016, strategic objective 2 specifies that everyone should be screened for TB , at least annually”. WHWC screens every patient both at facility and community level for TB at every visit unless they are being actively treated for TB. The NSP also refers to “Prevent TB infection through intensified case finding (ICF), TB infection control, Isoniazid preventative therapy (IPT), immunization….”WHWC as part of its operational research studies has a study “Community-based ICF for TB and HIV using mobile information technology” which includes the activity of conducting household visits on newly diagnosed HIV positive patients and TB patients as well as HIV and TB defaulting patients. Each member of these households is symptom screened for TB and if positive sputum is collected for TB investigation. In addition household members are offered VCT. Other activities include a TB infection control program with reporting to senior management every second month. IPT is incorporated into the standard of care for HIV positive patients and children under the age of 5 living with a person with active TB. TB and HIV integrated care is standard of care at WHWC. Coordination WHWC is at the cutting edge of defining TB diagnostic methods in children in a primary health care (PHC) setting and is the only PHC in Johannesburg providing integrated paediatric HIV and TB care and support in a family centred approach. WHWC gladly accepts referrals to manage complicated cases. WHWC provides training for all NIMART models including TB/HIV treatment. HR:WHWC ensures that succession planning addresses these issues and in addition staff are trained to ensure backup for activities. Staff retention forms part of our HR strategy.Monitoring and Evaluation: Indicators collected at WHWC are directly aligned to the National TB and HIV M&E framework. The programme utilises the medical Database-Therapy Edge as well as the Excel spread sheets. The systems source information from the registers that are guarded against the common data quality threats. The program is flexible and always ready to comply with the changing or amended indicators without compromising quality. Accomplishments: A workshop to identify and document lessons learned and best practices developed was held.WHWC was one of the few sites in South Africa investigating GeneXpert TB diagnostic testing at point of care. The final data is being collated and the results of the study will be disseminated to stakeholders including the National and Gauteng Department of Health, and the Johannesburg Region A Department of Health. Results may also be presented at relevant national and international scientific meetings.The impact of the pilot ICF project in Diepsloot which incorporated case finding (HIV and TB) and defaulter tracing is being evaluated and parts of it will be revised to strengthen it as it is brought to scale.
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Care
|
PDCS
|
471,922
|
0
|
Narrative:
|
As WHWC establishes itself as a district centre for pediatric primary HIV care, aligned with the PHC reengineering approach adopted by the DOH for a district based clinical specialist team focusing on child health, it will be able to train NIMART nurses and in particular provide them with practical training and ongoing mentoring so as to instil the knowledge and confidence required of the clinical staff to ensure a successful scale up the pediatric program. The programme aims at providing comprehensive care and support to all (100%) HIV exposed babies presenting at WHWC, however, the target is set at 800 babies by end of FY13 based on past experiences.
Provide drugs, food WHWC Pharmacy provides antiretroviral medication as well as any other acute or chronic medication. In addition, the dietician, Mariske de Beer, assesses nutritional status and is able to supply nutritional supplements and dietary advice to caregivers of pediatric cases. Food parcels and other essential commodities such as clothing, stationery for school, blankets are provided via our social services department.
Needs Research studies will be commenced to evaluate retention in care in adolescent. In addition, psychosocial/psychometric evaluations will be done at baseline and repeated in year 3. Qualitative data will be collected assessing stigma, mental health/well-being, school enrolment and achievement and social support
Quality of care Establish a hub-spoke pediatric referral center for the local DoH PHC facilities, under the guidance of Dr Leon Levin with Right to Care. He is one of South Africa’s leading pediatricians with expertise in PMTCT and pediatric ART. Patient outcomes are monitored on the software system Therapy Edge – HIV so as to ascertain quality of care. NIMART nurse trainees also have the opportunity for supervised practical training and whilst they are at WHWC a locum is provided at the DOH site so that service delivery at DOH sites is not disrupted.
Integration The Expanded Program for Immunizations (EPI) is incorporated into pediatric HIV care and support, as is anthropometric monitoring and referral for nutritional supplementation if necessary. The well being of mothers is also enquired into and the mother is referred to well woman clinic on site for routine pap smears, breast examination and family planning.
Diagnostics Routine chest Xrays are available as a baseline for all HIV infected children as part of an initiative funded by a private radiology practise
CTX and INH These activities have been incorporated into standard practise and are reflected in the relevant SOP
Nutrition The services of a dietician are available daily for nutritional evaluations, advice and prescribing of supplements. In addition referral to our social services department will address issues such as food security and the reasons for this such as financial insecurity and assist with the application of relevant government grants
Activities psychosocial support These activities are managed by specialized Lay Counsellors trained in such matters. The Counselling Psychologist and Social Workers are able to provide additional support and expertise if required
Direct linkages Attending service providers meeting in our target communities increases linkages to the community and improves communication. The Counselling Psychologist interacts and provides group and one on one counselling for HIV infected and affected children within a few of the schools
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Governance and Systems
|
OHSS
|
0
|
0
|
Narrative:
|
WHWC addresses the following barriers
• Insufficient clinical staff capacity – Human resource development at DOH and WHWC
• Inadequate clinical quality
• Innovative approaches to patient outcomes
• Poor community strength and mobilization
Practical training and mentoring to develop skill sets of all nurses, doctors, counsellors, community health workers, pharmacist assistants both basic and post basic
Clinical quality assessments identifying gaps and providing targeted mentoring to improve the gaps both at WHWC and DOH sites
Conducting various operational research studies aimed at improving patient outcomes
Training community health workers and liaising with community structures and the community itself so that there is buy in and that they assist with the development of the reengineered primary health care model as described by the SAG.
Yes linkages are across functional areas eg Training of Pharmacist Assistants will address the skills shortage in this area but will also improve the knowledge of supply chain management
Funding inputs are received from DOH for the cost of drugs and consumables. GEMS nursing College and Empirical Academy as 2 examples provide Auxiliary Nurses and Lay Counsellors respectively who receive their practical training on site. WHWC is also a sub-recipient with Right to Care to provide tutoring for Pharmacist Assistants in regions A and B of Johannesburg. Drs Bloch and Partners provide X-rays as a baseline for newly diagnosed HIV positive children and also as a TB diagnostic tool in adults.
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Prevention
|
MTCT
|
433,562
|
0
|
Narrative:
|
Mother to child transmission of HIV virus has been a priority within WHWC. Over the past year services were provided to 2,820 mothers and 2266 babies. The program aims at providing services to 3200 mothers by end of FY13 and 4,800 by end of FY14. All (100%)HIV exposed children will be provided with care as they present to WHWC.
Building capacity to provide PMTCT Provide 3 weeks NIMART module of clinical mentoring (practical training) on PMTCT to identified DoH nurses enabling them to register with SA Nursing Council. Provide *locums* at DoH sites for nurses undergoing clinical mentoring for NIMART. Evaluate DoH nurses that have received clinical mentoring for NIMART. Provide continued support and in-service training (including case discussions and patient management advice) to DoH nurses that have received clinical mentoring for NIMART. Provide 3 weeks per NIMART module of clinical mentoring (practical training) to identified DoH nurses enabling them to register with SA Nursing Council. Provide (locums) at DoH sites for nurses undergoing clinical mentoring for NIMART. Evaluate DoH nurses that have received clinical mentoring for NIMART. Provide continued support and in-service training (including case discussions and patient management advice) to DoH nurses that have received clinical mentoring for NIMART
Build capacity at national, regional, district and health facility level WHWC provides clinical quality assessments to identify gaps. Reports are written and targeted interventions discussed and implemented to improve quality of identified gaps
Activities initiation of ART All newly diagnosed HIV positive ANC patients are initiated on treatment the same day as diagnosis – Option B+ with the exception of patients that are TB suspects, per standard operating procedure at WHWC. There are 2 dedicated ANC Lay Counsellors emphasizing program retention and ART adherence. Patients who have missed appointments are contacted telephonically or receive a home visit if they have not responded to the telephone call. Scale-up. Output of all activities is monitored and recorded by the monitoring and evaluation unit. Deviations from the norm and specific targeted areas for improvement are monitored closely to see that targets are met. Reason for failure is addressed with solutions and change sought to improve. Aspects of quality improvement in PMTCT are part of an operational research study to evaluate effectiveness and efficiencies of change. If proven to be successful through data analysis, reports will be written up and distributed and larger scale up will be discussed with the DOH. Activities for demand creation: A research study is being conducted titled ”Patient demand and preferences for safer conception interventions among individuals and couples affected by HIV”. 4. WHWC provides ANC invitation letters to women to invite their male partners to attend ANC with them. WHWC will assess the impact of male ANC attendance.Activities for integration: Comprehensive integrated care is the cornerstone of WHWC’s service delivery model. Thus ANC patients requiring ART are managed at the ANC clinic. During ANC patients are informed about postnatal care, family planning and immunization services At postnatal visits the mother baby pair is managed together examining both the mother and her baby. Eg Family planning and annual pap smears are given at their postnatal visit and at risk infants have their PCR test and immunizations
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Treatment
|
HTXS
|
1,847,342
|
0
|
Narrative:
|
WHWC provides in service training in the form of weekly presentations and discussions on predetermined topics. Staff regularly attend training provided by external service providers eg Right To Care, South to South etc. NIMART practical training and ongoing mentoring is provided to WHWC and DOH staff after they have completed their didactic training so that they can complete their required log books and register with the South African Nursing Council as accredited NIMART trained nurses. This covers all aspects of NIMART ie Adult and Pediatric treatment, PMTCT and HIV/TB co-infection. Pre-service training is done for all levels of nurses and for community service doctors on site.
Level of supervision Trained mentors both nurses and doctors
Evaluate clinical outcomes Therapy Edge – HIV is used to monitor clinical outcomes of patients. Trend analysis is conducted and reports are generated monthly.
Performance measurement Periodic assessments of collected data are done to evaluate the needs and progress of the programme including adjustments to improve different programmatic areas within the clinic. Data is analysed during the meeting and is also shared with the relevant stakeholders
Activities WHWC embarked on an intensified case finding system. On-going counselling is provided at every visit for HIV positive patients. Patients who have missed their appointments are contacted telephonically by designated staff for a rebooking of their appointment. Patients who are not contactable are handed over to tracing teams (both WHWC and other partners) who go to the community to do a home visit and encourage the patient to remain in care.
What are the outcomes of these activities?
WHWC enrolled had enrolled 5534 patients on HIV/AIDS care by end of December 2012, A total of 4502 patients are on ART Through our intensified case finding system, The prgram managed to lower the number of total defaulters at the beginning of the quarter, as well as to lower the rate of accumulating new defaulters. As a result the number of defaulters decreased by 27 patients by end of last (Oct-Dec 2012) quarter. Tracing of patients will remain a priority for FY13 to achieve high retention of patients. The program targets to reduce the number of defaulters by at least 20% every year.
Adherence activities
Readherence counselling is provided for caregivers and patients who are not adherent to treatment. Social issues are managed by a specialized social worker. Patients who are adherent to treatment and virologically suppressed are given the option to join adherence clubs where their medication is distributed to them via a central point I the community. This encourages adherence as patient queues are non-existent, travelling time reduced and collection times are more convenient. Monitoring bloods are taken by a professional nurse at the designated community point and thus the patient only requires an annual visit to the clinic if he/she is well controlled.
Target population(s)
With the population of more than 2.6 million within WHWC’S catchment area (Region A, B and C of City of Johannesburg), in line with the national HIV prevalence, it is estimated that 780,000 people are HIV infected and 31,200 are on treatment. WHWC contributes 15% (4,770) towards provision of treatment. WHWC is targeting to enroll at least 2, 500 new patients on treatment yearly.
|
Strategic Area
|
Budget Code
|
Planned Amount
|
On Hold Amount
|
Treatment
|
PDTX
|
397,432
|
0
|
Narrative:
|
WHWC enrolled 75 children to treatment. 414 children ever on treatment with 268 current. The plan is to continue to target all children through Pediatric centre of excellence within WHWC. Activities are practical training for DOH and WHWC staff. Mentoring and quality improvement provided
NIMART trainee ratio of 1:4 with 4 modules, namely: adult, Pediatric PMTCT and HIV/TB. WHWC will provide a “locum” nurse for the DoH sites so as not to disrupt service delivery. Peer mentorship and continued support is provided. Quality assessments done at WHWC and DoH sites.
Adherence Refer adult treatment program Integration During antenatal care attendance at postnatal care is encouraged. Patients missing a postnatal visit by more than 1 week are contacted via phone call. All at risk babies receive PCR testing and HIV positive infants are sent to the Pediatric clinic and are initiated on treatment. Anthropometric monitoring and referral for nutritional supplementation is provided. Food parcels are provided for food insecurity. All children of HIV positive mothers are assessed by our OVC Project to determine vulnerability and registered on the programme. Capacity Tracking is done of mother baby pairs to improve PCR testing. PICT is provided for all children Adolescents Research studies evaluate retention in care. Psychosocial/psychometric evaluations are done Transitioning is dealt with by the clinician and the adolescent who is able to meet the attending clinicians of the adult clinic. The pediatric counsellor assists. This transition is not age specific but occurs when the adolescent feels ready to make this change. Family planning services are available. Children and adolescents are monitored regarding scholastic achievements and referred to the Counselling Psychologist who does educational assessments.,
Improve capacity Pediatric HIV data is collected through Therapy Edge. Pertinent indicators are defined using the indicator protocol sheet which gives the description of indicators including unit measures, disaggregation, collection tools and methods as well as measures to avoid known data quality threats. Indicators collected are directly aligned to the USG and national indicators. New employees are trained on data collection and collation methods. It is a norm within WHWC to assess analysed data in departmental meeting in an effort to improve the programmatic activities. Data yielded by WHCW is shared on monthly basis with the government facilities to ensure that WHWC is at par with the other role players in South Africa.
Access to treatment:
Referrals from regional clinics. Practical training and mentoring is provided to DOH clinics Support groups address issues pertaining to adolescents. Stable patients can receive their ART in the community at adherence clubs Specialized counselling by our Counselling Psychologist Treatment VL monitoring is done routinely to identify treatment failure. Adherence issues are addressed and resistance testing done if required. Access to 2/3rd line drugs is available Procurement: Stock control management is the responsibility of our Pharmacy Stock Controller.
Disclosure issues are managed by the Pediatric Counsellor, clinician and caregiver. Staff know at what stage the disclosure process is at; be it non/partial/full disclosure.
|
Share with your friends: |
