STRATEGIES TO ACHIEVE THE 90-90-90 IN KISUBI HOSPITAL

 IN THE 1st 90- Identification and linkage of HIV positive persons

HIV Testing services (HTS)

As the entry point into HIV prevention, care and treatment services, knowledge of HIV sero-status is key, and therefore HTS shall remain paramount and FREE in Kisubi Hospital. As the prime step to the 1st 90 in the cascade, all interventions and innovations used will aim at;

Strengthening and expanding existing targeted HTS at the hospital and out reaches in order to reach more people.Continuing integrating provider initiated testing and counseling (PITC) for HIV in all Hospital departments and link those found to be HIV positive to Care.

Work closely at improving recording to ensure that all clients tested are captured and appropriately linked to care.

 Paediatric Care and Support

We intend to scale up paediatric care and support which will involve a concomitant expansion of HIV testing for children at PICT, in community outreaches and early infant diagnosis (EID) care points.

The strategy for achieving this is to continue HTS and EID at the Hospital and in the communities to identify positive children in the registers who were not linked to care and provide the appropriate linkage. Provider initiated testing and counseling for pediatric clients will also be emphasized in Paediatric ward and the Paediatric outpatient clinic, Immunization clinic and OPD to enable early identification of HIV positive children and link them to care.

STRATEGIES TO ACHIEVE THE 90-90-90 IN KISUBI HOSPITAL

IN THE 2ND 90- Enrolment into care and on ART

Adult Care and Support

Enrolment into care refers to appropriate linkage of positives clients into care and on ART. Kisubi Hospital aims at 100% linkage of all identified positives into care and where possible same day initiation on ART as per standards in the new HIV treatment guidelines of Test and Start.

Adult care and support aims at providing services in an integrated manner to adults 15 years and above along the continuum of care with particular emphasis on three key aspects;

  • Linking HIV-infected adults into care and retaining them in care throughout the pre-ART (if found with TB or other OIs) and ART periods.
  • Providing non-ART services that improve morbidity, mortality and reduce HIV transmission in the pre-ART and ART periods. E.g. Nutrition assessment and support, provision of Septrin and Dapsone prophylaxis, diagnosis, prevention and treatment of TB and CCM disease and viral hepatitis e.t.c.
  • Ensuring timely initiation of ART for all eligible individuals as per the new HIV Treatment guidelines.

Overall, there is increased focus on quality and continuous quality improvement of HIV care and support services across all clinical care activities.

ART is recommended for all HIV-infected individuals, regardless of CD4 cell count, to reduce the morbidity and mortality associated with HIV infection. According to the new treatment guidelines, HIV Positive persons identified are supposed to be initiated on ART the same day.

ART is also recommended for HIV-infected individuals to prevent HIV transmission. When initiating ART, it is important to educate patients about the benefits of ART, and to address barriers to adherence and recommend strategies to optimize adherence. On a case-by-case basis, ART may be deferred because of clinical and/or psychosocial factors; however, therapy should be initiated as soon as possible. Patients should also understand that currently available ART does not cure HIV. To improve and maintain immunologic function and maintain viral suppression, ART should be continued indefinitely.

Addressing the unique needs of special groups regarding ART delivery including children, adolescents, TB patients, pregnant women, patients with complications like anemia, renal disorders and the elderly.

STRATEGIES TO ACHIEVE THE 90-90-90 IN KISUBI HOSPITAL

IN THE 3rd 90- Retention of clients on ART and Viral Suppression:

To ensure achieving the 3rd 90 in the cascade, the following activities are what Kisubi engages;

  1. Timely Viral load monitoring test for all clients on ART as per testing algorithm.
  2. Following up of clients with high viral load through home visits, intensive adherence counseling support.
  3. Adherence retreats for clients with poor suppression.
  4. Treating of any OIs to improve quality of life while on lifelong ART
  5. Routine switch committee meetings to switch clients failing on 1st and 2nd
  6. Engaging differentiated service delivery models where patients receive HIV services with less cost and strain. E.g reduced visits to the hospital through community ART groups.

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The strategy for achieving this is to ensure that all children enrolled into care are initiated on ART in an appropriate manner and strategies are laid to retain them into care. While continuing HTS and EID at the Hospital and in the communities to identify positive children and register them in the clinic but also to trace all positive pediatric paediatrics who are lost to follow-up and re-initiate the on ART.

Under this programme area, expanding paediatric treatment is critical to improving child survival and closing the gap in paediatric treatment coverage. It is important to tailor HIV care and treatment to meet the peculiar needs of adolescents and facilitate the transition from paediatric to adult treatment.

Since it was proven that TB remains the biggest cause of death among PLHIVs, therefore one of the UNAIDs goals was and is still to reduce tuberculosis deaths in people living with HIV by 50%. Kisubi Hospital will promote the three I’s in strengthening TB services and interventions i.e.

  • Intensified Case Finding / Provider Initiated Routine Screening for TBInfection Control Specific for TB
  • Isoniazid Preventive Therapy (IPT)

The facility has a TB Focal person who ensures infection control, develops CME sessions and ensures patient follow-up and coordination of TB services and logistics.

Kisubi Hospital has the ability to perform microscopy, X-rays and for confirmatory results, we do sample referral for GeneXpert for better management.Any MDR (Multi Drug Resistant) clients are referred to Mulago main Referral Facility.

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