RESPOND Project newsletter

IMPROVING HIV/AIDS SERVICES FOR KEY POPULATIONS
IN UKRAINE

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#31, December, 2016
 

RESPOND’s 2016 at a Glance


Collaborative
Improvements

NGOs
in the Collaborative


Capacity development
 

The Quality Improvement Collaborative

RESPOND and its partners in Dnipropetrovsk, Mykolayiv, Kherson, Kirovograd, Kyiv, Odesa, Zaporizhzhya regions and Kyiv City launched a collaborative effort to improve the continuum of HIV services and close the gaps in the HIV service cascade against the 90-90-90 targets.

Collaborative Framework
  • Memoranda of Understanding between regional health authorities, AIDS Centers, UCDC and RESPOND.
  • Eight QI charters (roadmaps) reviewed by regional HIV/TB Coordination councils and approved by regional health departments.
  • Change packages based on 42 changes, from six to 27 changes per region.
  • Executive orders of regional health departments approving the structure of the collaborative and local HIV service protocols outlining improved patient flows.

Collaborative Scope
  • 144 QI coaches (ART site physicians) trained by RESPOND managing the implementation of QI changes at 117 ART sites.
  • 117 local QI teams, which include TB, narcology, STI and OB/GYN specialists, primary healthcare physicians, nurses and NGO social workers jointly implementing the QI changes.
  • Eight regional implementation groups comprised of the regional coordinator, QI mentors and data quality mentors providing technical support to QI coaches and local teams.

Collaborative Activities
  • Regular bi-weekly or monthly meetings of local QI teams to review progress, analyze data and discuss challenges to the changes.
  • Three rounds of regional community of practice meetings (QI learning sessions) in March-April, June-July and November-December to share experience, learnings, best practices, and to revise the change packages.
  • Two cross-regional QI meetings in April and September for exchange of experience and dissemination of the most successful changes across eight focus regions.
  • Improving data collection, analysis and use for decision-making through the implementation of the Simplified Treatment Management Application (STMA) in six regions (except Odesa and Kyiv City, which pilot the electronic Medical Information System, MIS); procurement of 129 desk-top computers; and training of QI coaches on basic computer skills and STMA use. Patient data entered into STMA will be transferred into MIS thus facilitating its roll-out in the remaining six regions.
  • Training local QI team members on HIV testing services utilizing two rapid tests, ART basics, management of HIV/TB co-infection, case conferencing and facilitation skills through 737 person-courses.
  • Leadership skills training for 43 chief physicians of facilities to facilitate their support of the changes and quality improvement activities.
  • Over 550 regular (at least quarterly) mentoring visits to QI sites by QI mentors to support local teams in implementing their changes.
  • Provision of QI sites with computers and office equipment, furniture, reporting forms and information for patient education.
For more information on the structure, scope and activities of the QI collaborative, see QI collaborative overview.

Collaborative Improvements

Over 12 months, RESPOND and its partners piloted, evaluated and scaled-up successful changes to close the three main gaps in the cascade of HIV services towards the 90-90-90 targets: the HIV testing gap, the linkage to care gap, and the treatment gap.
Closing the HIV Testing Gap
  • Six regions implemented screening for behavioral HIV risks and clinical indications for HIV testing by primary healthcare and/or specialty providers (in Zaporizhzhya, this change was implemented earlier). RESPOND developed and disseminated job aids for physicians.
  • Seven regions implemented provider-initiated HIV testing with two rapid tests provided by AHF or ELISA testing by primary healthcare or specialty providers (TB, STI, narcology, GYN, and others).
  • Over nine months, provider-initiated HIV testing services by primary healthcare or specialty providers reduced the number of HIV tests at ART sites by 16%.
  • Improved screening for risk behaviors and clinical indications for HIV testing improved the HIV detection rate at QI sites from the median 4.0% in 2015 to 6.5% in July-September 2016.
  • Over nine months of 2016, QI sites identified 15% more PLHIV, compared to the same period of 2015.
  • See an example of successful changes from Kyiv Region.

Closing the Linkage to Care Gap
  • For patients who screen positive for HIV, six regions implemented the required lab testing (confirmatory ELISA, CD4, blood chemistry) and chest X-ray over one patient visit (see example from Kherson Region).
  • Six regions extended the operation hours of ART/Trust Offices from a few hours to the full working day, and improved logistics between ART sites and laboratories (see example from Zaporizhzhya Region).
  • Five regions implemented in-patient HIV testing and registration of PLHIV with AIDS services before their discharge from the hospital (see example from Dnipropetrovsk Region).
  • To return into care patients lost to follow-up, six regions implemented mobile phone calls and text reminders from healthcare providers or NGO social workers (see example from Mykolayiv Region). To allow for active outreach to PLHIV, three regions modified the standardized text of informed consent at HIV testing.
  • As a result, over nine months 84% of patients screening positive for HIV at QI sites were registered with AIDS services. This achievement was impeded by the shortage of confirmatory ELISA tests across RESPOND regions in 2016.
     
Closing the Treatment Gap
  • At the regional QI community of practice meetings (learning sessions) in the summer, QI partners set targets for every QI site to put new people and support them on ART in accordance with treatment goals of the national budget, Global Fund and PEPFAR.
  • Six regions planned to increase the network of ART sites as part of their QI efforts. As a result, 23 new ART sites were opened and QI coaches trained by RESPOND in six regions (see example from Kyiv City).
  • Five regions decentralized ART initiation and management from regional AIDS centers to local ART sites. RESPOND supported training of ART site physicians on ART management and developed materials for patients (see example from Odesa Region).
  • As a result, over nine months RESPOND QI sites initiated 8,138 patients on ART, which is 72% more than over the same period of 2015. This achievement was facilitated by the updated national treatment protocol adopted in December 2015, and the arrival or ART drugs funded by PEPFAR.
 

NGOs in the Collaborative

  • Local QI teams include staff of NGOs funded by RESPOND, PLHIV Network, Public Health Alliance or other donors, where present.
  • Over nine months of 2016, nine NGOs implementing the Partner Health intervention, provided HIV testing services to 3,101 sexual partners of PLHIV testing 354 (11.4%) HIV positive and linking 279 of them to care. Of 2,808 sexual partners of PWID, 211 (7.5%) tested HIV positive, and 68 were linked to care.
  • The Gay Alliance implementing the reach, test and link intervention for MSM in Kyiv and Odesa cities, of 1,160 tested identified 53 (4.6%) HIV positive, of whom 45 were linked to care.
  • To improve the continuum of HIV services at 36 ART sites where no NGO was available, RESPOND developed an intervention and awarded nine grants to provide HIV testing services and linkage to care for sexual partners of PLHIV, return to care PLHIV lost to follow-up, and support adherence in patients on ART.
 
 

Capacity development


In 2016, to ensure sustainability of HIV services provided by NGOs, RESPOND supported eight local organizations in developing social enterprises.
  • Activities to develop NGO social entrepreneurship included: two direct 5-day business model validation workshops, 5-day mini-MBA program focusing on issues of risk management, financial performance, HR management, business strategy and business processes), two community of practice meetings, a study tour to the US, and mentoring support.
  • As a result, four NGO social enterprises are up and running:
    • Furniture production by From Heart to Heart, Cherkasy;
    • Conference support center "Comfort" by Penitentiary Initiative, Mykolayiv;
    • Family club "Doloni" (early child development services, parents support groups and psychological counseling) by the Kryvyi Rig City branch of the PLHIV Network, and
    • Handmade soap production by the Kyiv City branch of the PLHIV Network.
  • Two more enterprises on cleaning services and agro business by the Cherkasy and Lviv regional branches of the PLHIV Network are in the preparatory phase.
  • The Dnipro branch of the PLHIV Network is testing internet sales of its hand-made pottery. Vse Mozhlyvo from Melitopol is at the stage of developing a business plan for a medical waste utilization enterprise.
 
 

RESPOND:

  • Quality of Services
  • Network and Organizational Strengthening
  • Data for Decision Making
The USAID RESPOND Project funded under the U.S. President's Emergency Plan for AIDS Relief is aimed at reducing the HIV transmission among key populations in Ukraine. The project is implemented by Pact, Inc. in partnership with FHI 360.
This publication is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents do not necessarily reflect the views of USAID or the United States Government.
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