QI Collaborative Change Package

Gap

Change

1.1. HIV risk assessment by specialists and/or PHC providers

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1.2. HIV testing with two rapid tests or ELISA by specialists and/or PHC providers

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1.3. Making HTS info materials available for physicians and patients

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1.4. Implement a patient tracking system (vouchers, coupons or invitations)

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1.5. Escorting patients by medical or social workers

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1.6. HTS for sexual partners of PLHIV

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1.7. Assessment of behavioral risks and clinical indicators, and HTS for in-patients within the first day of hospitalization

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1.8. Double coding at the time of HTS to ensure identification of PWID

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1.9. Redistribution of the HTS duties among doctors and medical nurses

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1.10. Change in the text of the informed consent to HTS

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1.11. Provider initiated HST

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2.1. Providing the required lab tests (2 rapid tests+ELISA, CD4 and biochemical screening) over one patient visit to the Trust Office/ART site

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2.2. Extend/adapt the working hours of Trust Offices/ART sites

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2.3. More frequent transporting of biomater

ial to the lab

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2.4. Returning lab results (CD4, viral load) to ART sites through Internet

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2.5. Lab tests based in local blood transfusion center

2.6. Text messages, phone calls or letters to patients

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2.7. Active home visits by medical and social service providers

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2.8. Engage specialists and family doctors into care for PLHIV

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2.9. Registering with AIDS service the HIV-positive in-patients before they are discharged from the hospital

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3.1. Initiation and management of ART at ART site

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3.2. Transfer patients on ART from AIDS Centers to local ART sites

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3.3. Identification and treatment of PLHIV in discordant couples, par.1.8.

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3.4. ARV drugs stock management at ART site

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3.5. Dispensing of ART for six months

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3.6. Follow-up visits once in 12 months

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3.7. ART by PHC physician

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4.1. Implement electronic database for the patient and individual-level PLHIV service tracking

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4.2. Develop and implement regional and local referral protocols/patient pathways

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4.3. Increase the number of Trust Offices/ART sites

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4.4. Train physicians and nurses on HTS

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4.5. Train physicians on ART

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4.6. Train physicians on management of HIV/TB co-infection

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4.7. HIV rapid tests purchasing by a local/district budget

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4.8. At least monthly meetings of local QI teams

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4.9 Cooperation with NGOs (case management by social workers) for linkage and enrollment in care of PLHIV from key populations

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4.10. Introducing a position of social worker at health care facility/ART site

4.11 Implementation of the “Trust” hotline in a region.

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