A STUDY ON LINKAGES BETWEEN INTERVENTIONS AND IMPROVEMENTS OF HIV AND AIDS SERVICES IN MAFIA Dr. Credianus Mgimba (DMO Mafia) Dr. Naomi K Manzi (CTC I/C Mafia District Hospital) Abushiri Ally (DACC Mafia) Grace Lyakwipa (DNO Mafia) Omary J Kambangwa (DHS Mafia)

Background Mafia CHMT has been conducting: Supportive supervision Mentoring Follow-up actions following resolutions of weekly, monthly and quarterly CHMT meetings, multidisciplinary team (MDT) meetings, coordinating meetings with health facility in-charges. Improvements have been observed in some of the quality indicators of HIV/AIDS services. Effectiveness of these activities is often explained through empirical or sometimes anecdotal stories without confirming linkages between such activities and the improvements based on records of available documents.

Objective To find out with evidence whether there are linkages between activities and improvements.

Methods Available documents were reviewed retrospectively: Supportive supervision reports, Mentoring reports, CHMT and MDT meeting minutes, HMIS and CTC databases, and CTC Client Files

Results Cohort CD4 at 6 months at Mafia District Hospital (CTC Database) Improved from 17% in Jul-Sep 2012 to 80% in Apr-Jun 2013. Mentoring was conducted in 5th, 6th and 26th September 2012, following a resolution of MDT meeting of 28 Aug 2012.

Results Cont…. % partners tested at ANC among all pregnant women who tested for HIV at ANC at Mafia District Hospital Improved from 14% in Apr-Jun 2012 to 81 % in Jan-Mar 2013 (Mafia District HMIS Database). The figure went down in Apr-Jun 2012 due to some misunderstanding between the HCWs and the community people regarding male participation. Discussion with the community leaders was held in Jul-Sep 2012. Mentoring also was conducted in September 2012, following a resolution of MDT meeting of 28 Aug 2012.

Results Cont…. % HIV+ pregnant women assessed for ART eligibility using CD4 at ANC among new enrolees at ANC not yet initiated on ART at Mafia District Hospital (CTC & HMIS data base) Improved from 0% in Jan-Mar 2012 to 100% Oct-Dec 2013. Mentoring was conducted on 5th, 6th and 26th September 2012 , following a resolution of MDT meeting of 28 Aug 2012.

Results Cont…. Incomplete filling of TB Screening tool at Chemchem Dispensary (CTC Client Files) Decreased from 27% in Jun 2012 to 5% in Dec 2012. Mentoring was conducted on 6th with follow ups on 20th of September and 7th October 2012, following supportive supervision of 26 Aug 2012.

Discussion, Conclusion and Recommendation The results of documents review show linkages between the activities such as MDT meeting, mentoring and supportive supervision and their outcomes. Only one consecutive relation (supportive supervision -> mentoring -> improvement) was confirmed with one indicator, i.e., reduction of improper filling of TB screening tool for HIV+ clients. Mentoring was introduced in 2010 and has been supported by an IP. Systematic linkage between supervision and mentoring was created after the training on comprehensive supportive supervision and mentoring by the NACP/JICA Project. Mentorship could be one of the effective interventions to solve technical problems in a specific service as shown in this study and shall be incorporated in our district plan.

Discussion, Conclusion and Recommendation Mafia district has incorporated HIV/AIDS into our general supportive supervision and has conducted and documented the activity regularly in accordance with the national manual and tools However, HIV/AIDS services were not always covered and some of the reports submitted were shallow in contents. The weak documentation made us difficult to establish linkages between the interventions and the improvement. We need to be more conscience on the process of QI (identification, analysis, development and implementation of PDSA) and the documentation of each of the steps.

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