VL-EID-TB Performance TASO Soroti Region VL-EID-TB Performance Dr Ninsiima Muhairwe Francis Ocen

TASO Presentation outline VL coverage by district Trends of VL coverage VL suppression & Rejection rates VL QI projects running by district, tested changes and outcomes Next steps EID Cascade TB/HIV management

TASO District Health Centre VL Supression Rate Health centre VL Suppresion Rate Amuria Ongutoi HC III 100 St. Michael Wera HC III 62.5 Bukedea Kachumbala HC III 90.8 Malera HC III 73.3 Kaberamaido Kakure HC II Kaberamaido Catholic Mission HC III 72.7 Katakwi Katakwi Akoboi HC II GOVT Aketa HC III 70.3 St. Kevin Toroma HC III Kumi Kamaca HC III 80 Akide HC II Ngora Kobwin HC III 61.9 Ongino HC III Serere Kyere mission HC III 50 Ngora District Maternity HC III 92.3 Soroti Eastern Div. HC III 71.4 St. Martins Amakio HC III   Ojom HC II

TASO

TASO Strategies Next steps Activation of VL teams Re-organization of VL teams. Monthly data review – dash board Targeted CMEs. IAC forms, Non-Suppression register Counselors – HV sites Weekly tracking of rejection, causes Non-Supression clinics Next steps Stake holders meeting Increased involvement of DHT Targeted psychosocial support Uphold the current strategies

TASO Running Viral load QI Projects Created a non- suppressed clinic Creation of a viral load committee

TASO EID Cascade April to June 2018 HIV+WO MEN TESTED 1ST PCR   HIV+WO MEN TESTED 1ST PCR EID COVERA GE(1ST PCR <12 MONTHS) # OF HEI TESTED <2 MONTHS OF BIRTH(1S T PCR) PROPORT ION FOR 1ST PCR(<2M ONTHS) # OF HEI GIVEN CPT TOTAL # OF HEI GIVEN CPT <2 MONTHS OF BIRTH %AGE CPT UPTAKE TESTED POSITIVE AT 1ST PCR %AGE HEI TESTED HIV+ LINKED TO CARE Amuria 111 94 85% 50 53% 59 49 63% 1 1.10% Bukedea 42 119% 18 36% 19 16 38% 2.00% Kaberamaido 92 91 99% 54 59% 52 57% 4 4.40% 3 Katakwi 87 89 102% 38 43% 44 35 49% 0.00% Kumi 53 77 145% 25 32% 39 51% 2 2.60% Ngora 27 93% 14 56% 8 6 Serere 70 91% 29 41% 30 2.90% Soroti 150 128 47 37% 67 31 52% 3.10% IM 639 624 98% 275 44% 318 239 2.20% 13

TASO Final outcomes for 24 Months cohort April- June 2018 District HEI IN BIRTH COHORT DISCHARGED NEGATIVE POSITIVE LINKED TO ART DIED TRANSFER OUT LTFU Amuria 99 80 5 1 8 Bukedea 32 25 3 Kaberamaido 90 73 2 10 4 Katakwi 69 57 Kumi 54 45 Ngora 17 14   Serere 58 42 9 Soroti 102 83 6 TOTAL 521 419 (80.4%) 16 13 38 35

TASO Interventions employed to improve EID Functionalizing Testing Point at ANC/MCH Notification for results that are not received within 3weeks. Structuring of mothers next appoint to expected EID return date. Developed data base that captures the HEI date of birth and expected dates for EID testing. Integrated EID into EPI outreach static and outreach. Used reminder stickers for 1st, 2nd and 3rd PCR Improving outcomes for 24 months cohorts Intensified referral and tracking of LTFU-MBPs Integrated of EID into EPI outreach/ static Assigned mentors to specific facilities to follow-up MBPs. Scaled up use of reminder stickers for 1st, 2nd and 3rd PCR and 18 months rapid test. Monthly reviews of retention and birth cohorts for MBPs.

TASO HTS- TB Clinic Jan- Mar 2018 Apr-Jun 2018 District HTS_TST   Jan- Mar 2018 Apr-Jun 2018 District HTS_TST HTS_POS Yield Amuria 277 3 1.08% 100 10 10.00% Bukedea NA 86 5 5.81% Kaberamaido 27 1 3.70% 265 2 0.75% Katakwi 53 0.00% 248 8 3.23% Kumi 25.00% Ngora 297 22 7.41% 402 6 1.49% Serere 7 111 4 3.60% Soroti 131 1.53% 76 1.32% 800 30 3.75% 1288 36 2.80%

TASO TB SCREENING IN ART Jan- Mar 2018 Apr-Jun 2018 District TX-CURR   Jan- Mar 2018 Apr-Jun 2018 District TX-CURR TX_TB % TX_TB TB_ART % TB_ART Amuria 5282 100.0% 40 0.76% 5480 5447 99.4% 34 0.62% Bukedea 2237 2222 99.3% 5 0.22% 2322 2303 99.2% 7 0.30% Kaberamaido 5641 5508 97.6% 18 0.32% 5721 5734 100.2% 47 0.82% Katakwi 5054 4850 96.0% 28 0.55% 5174 5045 97.5% 25 0.48% Kumi 4356 4339 99.6% 23 0.53% 4430 4423 99.8% 0.63% Ngora 2405 2398 99.7% 14 0.58% 2491 2489 99.9% 0.20% Serere 3712 3603 97.1% 20 0.54% 3849 3775 98.1% 0.36% Soroti 9690 45 0.46% 10274 10021 32 0.31% 38377 37892 98.7% 193 0.50% 39741 39237 192

COP TB_STAT PERFORMANCE ACHIEVEMENT Quarter target achievement of 96% Cumulative 63% annual target achievement of the expected 75% by 3rd QTR Need 794 cases to 100% annual target

TB Case Notification Rate –Soroti Region

GeneXpert Utilization from the seven hubs TASO GeneXpert Utilization from the seven hubs The chart illustrates GeneXpert utilization and this has greatly improved case finding in the region

TB_ART PERFORMANCE

TB PREV Indicator performance April-June 2018 TASO TB PREV Indicator performance April-June 2018   District TB Prev(Expected) TB Prev(Completed) Completion Rate (%) Kaberamaido - Bukedea 47 17 36 Ngora 5 100 Soroti 32 30 94 Amuria 20 25 Serere 149 11 Kumi 64 4 6 Katakwi 1 9 TOTAL 328 79 24 Improvement from 16% in Jan to March 2018 to 24% in April to June 2018 Affected by unreliable stock levels and knowledge gap Site reorientation carried out for 11 sites in May 2018

Facilities are now employing the VHTs in tracking lost TB patients TASO TB Treatment Success all forms Treatment success has been poor because of suboptimal tracking systems at facility level. Facilities are now employing the VHTs in tracking lost TB patients

KEY IMPROVEMENT STRATEGIES Regional TB Collaborative (15 collaborative sites) Improved screening at key entry points Improved evaluation among presumptive cases High index of suspicion (PCDs) Appointment Keeping and active follow up TB Cohort Review during treatment

RUN CHART FOR SELECT INDICATORS-TB COLLABORATIVE

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