1. Using Continuous Quality Improvement approaches to identify facility-based innovations to increase retention of TB/HIV co-infected patients on treatment in Uganda Authors: K. Mutesasira, D. Murdoch, N. Tumwesigye, A. Muhwezi, A. Musisi, M. Irige, H.Mutabarura, E. Alunguru, S. Muchuro Presenter: Kenneth Mutesasira 3 July 2013

2. Methods Trained providers in basic TB/HIV co-management and application of continuous quality improvement (QI) approaches Supported TB process improvement team formation and application of QI methods using onsite QI coaching and clinical mentorship approaches Quality Improvement Model Objective: To improve TB treatment completion towards the National target of 85% CQI training & team formation Quarterly mentorship & QI coaching Orientation on indicator definitions and reporting tools Integrated clinical mentoring and QI coaching

3.  TB care providers measure and track performance  Regular team review and updating of patient records  Capturing of patient phone numbers to enable patient tracking  Initiation of regular cohort reviews to identify and track missing patients using telephone calls and in collaboration with the district TB supervisor  Implementation of family- supported DOT  Patient referral to treatment facilities closer to home Implemented change package and results CQI training & team formation Quarterly mentorship & QI coaching Orientation on indicator definitions and reporting tools Integrated clinical mentoring and QI coaching

4. Lessons and Implications Improvements in retention of TB/HIV patients on treatment can be achieved through simple, routine facility-based interventions identified and implemented using QI approaches Provider involvement in performance measurement enhances ownership and motivation for implementation of improvement changes Integrating clinical mentorship and QI coaching facilitates rapid improvements More work remains to uphold the improvements gained from application of QI approaches