PMTCT: Improving postnatal follow-up systems for mother-infant-pairs in the Tshwane District

Transcription

1 PMTCT: Improving postnatal follow-up systems for mother-infant-pairs in the Tshwane District UTE FEUCHT TSHWANE DISTRICT HEALTH SERVICES & UNIVERSITY OF PRETORIA 13 JUNE 2017

2 Tshwane District: Working smarter, not harder

3 PMTCT cascade HIV-exposed but uninfected child Antenatal care Delivery Clinical care, including HIV tests ART Clinical care, including HIV test Maternal ART Infant birth PCR test Infant ART prophylaxis Clinical care, including Repeated HIV tests Growth Maternal HIV care HIV-infected child Clinical care, including Confirmatory HIV test Urgent ART Growth Maternal HIV care Long road Mom & baby Various health facilities

4 Who are the HIV-exposed babies?

5 EID in weeks of life (Tshwane District July 2016) Age in Weeks # HIV PCR Tests Weeks of Life Negative Positive Indeterminate Other 5

6 Tshwane District: Paediatric HIV case surveillance WBOT & Family Medicine MCWH & HAST NHLS Health facilities (Test, trace, treat) DCST District support partner FPD Data systems M&E

7 Closing the loop: Weekly HIV PCR results from laboratory Facility Ward Folder No Patient Surname Patient Name Patient DOB Patient Address Patient Tel No Patient Age Taken Date Reviewed Episode No Date Unique HIV RTHB No Patient ID Atteridgeville Clinic Ward Not Stated Mathama Molebogeng 07-NOV months 13 days 20-AUG AUG-2016 MG Positive Bronkhorstspruit Hospital Unknown UNKNOWN Chauke Suzan b/t 21-AUG day 21-AUG AUG-2016 MG Positive Dr George Mukhari Hospital Paediatric Opd GT Modau Thapelo 03-SEP months 13 days 16-AUG AUG-2016 MA Positive Dr George Mukhari Hospital Ward 30 GT Suthu Khensani 17-AUG day 18-AUG AUG-2016 MA RTHB2136FBCD Positive Dr George Mukhari Hospital Ward 22a High Care GN Mogashoa Thato 21-OCT months 28 days 18-AUG AUG-2016 MA Positive Dr George Mukhari Hospital Paediatric Opd GP Boikanyo Bokang 10-JUL month 13 days 23-AUG AUG-2016 MA Positive Dr George Mukhari Hospital Paediatric Opd GT Shoniwa Sesi 13-AUG days 23-AUG AUG-2016 MA Positive Gazankulu Clinic Arv Clinic 6390 Lebea Keitumetse 14-MAY months 8 days 22-AUG AUG-2016 MG Positive Jubilee Hospital Ward Mahlare Letlhogonolo 25-MAR year 4 months 24 days 18-AUG AUG-2016 RC Positive Kalafong Hospital Ward Skhosana Nhlanhla 21-AUG day 21-AUG AUG-2016 RH Positive Kgabo Health Centre Clinic Not Applicable Madikizela Pearl 19-MAY months 28 days 16-AUG AUG-2016 RG RTHB3796EBCD Positive Kgabo Health Centre Clinic Not Applicable Vilakazi Bathabile 22-AUG days 20-AUG AUG-2016 RG RTHB6823CBCD Positive Laudium Community Health Arv Clinic UNKNOWN Baby to myo Bridget 17-AUG day 17-AUG AUG-2016 MG RTHB4465CBCD Positive Centr Lotus Gardens Clinic Arv Clinic Selemane Rorisang 21-JAN months 28 days 18-AUG AUG-2016 MG Positive Mamelodi Hospital Post-natal Ward 7 GT Segogela B/t ennie 18-AUG day 18-AUG AUG-2016 RE RTHB9597BBCD Positive Mamelodi Hospital Neonatal Ward GT Boseka Katlego 19-JUL month 6 days 25-AUG AUG-2016 RE Positive Mamelodi West Clinic Ward Not Stated Malebana Omphile 12-DEC SECTION K MAMELODI WEST 8 months 11 days 23-AUG AUG-2016 MG Positive GPZA 0101 Maria Rantho Clinic Arv Clinic Masalesa Koketso 03-AUG BLOCK L SOSHANGUVE 1 year 16 days 19-AUG AUG-2016 MA Positive Pretorius Park Clinic Arv Clinic Boseka Katlego 19-JUL days 18-AUG AUG-2016 MG Positive Pretorius Park Clinic Arv Clinic Boseka Katlego 19-JUL PLASTIC VIEW month 5 days 24-AUG AUG-2016 MG RTHB0607EBCD Positive Soshanguve Clinic 3 Arv Clinic 1080 BLOCK FF Seema Bokamoso 12-OCT BLOCK FF SOSHA PCR Result 10 months 4 days 16-AUG AUG-2016 MA Positive Stanza Ii Clinic Ward Not Stated Ndou Pfumulani 12-JUL month 11 days 23-AUG AUG-2016 MG RTHB0689DBCD Positive Dr George Mukhari Hospital Ward 23 GT Maretela Naledi 01-JAN-1800 Unknown 18-AUG AUG-2016 MA Indeterminate Dr George Mukhari Hospital Ward 23 GT Maretela Naledi 30-MAY months 24 days 23-AUG AUG-2016 MA Indeterminate Eersterus Clinic [hammanskraal] Not Applicable 3693 Masango Betty 23-AUG years 11 months 30 days 22-AUG AUG-2016 MA Indeterminate Jubilee Hospital Labour Ward Mhlaola Tebogo 21-AUG day 21-AUG AUG-2016 RC Indeterminate Suurman Clinic Not Applicable Ramolobeng Tumisang 14-JUL year 1 month 2 days 16-AUG AUG-2016 RC Indeterminate

8 Minimizing missed opportunities in access to care Tracing: How to find the infected babies? Linking to WBOT NB: Babies from difficult psycho-social backgrounds Retention in care: Counselling If mothers understand the process they are more compliant with follow-up Issues: Language, finances, travelling, support, fear Linking of data systems

9 Tshwane District: The unique RTHB identifier

10 The RTHB is a constant factor and now it has a unique number in order to identify and trace children!

11 NHLS lab request form with RTHB identifier placed on top right-hand side

12 Reducing stigma Even if page 7 of RTHB is missing, the child s HIV PCR results can still be obtained using the RTHB Unique Identifier Other advantages: No IT infrastructure needed at time of issuing of the unique RTHB Nr Linkage to other health system identifiers can be done at any stage

13 Fast-tracking HIV+ babies into care Finding mother-infant pair Investigate gaps in PMTCT cascade Confirmatory HIV DNA PCR Refer infant for neonatal ART Ensure child is in follow-up

14 PMTCT cascade HIV-exposed but uninfected child Antenatal care Delivery Clinical care, including HIV tests ART Clinical care, including HIV test Maternal ART Infant ART prophylaxis Clinical care, including Repeated HIV tests Growth Maternal HIV care HIV-infected child Clinical care, including Confirmatory HIV test Urgent ART Growth Maternal HIV care Continuum of care is absolute crucial!

15 Use of data to optimize patient follow-up Weekly name based reports based on NHLS report: Positive PCR: Repeat PCR testing & ART initiation Indeterminate PCR / No result PCR: Tracing for repeat PCR testing Negative PCR: Ensure follow-up testing as per protocol If electronic birth register: Weekly report on all HIV infected moms who gave birth, highlighting HIV-exposed babies without birth PCR Cohort monitoring But how do we do this??

16 Tshwane: 1 March 2017 What happened??? Induced traffic jam!! It is all about (up-to-date) information! You WANT to use Google maps! You WANT to LEARN to use Google maps!

17 VL monitoring VL monitoring HIV positive Woman HIV positive Mother HIV exposed Infant HIV Diagnosis ART initiation VL monitoring HIV Diagnosis ART initiation VL monitoring Birth PCR Routine Monitoring 10w PCR +/-18w PCR Routine Monitoring Symptomatic testing 6 weeks post breastfeeding Routine Monitoring 18m rapid/ ELISA Routine Monitoring Positive HIV-test: Confirmatory PCR ART initiation

18 PMTCT cohort monitoring Interoperability of data systems VL monitoring Linking of mother and baby VL monitoring HIV positive Woman Detectable VL HIV positive Mother Birth HIV exposed Infant! Also trigger action for baby! HIV Diagnosis ART initiation VL monitoring HIV Diagnosis ART initiation VL monitoring Birth PCR Confirmatory Routine PCR AR Monitoring initiation 10w PCR +/-18w PCR Routine Monitoring Symptomatic testing 6 weeks post breastfeeding Routine Monitoring 18m rapid/ ELISA Routine Monitoring Individualized patient care Consolidated reports M&E Positive HIV-test: Confirmatory PCR ART initiation

19 Working smarter, not harder Thank you!

20 Linking of data systems: PMTCT cohort monitoring ANC E-Health record Clinical care, including HIV tests ART DHIS Health Information Exchange Norms & Standards Patient-centered M&E from capturing of clinical activities WBOTs WBOT db Register baby at birth Labour ward Link mom & baby Electronic birth register Clinical care (mother & baby), including HIV tests ART Patient registration (HPRS) Electronic Health record ID Nr Laboratory HIV results TB programme & ETR Clinic visits E-Health record Outcome data HIV programme Tier.net Clinical care, including HIV tests (repeated) Immunizations Growth Hospitals Maternal mortalities, PPIP, Child PIP Clinical care, including ART care HIV tests (repeated; also negative) MCWH module (including pregnancies and maternal VL)