The CQUIN Learning Network Annual Meeting

Transcription

1 The CQUIN Learning Network Annual Meeting Kenya s Differentiated Care Scale up plan Dr. Bartilol Kigen NASCOP February Maputo, Mozambique

2 Outline HIV epidemic in Kenya Treatment guidelines and operational guide/toolkit DC scale up plan Mentorship cascade PQE Roll out M&E tools Performance measures Opportunities The CQUIN Learning Network 2

3 HIV epidemic in Kenya Kenya has the 4 th largest epidemic globally Source: Kenya HIV Estimates, 2015 New HIV infections: 46% - Among young people(15 24 years) 30% - Attributed to Key Populations

4 Progress towards (as at December 2017) 1,600,000 1,400,000 1,200,000 Number of PLHIV 1,000, , , ,000 1,517,707 76% 85% 322, ,803 1,043,269 1,040,540 79% 232, , ,000 - Total PLHIV(2015 Estimates) Care On ART Virally suppressed Achieved Gap Source: DHIS2

5 1,200,000 1,000, ,000 Trends in ART Scale-up in Kenya (Period under Review: 2003 to April 2017) CD4<350 D4T Phase out All children start ART CD4<500 EFV/TDF/3TC STR Preferred VL scale up; HIVDR/Salvage 755,225 Test and start DC 872,938 Patient centered care DTG phase in 1,052,000 1,018,905 # of ART Patients 600,000 CD4<250 TDF for toxicity Management EID 440, , , , ,000 Where are the children? 244, , , , , ,764-10, , Patients on ART As at April 2017

6 Outline HIV epidemic in Kenya Treatment guidelines and toolkit DC scale up plan Mentorship cascade PQE Roll out M&E tools Performance measures Opportunities The CQUIN Learning Network 6

7 Kenya s DC guidelines & Toolkit HIV TREATMENT GUIDELINES Key guideline highlights include: test and start, differentiated care and PrEP Mentorship cascade DIFFERENTIATED CARE HANDBOOK Collection of practices on DSD approaches across the cascade of care Relies on using existing infrastructure and resources DIFFERENTIATED CARE TOOLKIT Provides stepby-step guidance on DSD Includes tools and job aids

8 Models of ART Delivery for Stable Patients in Kenya Facility-based Fast Track System for ART Refills Community ART Groups for ART Refills Peer-led Community ART Groups Healthcare Worker-led Community ART Groups Facility ART groups Peer led Facility ART groups Healthcare worker led facility ART groups Community ART Distribution Points

9 Outline HIV epidemic in Kenya Treatment guidelines and toolkit DC scale up plan Mentorship cascade PQE Roll out M&E tools Performance measures Opportunities The CQUIN Learning Network 9

10 DC roll out plan Narrative Timelines Comments Launch of HIV treatment guidelines which incorporated DC July 2016 Implementation ongoing Launch of DC handbook collection of best practices in cascade of care July 2016 Implementation ongoing Development of DC operational guide Jan 2017 Implementation underway Training of health care workers using mentorship cascade model DC demonstration projects in 2 counties (Siaya and Kisumu) QI approach to DC implementation in 7 counties Revision and national roll out of M&E tools to capture DC data elements May-December 2017 Completed 2017 Ongoing June 2017 November 2018 Implementation is ongoing Completed Reporting of DC data through national M&E systems Performance measurement and progress review From April 2018 Quarterly Implementation is ongoing Done during care and treatment TWGs The CQUIN Learning 10

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12 PQE Implementation Science: Collaborative Improvement QI approach has been adopted in DC implementation in 7 counties to showcase program quality efficiency; costing studies are planned Participants Select Topic Prework Planning Group Identify Change Concepts LS 1 A P S D LS 2 A P S D LS 3 Supports 2002 Institute for Healthcare Improvement Phone Visits Assessments Senior Leader Reports

13 PQE Implementation Science: Collaborative Improvement QI approach has been adopted in DC implementation in 7 counties to showcase program quality efficiency; costing studies are planned Launch of start up activities PQE start up activities Jun 25 National Secretariat Meetingtechnical launch of PQE Jul 13 County Representative Meeting (all 7 counties): Selection of Sub-counties, Sites Sep 8 PQE baseline 1b: County and Sub-county Preparedness Coach Recruitment and Training Learning Session 1: Sites learn QI, create plan to collect sitelevel baseline indicator and process data (part 2) PQE baseline part 1a: County data to finalize county selection Jul Jun Jul Aug Sep Oct Nov Dec Jan Action Period 1: Sites collect baseline indicator and process data; coaches mentor Dec 15 PQE Baseline Part 3: Patient preferen ces and satisfact ion Jan

14 Outline HIV epidemic in Kenya Treatment guidelines and toolkit DC scale up plan Mentorship cascade PQE Roll out M&E tools Performance measures Opportunities The CQUIN Learning Network 14

15 Monitoring and Evaluation Patient Categorization tool 15

16 Clinical encounter tools The CQUIN Learning 16

17 The CQUIN Learning 17

18 Monitoring and Evaluation ART Distribution Form and Review Checklist 18

19 Monitoring and Evaluation ART Distribution Form and Review Checklist 19

20 Kenya s DC Performance Measures Treatment outcomes: What are the treatment outcomes of patients on DC models? How will DC affect treatment outcomes in different population categories: General population Adolescent and young people Quality: Will differentiated care improve the quality of care at facilities? Client satisfaction survey Cost benefit analysis: Will implementation of DC lead to cost savings in HIV care programming and to the patient? 20

21 Opportunities Ongoing mentorship to health care workers to support DC implementation National DC program data from April 2018 Incorporate DC data elements Best Practices forum for DC implementation for all counties scheduled in March 2018 Printing of DC Toolkit and IEC Materials in Feb

22 ASANTENI SANA 22