2. Improving HIV care and support service performance in Côte d’Ivoire M. N’goran 1 ; S. Ramachadran 2 ; J. Essombo 1 et al M. N’goran 1 ; S. Ramachadran 2 ; J. Essombo 1 et al

3. Background: EGPAF in Côte D’Ivoire The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) began supporting CDI’s Ministry of Health (MOH) in 2004 to expand HIV prevention, care, support and treatment activities through CDC/PEPFAR funding Since October 2011, EGPAF has been implementing clinically-focused Project Djidja in 4 health regions and 16 health districts Djidja strives to strengthen the Ivorian health systems by training health care workers in the provision of high quality HIV prevention, care and treatment services 3 3

4. Issue Project Djidja observed low performance in care and support indicators from October 2011 to September 2013 In September 2013: Percentage of HIV-positive patients receiving cotrimoxazole prophylaxis was 41% Percentage of HIV-positive patients who were nutritionally assessed was 48% Percentage of HIV-positive patients screened for TB was 46% 4 4

5. Objectives To improve care and support service performances, EGPAF aimed to: Increase the percentage of HIV patients receiving cotrimoxazole prophylaxis from 41% to 75% by September 2015 Increase the percentage of HIV-positive patients who were nutritionally assessed from 48% to 90% by September 2015 Increase the percentage of HIV patients screened for TB from 46% to 90% by September 2015 5 5

6. Strategy EGPAF implemented a quality improvement strategy called CAR, consisting of three phases: C onstat (Observation) A ction R esults CAR started in January 2014 in 76 care and treatment sites supported by Djidja CAR was implemented by EGPAF program officers at site-level in collaboration with data managers, community counselors and health care providers 6 6

7. Phase 1: Constat (Observation) Weekly review of all data collection tools (registers, records) used by care providers. Assess care services provided to HIV patients during their last visit (over the past week). Identify if the clients who have missed any needed care and support services. 7 7

8. Phase 2: Actions We aim to identify reasons why patients miss services and immediately take corrective measures. Key actions included: Interview care providers to understand why they did not provide the specific service, then respond to their need (e.g., increasing provider knowledge about specific health areas) Make phone calls to patients to bring them back to clinics to receive needed care Update the database with correct patient data based on new contact information. Respond to specific issues raised from gaps observed (e.g., provision of drugs) 8 8

9. Phase 3: Results EGPAF program officers weekly and monthly monitor care and support indicators to measure the effects of corrective actions. 9 9

10. HIV-positive patients receiving Cotrimoxazole prophylaxis 10

11. HIV-positive patients vin care who received nutritional assesment 11

12. HIV-positive patients in care who were screened for Tuberculosis 12

13. Conclusion Implementation of the CAR strategy has enabled EGPAF- Côte d’Ivoire to improve the quality of care and support services provided to HIV patients. Strengthened technical assistance for care providers is needed to ensure ownership and sustainability of the strategy. 13

14. Thanks