1

ONE STOP SERVICE

SAVANNAKHET PROVINCIAL HOSPITALHIV CARE UNIT

PRESENT BY : KHAMPHANG SOURINPHOMY, MD

target

LAOS MAP

SVK

• N. Blood tested : 50.961•• N. HIV test positive N. HIV test positive : : 22..131131• N. AIDS Case : 1.358• N. AIDS dead : 691• N. PHA group : 318

• N. Impact to Child : 139

Overall pictures of HIV Overall pictures of HIV 1993 1993 to to 20142014

1993 - 2013 2014

HIV HIV positive positive by Genderby Gender1993 1993 to to 20142014

55%45%

Male Female

57%43%

Male Female

Blood Tested: 50.961; HIV +: 2.131 Female: 940

0

100

200

300

400

500

600

6937 12 34

260

557

386345

184

10071

Numbers

HIV HIV positive by Age positive by Age 1993 1993 to to 20142014

Blood Tested: 50.961; HIV +: 2.131 Female: 940

93%

5% 2% 0%0%

HeterosexualMTCHomosexualIDUBlood

HIV transmissionHIV transmission1993 1993 to to 20142014

Challenges during the implementation

• From mother-to-child infection remains found

• Late admission of clients (almost come with OIs)

• Limited engagement of family members in providing care

• Insufficient number of human resources at the ARV clinic

Team meeting to discuss on the Late admission of clients

• Service provider - Limited number of medical

doctors/nurses, unable to handle broad services

- Nurses receive new roles (replacement)

- Lack skills of new staff .• Client - Being intolerant to sickness- Facing unsupportive family

(due to inability to disclose themselves)

- Hesitate to come due to familiarity with current service provider

Participatory planning and actions

• Service provider

- Modify roles and responsibilities of nurses so that PL+ could support

- Discuss with nursing technical team on proper replacement process

- Provide on-job training for new nurses who are not familiar with their tasks

• Client

- Propose group activities for new cases to share experiences with peers( meditation)

- Support self-disclosure of clients to trusted family members (shared roles in providing care)

• Extra visit at Doctor’s compound

One stop service activities for HIV/AIDS One stop service activities for HIV/AIDS

Concerted effort:

- Leader of all levels.- Mass organizations and religion organizations .- Health authorities of al levels- Governmental and non governmental organisations- Community, families and PHA

To Improve go long life and lively hood To Improve go long life and lively hood

Involve social and economic developingInvolve social and economic developing

Involve in HIV prevention processingInvolve in HIV prevention processing

II. II. Care and treatmentCare and treatment-OIs prophylaxis and treat-ART management-Adherence care

I. VCT/PICT-Op In and Op out case-Counseling-confidentiality-Blood test

III. Care and III. Care and PreventionsPreventions--Condom use >Condom use >9595%%--PMTCTPMTCT--Standard precautionsStandard precautions

IV. Care and support--Chico’s counselingChico’s counseling--Sisal Economic supportSisal Economic support--Nutrition supportNutrition support--Description and stigmaDescription and stigma

Reception

Adherence counseling

Consultation’s

Medicine Activity

Adherence counselingBefore go home

OPD Activities

CD4, VL,…

Go home

Patients Register

BMIBMI

IPD Activities

Diagnosis and treated .

Patients monitoringLab Activities

Round ward

Case study discuses

13/08/2015 13

Implemented activities: group discussion during the meeting with family members

Meditation

13/08/2015 14

Home visits when the patients have problem .

13/08/2015 15

Adherence Counselingis responsibility of all staff

PLACE TO OPEN DISCUSSION ON DAILY LIFE

Care, Treatment and Support

Activities

SOCIO-ECONOMICPROBLEMS are

discussed

TREATMENT COMPLIANCESARE EXPLORED

HOW TO TAKE DRUGS

THIS IS FOR

PLWAs BETTER LIFE

MEDICAL ISSUES ARE ADDRESED

MEET WITH ADHERENCE COUNSELOR

Follow up of clients in Savannakhetarea .

16

HIV positive access to care1993-2014

17

0

20

40

60

80

100

120

140

160

180

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

HIV+ 6 0 25 30 55 57 72 67 79 60 75 13 16 13 17 13 15 14 14 14 13 13

Acc.to care 0 0 0 0 0 0 0 0 0 0 75 13 16 13 17 13 15 14 14 14 13 13

Cumulative of HIV Patient Registered Since 2003-06/2015

total transferred out death lost of follow up on follow up

2132

434 442347

941

10334 8 15 48

2235

468 450362

989

adualt Child total

Cumulative of HIV Patient Registered on ART Since 2003-06/2015

1666

366242

166

909

7825 2 5 47

1744

391

244171

956

total transferred out death lost of follow up on follow up

adualt Child total

Current ARV regimen 2003-06/2015

0

50

100

150

200

250

300

350

400

450

500

adualt Child total

First line 461 32 493

alternative First line 372 3 375

Second line 76 12 88

CD4 Monitoring

21

0

500

1000

1500

2000

2500 2218

1875

1244

381250

136 13615 104 17

20032003--20142014 20142014

VL Monitoring 2014

N.p.on ART VL test VL Und VL Detact VL>1000

Series1 959 935 881 54 36

0

200

400

600

800

1000

1200

MDR Monitoring MDR Monitoring 2014 2014

78

27

10

13

7

2726

10

0

5

10

15

20

25

30

AZT DDI 3TC/FTC D4T ABC TDF NVP EFV ETV

VL>VL>10001000 copiescopies MDR test MDR test

3636 3636

ນົດນົດ ຮຽຘຮຽຘ ທ ີ່ທ ີ່ ຖອດຖອດ ຖອຘຖອຘ(Lesson learn)(Lesson learn)

• ທ ຳຄຳຘ ເບັຘທ ມ (Team work)

• ມ ກຳຘ ຖອດຖອຘນົດຮຽຘ (lesson learned )

• ມ ເ ີ່ ອີ່ ຳຍບະສຳຘຄຳຘ (Network )

• ປ ູ້ ຮັນນ ລິ ກຳຘ ເບັຘສ ຘກຳຄ (Clients center)

• ທ ຳຄຳຘ ດູ້ ວຍໃ (Work from Heart )

– ທ ມດຽວກັຘ (One team)

– ໃດຽວກັຘ (One Heart )• ກູ້ ຳວໄບ ດູ້ ວຍກັຘເພ ີ່ ອສູ້ ຳຄສັຘຸຘ ຘະ ພຳນ!!

Thanks youThanks youຂ ຂ ຂອນໃຂອນໃ