TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

To

30/6/2014

DATE OF ASSESSMENT

30/7/2014

SITE INFORMATION

Quy Chau OPC, Quy Chau district, Nghe An province

SERVICES PROVIDED

ARV for adults

ARV for children

HTC

MMT

PMTCT

C&S

Out-reach

TB

STI

AREA

City

Rural

Mountainous

OTHERS

Clients in prison

Ethnic group clients

% total clients)
85%

Total clients under management:

HUMAN RESOURCES
Full-time: 7
Part-time: 2
Total: 9

Name

Position

Dung
Giang
Cuc

OPC chief
OPC nurse
OPC
pharmacist
Counselor
Lab
technician

Hoai
Lap

% total clients)
159 (34 Pre-ART/ 125 ART)

Contracted
Part-time
Full time

Gov
Part-time Full-time
X
X
X
X
X
X

Name of USAID/SMART
TA provincial site
monitor
Dr. Nguyen Thanh Ha

Name of OPC chief

Name of PAC
representative

Dr. Nguyen Tien Dung

Ms. Luong Thi Thu

File assessment data

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TA PLAN FORM (v 4.8.14.0)

USAID/SMART TA

TA Assessment
Summary Results

Result

HUMAN RESOURCES

50%

STRUCTURE AND
ACCESS

21%

DRUG SUPPLY

70%

LABORATORY
CAPACITY

60%

DATA MANAGEMENT

60%

CASE MANAGEMENT

0%

ART/Pre-ART
DELIVERY

70%

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USAID/SMART TA
SUMMARY RESULT OF HIVQUAL AND SMART TA INDICATORS
SMART TA
Standard

No Indicator

1
2

4
5
6

8
9
10

Proportion of medical record is more than 80%

of score used the patient chart review tool
Proportion of patients who newly registered at
the OPC in last 6 months are tested for CD4
within 15 days of enrolment
Proportion of pre-ARV patients who visit the
OPC regularly (according the national guideline
every 3 months and per appointment with
doctor)
Proportion of patients who were newly
registered at OPC was prescribed INH
Proportion of ARV patients visiting the OPC for
medication pick-up according to scheduled
appointment in the last visit
Proportion of ARV patients who are assessed
for medication adherence in the last visit
Proportion of patients were initiated ART within
15 days after qualification in last 6 months
Proportion of qualified HIV patients are
prescribed for Cotrimoxazole or DAPSONE for
the last visit
Proportion of patients are screened for TB in
the last medical visit
Proportion of patients are tested CD 4 at least 1
in last 6 months

Proportion of patients who still alive and on

treatment after 12 months on ART (NGI ID)
Proportion of patients retained in care after 12
12 months of registration (SMART TA
recommended ID)
11

Present result

Difference

Score

Pass or fail

30%

30%

Fail

75%

0%

Fail

75%

0%

Fail

80%

0%

Fail

85%

0%

Fail

90%

0%

Fail

65%

0%

Fail

90%

0%

Fail

80%

0%

Fail

85%

0%

Fail

85%

0%

Fail

80%

0%

Fail

80%

Last round result

SMART monitoring score

SMART TA classification

Improving

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TA PLAN FORM (v 4.8.14.0)

USAID/SMART TA

No
A

Issue

th

1.

Supporter

Other
sources

Deadline

Actual
date of
completio
n

Note

HUMAN RESOURCES
From 14 July 2014, Dr. Dung and
Ms. Giang & Hoai have been
contributed full time in charge for
Quy Chau OPC activities.

1.

Solution

Person in
charge

Dr. Dung has been trained on 2

ARV modules. Although the OPC
has just been opened since
September 2013, the treatment
quality has been improved
significantly.

It is necessary to be continued
receiving support from Quy Chau
Hospital to ensure the normal
activities of Quy Chau OPC in not
only HIV Care and Treatment but
also MMT
There should be another part-time
doctor/assistant doctor from Quy
Chau Hospital who has been trained
on ARV as well to support Dr. Dung
in OPC treatment activities,
especially when the total number of
OPC registration is increasing
significantly

Dr. Minh
Director of
Quy Chau OPC
Dr. Dinh
Director of
Nghe An PAC

Dr.
Thanh/TAC
FHI 360

Routinely

STRUCTURE AND ACCESS

TB Infection Control: Medical

mask available but not welldelivered to needed patients (TB
suspected/ coughing patients)

QI PDSA Activity #1
Plan: Implement TB infection control
Do:
- Triage nurse distributes medical
mask for needed patient (TB
suspected/coughing patients)
- Counselor provides counseling
session for the TB
suspected/coughing patients to
understand the importance of
medical mask wearing.
See: After 1 month, the OPC counts
how many medical masks have been
distributed and if they are provided
appropriately for the TB
suspected/coughing patients.
Act: Triage nurse leads discussion of
data and team provides feedback,
solutions, and plan for ongoing
monitoring.

Triage nurse,
counselor

OPC doctors

Ms. Binh,
Nghe An
PAC

December
2014

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USAID/SMART TA

2.

IEC materials on Universal

Precaution: not available

SMART TA, PAC to send UP IEC

materials to OPC including hand
washing procedure, safe coughing
guidelines

Thanh Ha, Mai

Phuong FHI
360

OPC Chief

September
2014

Thu Binh - PAC

DRUG SUPPLY
Dr. Dinh PAC

INH: not available for IPT

PAC Nghe An will discuss with TB

provincial hospital to find a way
which enable purchasing INH and
delivering to OPC
Experience from Dien Chau OPC
could be taken into account

LABORATORY CAPACITY

There was an interruption of CD4

test in the two recent months

PAC reports the issue to their

supplier and avoid running out of
CD4 test kit in future

Viral Load has not been

implemented in Quy Chau OPC

Hand on training for OPC doctors

about criteria for VL test, supported
by FHI 360 and PAC clinical experts

Not only OPC staff but also PAC

staff has very limited knowledge
on GeneXpert, which may lead to
difficulties in scaling up ICF and
enhancing the collaboration
between PAC and provincial TB
program

Hand on training for OPC doctors on

GeneXpert
Sending OPC and PAC staff to attend
advanced trainings of ICF if possible
Promoting and encouraging the
exchange activities between PAC and
provincial TB program

Dr. Minh, Quy

Chau Hospital
October
2014

Dr. Tien - Dien

Chau Hospital
Dr. Lam TB
Hospital

September
2014

Dr. Dinh - PAC

Dr. Dinh - PAC

October
2014

Dr.Bich Thuy FHI 360

Drs. Dinh, Dr.
Tien - PAC
Dr. Lam Provincial TB
Hospital

PHS

December
2014

Ms Binh, PAC

Monthly

DATA MANAGEMENT

Documentation: paper work,

lacking of e-logbook. Contact
information of patients have not
been updated regularly

E-logbook will be issued very soon.

In the meantime, the triage nurse is
encouraged to use the Excel file of
HIVQUAL to manage and update all
OPC patients

Triage nurse,
counselor,
C&S

Triage nurse, counsellor, C&S team

to talk to patients and their

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USAID/SMART TA
supporters to update their contact
information regularly

Documentation: Three logbooks:

ART, pre-ART, daily medical checkup are updated, but not regularly.
There is no logbook to follow up
with transfer out patients.
All the patient charts are
organized by ID number which
allow OPC staff easily find out and
manage them.

1.

G
1.

Some administration information

still needs to be fulfilled such as:
test result summary table, inform
consent, etc.
CASE MANAGEMENT

Patient Follow-up: Follow-up of

referral cases, patients late reexamination, poor treatment
adherence must be improved.

ART/ Pre-ARTDELIVERY
Prescriptions in patient charts
were too simple and lack of

All the key logbooks of OPCs should

be updated at least on weekly basis
for better management and reducing
the workload in the last minute.

Triage nurse

Ms. Binh, PAC

Sept, 2014

Use the form/template of test result

summary table and inform consent
that Dr. Thanh Ha FHI 360 has
provided

OPC nurse and

doctors

Ms. Binh, PAC

September
2014

QI PDSA Activity #2
Plan: Increase the rate of retention
in care of the all the patients
including Pre-ART and ART
Do: Triage nurse records late reexamination, referral cases, phone
to them to remind for reexamination, confirm the successful
referral. Counselor provide
counseling session to the patients on
benefits of early treatment,
significance of treatment adherence,
etc; implementation of LTFU SOP
See: Check with the number of
patients who show late reexamination and poor treatment
adherence and see the records at
the record books.
Act: Continue with the action above
or change as appropriate.

Triage nurse,
counselor,
Doctors

Dr. Binh, PAC

to monitor

December
2014

Discussion has been made on how to

write a proper medication

Dr. Dinh, PAC

OPC doctors

The transfer out logbook should be

developed and used regularly

Bi-monthly

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TA PLAN FORM (v 4.8.14.0)

USAID/SMART TA
information
Cotrimoxazole is still prescribed
for patients whose CD4 count >
350 or clinical stage 1, 2

prescription and Cotrimoxazole

criteria

Dr. Thuy,
FHI360

PAC should continue to monitor and

support Quy Chau OPC doctor to
improve this area

2.

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