Harriet Shezi Paediatric ARV Clinic at Chris Hani Baragwanath Hospital in Soweto is one of the largest clinics of its kind in South Africa. With guidance from IHI, a dedicated and increasingly systems-focused local staff used the Chronic Care Model and the Model for Improvement to increase treatment rates for patients with HIV. As a result, the number of patients receiving highly active antiretroviral treatment (HAART) increased from 166 in October 2004 to 1,500 in September 2006.
The clinic staff tested and implemented changes to clarify staff roles; improve patient triage; create records and a database supporting disease management; and improve pre-clinic preparation. As the clinic increased in size and worked down the backlog, referral demand for treatment was static, even though many children remained untreated. Lillian Obidike, a former pharmacist at the clinic, led the team to design outreach and case finding opportunities in their own pediatric inpatient wards.
The team identified inpatients who were not being referred to the ARV clinic in the numbers expected. Testing a system that included referral, ward counseling and access to the ARV clinic, the team tripled the average monthly ward referrals over a few months and has sustained that level since. Now the team is looking to spread the case finding changes to all other wards within the hospital.
02/05/2007
