TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

DATE OF ASSESSMENT

5/8/2014

To

30/6/2014

SITE INFORMATION
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)
5%

Total clients under management:

HUMAN RESOURCES
Full-time: 9
Part-time: 0
Total: 9

Name

Position

Thin

OPC chief,
doctor
Doctor
Nurse,
secretary
Counselor
Pharmacist
Peer, C&S
team

Binh
Be
Chi
Van
Phuong,
Hoa,
Thuy, My
Linh

Name of USAID/SMART
TA provincial site
monitor
MA. Dinh Thi Bich Hanh

% total clients)
773 (43 Pre-ART/ 730 ART)

Contracted
Part-time
Full time
X

Gov
Part-time Full-time

X
X
X
X
x

Name of OPC chief

Name of PAC
representative

Dr. Pham Thi Thin

Dr. Le Thi Hoa

File assessment data

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TA Assessment
Summary Results
A

HUMAN RESOURCES

STRUCTURE AND
ACCESS

DRUG SUPPLY

LABORATORY
CAPACITY

DATA MANAGEMENT

CASE MANAGEMENT

Result
96%
74%
100%
100%
90%
33%

50%
ART/Pre-ART
DELIVERY
MMARY RESULT OF HIVQUAL AND SMART
TA INDICATORS
G

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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

Last round result

Present result

80%

Difference

Score

Pass or fail

-84%

Fail

75%

84%

91%

10%

Pass

75%

81%

94%

94%

Pass

29%

-65%

Fail

80%
85%

94%

94%

-4%

Pass

95%

98%

100%

59%

Pass

65%

41%

25%

-6%

Fail

90%

31%

70%

10%

Fail

80%

60%

97%

2%

Pass

85%

95%

68%

-2%

Fail

85%

70%

91%

21%

Pass

Pass

80%

81%

SMART monitoring score

SMART TA classification

Effective

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No
A

1.

Issue

Solution

Person in
charge

Supporter

Other
sources

Deadline

Actual
date of
completio
n

Note

HUMAN RESOURCES

Staff Integration: OPC Cm Ph

staff is fully on contract paid, thus
not able to participate in routine
activities of the hospital, such as
attending the regular meetings in
the hospital, including related
environmental content, standard
precaution.

Integrate step by step Cam Pha OPC

into the infectious department of
Cam Pha General Hospital, then
contribute to sustainable transfer.
QN PAC to discuss with Director of
CP General Hospital to send the
doctors and staff to the OPC to learn
and work instead of contracted staff.
Cam Pha General Hospital involves
OPC staff in regular activities,
especially regular meeting of the
hospital.
One or two part-time staff to change
the contracted staff in the next SA.

QN PAC and
CP General
Hospital

QN PHS

31/12/2014

STRUCTURE AND ACCESS

1.

TB Infection Control: Medical

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

2.

IEC materials: Very few updated

QI PDSA Activity #1
Plan: Implement active TB infection
control and prevention
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.
- SMART TA, PAC to send more

Triage nurse,
counselor

OPC Chief

SMART TA,

Cam Pha OPC

QN PAC staff
monitor
infectious
control
procedures
and check
regularly

Nov, 2014

October,

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IEC materials available including
updated job aids for staff to use
for patient counselling

3.

4.
C
D
E

1.

Environmental Waste
Management: No classified bin
such as bin for medical waste, i.e.
cotton, bandages, alcohol, swabs
with patients blood, etc and bin
for domestic waste
DRUG SUPPLY
No current issues
LABORATORY CAPACITY
No current issues
DATA MANAGEMENT
Documentation: Patient record
has been filled with relatively
adequate information but not
updated with phone numbers,
contact address of patients and
supporters
Documentation: Three logbooks:
ART, pre-ART, daily medical checkup are updated, but referred
patients from other OPCs are not
recorded in the month initiating
ART

updated IEC materials to OPC

including hand washing procedure,
safe coughing guidelines, nutrition
for PLWH
- PAC send the latest flipcharts to
Cam Pha OPC
- OPC Cm Ph to request more bins
for medical waste and use coloured
nylon bags to classify waste from
hospital administration

PAC

2014

Cam Pha OPC

Cam Pha
General
Hospital

Oct, 2014

Triage nurse,
counselor,
C&S

QN PAC staff
to check

Sept, 2014

Triage nurse can still write down the

referred patients in the pre-ART
logbook but note that this patient is
transfer-in and also write down in
the ART logbook in the month this
patient initiated ART

Triage nurse

QN PAC staff
to check

Sept, 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

Triage nurse,
counselor,
Care and
support team

QN PAC staff
to check

Nov, 2014

Triage nurse, counsellor, C&S team

to talk to patients and their
supporters to update their contact
information regularly

CASE MANAGEMENT

Patient Follow-up: Follow-up of

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

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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.

2.

TB Diagnosis: When the patients

has signs of TB, the OPC will send
the patients to the DTU for AFB
test. However, in many cases of
HIV patients, they are still TB
infected although the AFB test
result is negative. There is no
mechanism of sending sample to
the TB hospital and there is no
feedback system between TB unit
and HIV OPC. That is the reason
why some patients do not receive
any TB treatment and die because
of that.
ART/ Pre-ARTDELIVERY

1.

HIVQUAL # 3 : Date quality issue

with proportion of newly
registered patients and eligible for
IPT are prescribed INH in the last 6
months is low

2.

HIVQUAL # 1: Proportion of
patients were initiated ART within
15 days after qualification in last 6
months is low due to some
reasons:
- OPC receives CD4 results after 8
days since the date of sample
sending, then 1 week on Cotrim
treatment to avoid allergies
caused by drugs.
- Follow-up of patients in early

SMART TA supports PAC QN in

implementing and promoting
cooperation and feedback
mechanism between TB and HIV
including laboratory specimen
transport and result reporting

PAC needs to review software

because after checking the input
data, there are more newly
registered patients prescribed with
INH and asked VAAC for help if
needed. After data collected, QI
plan will then be discussed.
QI PDSA Activity #3
Plan: Increase the proportion of
patients who were initiated ART
within 15 days after qualification in
last 6 months.
Do: PAC to discuss with the
provincial hospital to send CD4 test
results via e-mail.
See: PAC to check if there is any
difficulties of sending CD4 test
results via e-mail.

SMART TA
QN PAC
Cam Pha OPC

QN PAC staff
to check

Dec, 2014

QN PAC
Cam Pha OPC

QN PAC
Cam Pha OPC

31/8/2014

QN PAC
Cam Pha OPC

Provincial
General
Hospital

Nov, 2014

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treatment must be improved.

3.

HIVQUAL # 10: Proportion of

patients are tested CD 4 at least 1
in last 6 months is low due to
some reasons:
- The hospitals laboratory only
receives maximum 30 patients
blood samples for each CD4
testing, so if there is a large
number of patients, some patients
have to come back for the test
- Cam Pha OPC appoints the test
date of 6 months so when the
patient is busy or sick, he/she will
be late for CD4 test.
- Follow-up of patients for CD4
test must be improved

Act: Continue to send the CD4 test

results via e-mail or change as
appropriate based on the factual
situation
QI Activity #4:
Plan: Increase the proportion of
patients are tested CD 4 at least 1 in
last 6 months.
Do:
PAC QN to discuss with the hospitals
laboratory to increase the number of
patients for blood testing each time
Chief of Cam Pha OPC to
organize weekly meeting to
review all patients to avoid
omitting patients that are
eligible for treatment, need
CD4 and other routine tests.
Doctor to appoint the test
date earlier than 6 months.
Triage nurse to check who
will have CD4 test and
remind the doctor on that
by sticking a yellow sticker
on the medical record.
Counselor to provide
patients the importance of
CD4 and other routine
laboratory tests before the
regular test date;
Doctor to discuss with
patients the appointment
date for CD4 and other
routine tests,
The appointment date for
testing and re-examination
should be the same to
facilitate the patients
travelling;
Counselor to call to remind
patients before testing
date.
See and Act: QN PAC to check with

QN PAC
Cam Pha OPC

Nov, 2014

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the above practice and see it works
or should be changed if needed

4.

5.

HIVQUAL # 8: Proportion of
qualified HIV patients are
prescribed for Cotrimoxazole or
DAPSONE for the last visit is low
because the doctor forgets to
prescribe the cotrim

OPC- OPC referral, and referral to

other services must be improved
to follow-up with the patients.

Doctor to comply with guidelines on

prescribing Cotrim or Dapsone.
Triage nurse to check with CD4
results and remind the doctor.

Doctor
Triage nurse

QN PAC staff
to check

Nov, 2014

SMART TA will support PAC Quang

Ninh in performing and promoting
successful referral with the support
implementation of ACIS-software
and patient navigators
Cam Pha OPC to appoint one staff to
keep track of referral and have
logbook to record transfers, photo
referral slips

SMART TA
QN PAC
Cam Pha OPC

QN PAC staff
to check

Dec, 2014

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