TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

To

DATE OF ASSESSMENT

12/8/2014

SITE INFORMATION

Bac Giang OPC

30/6/2014

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

<1

% total clients)

Ethnic group clients

0%

% total clients)

Total clients under management:

HUMAN RESOURCES
Full-time: 3
Part-time: 6
Total: 9

Name

Position

Hin

OPC chief,
doctor
Doctor

Hi,
Phng
Tho

Phng
Nhung,
Huy,
Tuyt
Name of USAID/SMART
TA provincial site
monitor
MA. Dinh Thi Bich Hanh

Nurse,
secretary
Counselor
Pharmacist
Peer, C&S
team

Name of OPC chief

Bs. Nguyn Th Hin

344 (59 Pre-ART/ 285 ART)

Contracted
Part-time
Full time
X

Gov
Part-time Full-time

X
x
x
X
x

Name of PAC
representative

File assessment data

Bs. Trn Th Phng Lan

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USAID/SMART TA

TA Assessment
Summary Results

Result

HUMAN RESOURCES

67%

STRUCTURE AND
ACCESS

67%

DRUG SUPPLY

100%

LABORATORY
CAPACITY

60%

DATA MANAGEMENT

90%

CASE MANAGEMENT

17%

ART/Pre-ART
DELIVERY

40%

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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

Last round result

Present result

Difference

Score

Pass or fail

80%

80%

80%

Pass

75%

35%

35%

Fail

75%

36%

36%

Fail

80%

0%

0%

Fail

85%

92%

92%

Pass

95%

98%

98%

Pass

65%

53%

53%

Fail

90%

64%

64%

Fail

80%

86%

86%

Pass

85%

49%

49%

Fail

85%

75%

75%

Fail

80%

75%

Fail

SMART monitoring score

SMART TA classification

Improving

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USAID/SMART TA

No

Issue

HUMAN RESOURCES
OPC has now 2 counselors to
provide MMT and ARV adherence
counseling. However, both are not
trained on adherence counseling
so they do not provide ARV
adherence for the patient. So the
doctors have to provide
counseling sessions and treatment
at the same time.
There are 3 doctors to provide
MMT and ART. However, only 2
doctors taking the job are Dr. Hien
and Dr. Hai. Dr. Phuong, although
has been trained but lacking of
clinical experiences, he cannot
provide ARV treatment
confidently. So the OPC chief is
too hard to take all the job: MMT,
ARV treatment, chief of OPC, and
head of treatment department of
Bac Giang PAC.
There is not a secretary to support
Dr. Hien, chief of Bac Giang OPC.

1.

2.

3.
B

1.

Solution

Person in
charge

Supporter

Other
sources

SMART TA

Deadline

SMART TA and Bac Giang PAC create

favorable conditions for counselor to
participate in the training course or
ARV treatment modules.
While waiting for a training course,
SMART TA and Bac Giang PAC to
send the two counselors to Dong
Hung OPC to learn.

Director of BG
PAC, Chief of
OPC

Counselor,
Bac Giang
OPC,
Counselor of
Dong Hung
OPC

BG PAC considers and creates

favorable conditions for other
doctors who have learned modules
to replace Dr. Phuong to reduce
burden for the chief of OPC

Director of BG
PAC

Chief of OPC,
Treatment
doctor

Nov, 2014

The triage nurse to work as

receptionist and project secretary.

Director of BG
OPC Chief

Receptionist

Nov, 2014

Actual
date of
completio
n

Note

Nov, 2014

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 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

Triage nurse,
counselor

OPC Chief

Bac Giang
PAC staff
monitor
infectious
control
procedures
and check
regularly

Nov, 2014

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USAID/SMART TA

2.

IEC materials: Very few updated

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

3.

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

4.
C
D

1.

DRUG SUPPLY
No current issues
LABORATORY CAPACITY
Because Bac Giang is not one of
nine PEPFAR supported provinces,
LIFE Gap has not supported viral
load test for patients who are
suspected treatment failure and
appointed by the doctor and the
patients have to pay by
themselves.
DATA MANAGEMENT

CASE MANAGEMENT
Patient Follow-up: Follow-up of
referral cases, patients late reexamination, poor treatment
adherence must be improved.

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
updated IEC materials to OPC
including hand washing procedure,
safe coughing guidelines, nutrition
for PLWH
- PAC send the latest flipcharts to
Bac Giang OPC
- Bac Giang OPC to request more
bins for medical waste and use
coloured nylon bags to classify waste
from hospital administration

BG PAC to coordinate support

resources from GF to support for the
patient.

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 re-

SMART TA,
PAC

Bac Giang
OPC

October,
2014

Bac Giang OPC

Bac Giang
PAC

Oct, 2014

Bac Giang PAC

OPC chief

Nov, 2014

Triage nurse,
counselor,
Care and
support team

BG PAC staff
to check

Nov, 2014

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2.

3.

C&S team hasnt supported well

to the high-need patients due to
some reasons:
C&S team hasnt been
trained on C&S with the
new approach
OPC has not managed
well the work of C&S
team.
There isnt a good
connection among triage
nurse, counselor, doctor
and C&S team
Pre-ART patients.

examination, 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.
SMART TA and BG OPC creates
favorable conditions to C&S team to
be trained on C&S when there is a
training course.
SMART TA site monitor provide onsite training for C&S team
Chief of OPC organized a weekly
meeting to assign a concrete job for
the C&S team.
Enhance the connection among staff
in the OPC to support for high need
patients.
QI PDSA Activity#3:
Plan: Increase the proportion of PreART clients to come for reexamination, CD4 and other regular
test more often to avoid LTFU
patients.
Do:
The receptionist to check all
the patient charts of preART patients, follow-up
with the patients who show
late re-examination or noshow to call to remind.
Counselor to spend time for
counseling for Pre-ART

SMART TA, BG
OPC

OPC chief

Nov, 2014

Chief of OPC

Nov, 2014

Chief of OPC
Triage nurse,
counselor,
C&S team

Receptionist
Counselor
Doctor
C&S team

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patients.
Doctor to prescribe INH for
patients to come to the OPC
more regularly.
C&S team to support for
those patients.
See and Act: BG PAC to check with
the above practice and see it works
or should be changed if needed
G

ART/ Pre-ARTDELIVERY
HIVQUAL # 1: Proportion of client
newly registered at the OPC in last
6 months and tested for CD4
within 15 days of enrollment is
low due to some reasons:
- Lack of reagent for CD4 test
- Provincial hospital returns CD4
result late
- Follow-up of patients in early
treatment must be improved.

1.

2.

Proportion of newly registered

patients and eligible for IPT are
prescribed INH in the last 6
months is low due to:
- Doctors are not concerned about
prescribing INH for pre-ART
patients
- Patients are not fully provided

QI PDSA Activity #4
Plan: Increase the proportion of
client newly registered at the OPC in
last 6 months and tested for CD4
within 15 days of enrollment.
Do:
Chief of BG OPC to organize
weekly meeting to review all
newly registered patients to
avoid omitting patients that are
eligible for treatment, need CD4
and other routine tests.
Doctor to discuss with the newly
registered patients on the
earliest appointment date for
CD4 and other routine tests
Counselor to provide patients
the importance of CD4 and
other routine laboratory tests
Counselor to call to remind
patients before testing date
See and Act: BG PAC to check with
the above practice and see it works
or should be changed if needed.
Doctor to prescribe INH for Pre-ART
patients.
Pharmacist to increase INH proposal
to have more INH medication for
patients

OPC Chief

Reception
nurse,
counsellor,
C&S

Nov, 2014

Treatment
doctor

Triage nurse

Nov, 2014

Pharmacist,
Accountant

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3.

4.

with counseling session so they do

not come for re-examination on
time
HIVQUAL # 6: Proportion of
patients were initiated ART within
15 days after qualification in last 6
months is low due to some
reasons:
Patients need full
counseling session so
they come toreexamination on time.
Now, the OPC lacks of
trained adherence
counselor and doctors
are too busy to provide
counseling for the
patients.
Patients are not followed
up with because of
lacking the
communication n among
triage nurse, counselor,
doctor and C&S team.

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

QI PDSA Activity #5
Plan: Increase the proportion of
patients who were initiated ART
within 15 days after qualification in
last 6 months.
Do:
Triage nurse makes an
appointment to the patient
to have CD4 test and get
the result for 1-2 days
Counselor provides
counseling session to the
patient on the importance
and benefit of early
treatment
Right after knowing that the
patient is eligible for ART,
triage nurse call to the
patient and make an
appointment to the patient
to be on ART.
Triage nurse reminds to the
doctor and counselor for
the patient to be on ART.
Counselor calls to the
patient to remind him/her
right before the date of
appointment to start ART
PAC to check if there is any
difficulties of sending CD4
test results via telephone.
See: Next HIVQUAL Round
Act: Continue to change and
reevaluate process
Doctor to comply with guidelines on
prescribing Cotrim or Dapsone.
Triage nurse to check with CD4
results and remind the doctor that
prophylaxis is indicated for all

Counselor
Triage nurse
Doctor

OPC Chief

Nov, 2014

Doctor
Triage nurse

BG PAC to
check

Nov, 2014

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prescribe the cotrim
HIVQUAL # 10: Proportion of
patients are tested CD 4 at least 1
in last 6 months is low due to
some reasons:
Lack of CD4 reagent
Follow-up of patients for
CD4 test must be
improved

5.

6.

OPC- OPC referral, and referral to

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

patients with CD4

3
counts<350cells/mm
QI Activity #6:
Plan: Increase the proportion of
patients are tested CD 4 at least 1 in
last 6 months.
Do:
Chief of Bac Giang 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: BG PAC to check with
the above practice and see it works
or should be changed if needed.
Triage nurse to fill in the referral slip
and keep a copy of referral slip.
Counselor to provide counseling

BG OPC

Triage nurse
Counselor

Nov, 2014

Chief of OPC

Nov, 2014

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session for those patients on the
importance of consecutive
treatment.
Counselor to call to the patient and
receiving OPC to confirm that the
patient has come to the OPC already.

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