TA PLAN FORM (v 4.8.14.

0)
USAID/SMART TA
ASSESSMENT PERIOD

1/10/2013

DATE OF ASSESSMENT

7/8/2014

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)
1%

Total clients under management:

HUMAN RESOURCES
Full-time: 5
Part-time: 3
Total: 8

Name

Position

Kat

OPC chief,
doctor
Doctor

Hnh,
Minh
Ti
Minh
Lin
Giang,
Dng

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

Nurse,
secretary
Counselor
Pharmacist
Peer, C&S
team

% total clients)
317 (28 Pre-ART/ 289 ART)

Contracted
Part-time
Full time
X
x

Gov
Part-time Full-time

X
X

x
X
x

Name of OPC chief

Name of PAC
representative

Dr. L Mnh Kt

Dr. Le Thi Hoa

File assessment data

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USAID/SMART TA

TA Assessment
Summary Results
A

HUMAN RESOURCES

STRUCTURE AND
ACCESS

DRUG SUPPLY

LABORATORY
CAPACITY

DATA MANAGEMENT

CASE MANAGEMENT

ART/Pre-ART
DELIVERY

Result
63%
72%
90%
80%
70%
33%
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

80%

Present result

Difference

Score

Pass or fail

40%

-54%

Fail

75%

94%

96%

2%

Pass

75%

94%

42%

42%

Fail

32%

-53%

Fail

80%
85%

85%

86%

12%

Pass

95%

74%

56%

6%

Fail

65%

50%

13%

-58%

Fail

90%

71%

39%

-55%

Fail

80%

94%

87%

15%

Pass

85%

72%

87%

87%

Pass

85%

90%

90%

Pass

80%

76%

Fail

SMART monitoring score

SMART TA classification

Improving

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USAID/SMART TA

No
A

1.

1.

Issue
HUMAN RESOURCES
- Although 3 part-time doctors
attended the training courses on
ARV treatment, they still lack of
clinical treatment experiences.
- There are two part-time
counselors but only one spend
time to work at the OPC. Both of
them are not trained on
adherence treatment, lack of
factual knowledge, are not active
to learn to provide good
counseling session.
- The new triage nurse replacing
the old one who is on maternity
leave is not trained and lack of
experiences on HIV but she is
active and eager to learn.
STRUCTURE AND ACCESS

TB Infection Control: Medical

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

Solution

- The SMART TA clinical staff to

provide more on-site training for
part-time doctors.
- QN PAC to coordinate Dr. Siu, Van
Don OPC Chief to provide on-site
training for part-time doctors.
- QN PAC to coordinate to send the
counselor and triage nurse from Van
Don and Cam Pha OPC to support to
the counselor and triage nurse in
Hoanh Bo OPC for a week.

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

Person in
charge

Supporter

TTPC AIDS QN
and Hoanh Bo
General
Hospital

Dr. Su, B,
triage nurse,
Thy,
counselor,
Van Don and
Cam Pha OPC

Triage nurse,
counselor

OPC Chief

Other
sources

Deadline

Actual date
of
completion

Note

31/1/2015

QN PAC staff
monitor
infectious
control
procedures
and check
regularly

Nov, 2014

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USAID/SMART TA
monitoring.

2.

IEC materials: Very few updated

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

- SMART TA, PAC to send more

updated IEC materials to OPC
including hand washing procedure,
safe coughing guidelines, nutrition
for PLWH
- PAC to send the latest flipcharts to
Hoanh Bo OPC

SMART TA,
PAC

Hoanh Bo
OPC

October,
2014

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

- Hoanh Bo OPC to request more

bins for medical waste and use
coloured nylon bags to classify waste
from hospital administration

Hoanh Bo OPC

Hoanh Bo
General
Hospital

Oct, 2014

Staff of Hoanh Bo OPC hasnt

participated in regular meetings
its which content is related to
environment, standard
precaution, waste management of
the hospital.

QN PAC to work with Hoanh Bo

General Hospital to step by step
integrate the OPC into the infection
department of the hospital. The staff
of the OPC to be involved in the
training course, regular meetings on
standard precaution, waste
management and other issues
organized by the hospital.

QN PAC and
Hoanh Bo
General
Hospital.

Hoanh Bo
OPC

30/11/2014

Triage nurse,
counselor,
C&S

QN PAC staff
to check

Sept, 2014

4.

C
D
E

DRUG SUPPLY
No current issues
LABORATORY CAPACITY
No current issues
DATA MANAGEMENT

Documentation: Clinical record

lacked of some information:
updated phone numbers, contact
address of patients and
supporters; photos,
identifications, TB screening,
treatment adherence evaluation,
clinical stage, date of reexamination, etc

Triage nurse, counsellor, C&S team

to talk to patients and their
supporters to update their contact
information regularly.
Doctor to fill in the clinical record the
clinical stage, date of re-examination
appointment, treatment adherence
evaluation.
Triage nurse to do the TB screening
each time of re-examination for the
patient.

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1.

2.

Documentation: Three logbooks:

ART, pre-ART, daily medical checkup are updated, but the daily
logbook hasnt coded and no
record of the newly registered
patients, the Pre-ART and ART
logbooks lack of information filled
in the column to follow-up the
patient monthly and quarterly.
CASE MANAGEMENT

Patient Follow-up: Follow-up of

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

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

Triage nurse to fill information of

transfer-in patient to the Pre-ART
logbook and note that this is the
transfer-in patient and write down
on the page of the month of
initiating ARV in the ART logbook

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 re-examination, 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,
Care and
support team

QN PAC staff
to check

Nov, 2014

SMART TA supports PAC QN in

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

SMART TA
QN PAC
Hoanh Bo OPC

QN PAC staff
to check

Dec, 2014

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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 : Data 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
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:
- Hoanh Bo 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

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.
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:
Chief of Hoanh Bo 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

QN PAC
Hoanh Bo OPC

QN PAC
Hoanh Bo
OPC

31/8/2014

QN PAC
Hoanh Bo OPC

Provincial
General
Hospital

Nov, 2014

QN PAC
Hoanh Bo OPC

Nov, 2014

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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
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,
especially the patients in the 06
center. The large number of
patients in the 06 centers release
to integrate into the community
will be transferred out but they
are unconfirmed transfer-out.

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

QI activities #5:
Plan: Improve the OPC-OPC referral
especially referring the patients from
06 Centers to other OPCs.
Do:
SMART TA to support PAC
Quang Ninh in performing
and promoting successful
referral with the support
implementation of ACISsoftware and patient
navigators.
Quang Ninh PAC to work

SMART TA
QN PAC
Hoanh Bo OPC

QN PAC staff
to check

Dec, 2014

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USAID/SMART TA
with the 06 Center to create
a collaboration mechanism
between the OPC and the
06 Center:
06 Center to provide the list
of patients who are going to
release.
Counselor to provide
counseling session for those
patients; call to the
receiving OPC to inform
Counselor to call to the
receiving OPC to check if
the patient come to the
receiving OPC or not and
record it.
QN PAC to support to the
referral process and find
out the LTFU patients after
transferring out.
Hoanh Bo OPC to appoint
one staff to keep track of
referral and have logbook
to record transfers, photo
referral slips
See and Act: QN PAC to check with
the above practice and see it works
or should be changed if needed

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