SMART MONITORING TA PLAN

USAID/SMART TA
Assessment Period
date
Date of assessment
OPC name

Jan 2014

to

June 2014

27 August 2014
MMT & Care and treatment, HIV testing in TuanGiao District (Opened in 2009)
Services provided

ARV Adult
ARV Pediatric

HIV testing

MMT

PMTCT

HBC

Out-reach

TB

STI

Regional character

City

Urban

Mountainous

Patient in prison/detention center

Ethnic minority

Other character

Patient managed:
Key OPC staff

Name
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Project monitor
USAID/SMARTA

Tran Thi Hang

Phan Van Boc
Nguyen Thi Ly
Lo Thi Xom
Quang Van Thuy

(% Total client)
( 85

395

Tittle

OPC chief
OPC treatment
Data management
Reception nurse
Treatment nurse
MMT/ARV
Trinh Thi Loan
Counsellor
Hoang Thi Thao
MMT Counsellor
Giang Thi Pa
HIV testing
Trinh Thi Nguyet
Nurse
Bui Thi Nhung
Pharmacist
Pharmacist
Ha
Pharmacist
Hung
HIV+ peer
Quang Thi Tien
HIV+ peer
Lo Thi Thuy
HBC chief
Hoang Hai Hung
Total
15

OPC chief

( (% Total client)

Part-time
(GVN staff)
X

PAC representative

Full time
contracted
X

X
X
X
X
X
X
X
X
X
X
X
X
X
11

Assessment data file

File nh gi d n
USAID/ SMART TA

Bs. Nguyn c Anh

BS. Trn Th Hng

Nguyn Thin Hng

(P. CSDT)

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SMART MONITORING TA PLAN

USAID/SMART TA
Assessment content

Result

Human resource

92%

Data structure and

assessment

82%

Drug supply

100%

Lab capacity

100%

Data control

90%

Case management

50%

Service delivery (ART/ preART)

70%

A. Human
resource

100%
80%
60%
40%
20%
0%

G. ART and
Pre-ART
Delivery

B. Structure
and access

F. Case
management

C. Drug
supply

E. DATA
MANAGEME
NT

D. Lab
capacity

SMART MONITORING INDICATOR AND HIVQUAL RESULT

Microsoft Excel
2003 Worksheet

TT
1
2

3
4
5

Name of indicator

Target

Proportion of patient chart pass 80% of chart

scoring (chart review tool)
Proportion of client newly registered at the OPC
in last 6 months and tested for CD4 within 15
days of enrolment
Proportion of pre-ART patients visiting the OPC
regularly and per appointment with doctor
Proportion of patient was INH prescribed in last
6 month
Proportion of ARV patients visiting the OPC for
medication pick-up according to scheduled
appointment in the last visit
proportion of patient were adherence
assessment in the last visit

1/4/13 30/9/13

1/10/13 31/3/14

Last result

Current
result

Diff

Score

100.0%

100%

80%
75%

91.3%

90.0%

-1%

75%

92.1%

33.0%

-59%

75.0%

75%

80%
85%

89.1%

88.8%

0%

95%

95.1%

96.6%

1%

75%

26.2%

86.9%

61%

Proportion of patient were CTX prescribed

Proportion of patient were TB screening at the
last visit
Proportion of patient had CD4 testing every 6
month

90%

95.8%

92.0%

-4%

80%

100.0%

100.0%

0%

85%

88.7%

93.8%

5%

11

ART retention after 12 months of starting ART

85%

66.7%

67%

12

Retention rate after 12 month of registration

85%

60.0%

60%

6
7
8
9
10

Proportion of eligible clients initiating ART

within 30 days during the past 6 months

SMART monitoring score

Classified

Notes

Smart
monitoring
indicator
Smart
monitoring
indicator

Smart
monitoring
indicator

Smart
monitoring
indicator

Smart
monitoring
indicator
Smart
monitoring
indicator

3
Improving

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SMART MONITORING TA PLAN

USAID/SMART TA

TT
B

Issues

QI activities

Responsible

Supporter

Deadline

Note

STRUCTURE AND ACCESS

Plan: All staff understand and follow
Universal Precaution
Do:

Some new OPC staff have not

trained on Universal Precaution

Print-out training material for

Universal Precaution for
reference
OPC chief giving request to all
staff to complete self-training on
Universal Precaution
Hand washing is clearly displayed
and soap is available for hand
washing

Dr.Hang-OPC
chief and all
staff

September,
2014

PDSA 1

September,
2014

PDSA 2

Study: OPC chief interview all staff on

understanding of universal precaution
every three month
Action: Respond to staff feedback
Plan: Counselor use chart and job aids
when giving counselling

Lack of Job aids for patient

counseling

No fast examination for TB

active/suspected

Do: SMARTA send 2 set of patient

counselling picture book to OPC for
patient counselling
Study: Interview with staff to confirm that
job aids are available, understandable,
and use frequently
Action: OPC chief is monitoring the use of
job aids in counseling service provided
Plan: Implement the examination for
TB/TB suspected patient, improving

LoanCounselor

SMARTA
Duc Anh

Dr Hang and
reception

SMARTA send
instruction of

PDSA 3

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SMART MONITORING TA PLAN

USAID/SMART TA

infection control
No spit/cough instruction at
patient waiting area

nurse

cough/spit to
OPC.

Do:

Study

Discuss and build fast patient

flow for TB/TB suspected patient.
OPC buy medical mask and give
to TB suspected patient
Reception nurse deliver mask to
all TB/suspected as routine
practice
Instruction of cough/spit
available

Count on how many mask was

delivered to patient each month,
How many TB suspected was
send directly to doctor
Review infection control of
visiting patient room every
quarter

Action: Discuss with doctor and reception

nurse every quarter for infection control
F

CASE MANAGMENT
Plan: Improve case management
Do:

Weak case management

Apply E-logbook tool to monitor

delay/missed appointment
patient
Use LTFU screening tool to
screening patient who have high
risk of LTFU or poor adherence
Create the case management
logbook and follow-up by case
manager (counsellor)

HBC team
and
counsellor

SMARTA
Duc Anh

September,
2014

PDSA 4

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SMART MONITORING TA PLAN

USAID/SMART TA

Send special case to CHBC for

home visit and counseling when
needed

Study: OPC chief review the case

management logbook every month
Action: Discuss with case manager and
HBC team monthly to improve case
management
Plan: Follow-up and record all referred
case

Not follow-up on referral case

Do: Reception nurse write all referred

case to logbook and call patient to
confirm about their status. If the logbook
is empty or unconfirmed about the
patient status, contact HBC to visit patient
and send to case manager

HBC team
and
counsellor

Dr Hang- OPC
chief

September,
2014

HBC team

September,
2014

DienBien PAC
Dr. Khuyen

September,
2014

PDSA 5

Study: Keep documenting the log book of

referral case
Action: Case review of each unconfirmed
or unsuccessful transfer by clinical team
at end of month to improve process
G

2
3

ART and pre-ART service delivery

Low of retention rate

See the PDSA 4

Second-line drug for treatment at

Tuan Giao OPC as treatment
failure more rising
Low of INH prescription rate

PAC DienBien send official request to

VAAC for second-line treatment in
TuanGiao
Plan: Increase the INH prescription up to

OPC chief
and
reception
nurse

Dr Hang
Dr. Hang

September,

PDSA 6

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SMART MONITORING TA PLAN

USAID/SMART TA

70%
Doctor wait up to 6 month after
ARV initiated to prescribe INH

2014

Do:

Doctor give INH prescription for

patient who after 1 month of
ARV initiated
Screen all patient chart for INH
prescription: Put red sticker on
chart not yet on INH
With INH completed chart, write
notice on the chart summary

Study: Review all red sticker chart

monthly
Action: Doctor check the patient chart to
review INH prescription every time
patient examination

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