ISSN: 2578-5001
Authors: Urama B*, Nkiru A, Anthonia I, Owoicho B, Ibegbunam I, Uzoma A, Chukwukaodinaka N, Adelanwa A and Babatunji O
Background: Integrated monitoring and supportive visit (iMSV) to health facilities is a facilitative approach that promotes mentorship, team work, joint problem-solving, cross-learning, skill sharing and communication between programme staff and health care workers (HCWs) at the service delivery points. The National AIDS and STIs Control Programme (NASCP) instituted iMSV as part of the effort to monitor uptake of new antiretroviral drugs and quality of care of the antiretroviral treatment programme. A range of measures were taken to ensure that the iMSV team carry out the activities effectively to guide, support and assist health facility staff to become more competent in their work. This article highlights the processes of the iMSV and the outcome of the exercise. Methodology: A standard assessment checklist was used. Data were collected from 154 health facilities through interviews, direct observation, document review and physical inventory. Health facilities were sampled using three criteria: sites with population of patients on antiretroviral therapy (ART) above ≥ 1000; sites without logistics Management information report (LMIS) report in the last three cycles (July/August 2018, Sept/Oct 2018 and Nov/Dec 2018); sites with zero consumption of dolutegravir 50mg (DTG) and tenofovir/lamivudine/dolutegravir (TLD) from November/December 2018 LMIS data. Special consideration was given to states with highest HIV burden. Combined team from funders, implementing partners, national and state government took part in the exercise. Data entry and analysis were done using MS Excel.Results: Findings revealed that there are trained but inadequate HCWs of all cadres supporting the programme. It also showed that key elements of quality of care e.g. baseline laboratory investigations, WHO staging for treatment naïve patients, viral load testing, TB preventive therapy are been implemented but need to be improved. Necessary guidelines, standard operating procedures and job aids were available in most of the health facilities. The new antiretroviral drugs were generally available and most of the health facilities have commenced the use. There is slow pace of transitioning of existing adult and adolescent patients from previously preferred regimen to the new preferred regimen as approved by NASCP. Few incidents of HIV product stock out were recorded in some health facilities. Storage condition for the products is generally okay and laboratories carry out necessary quality control on reagents and kits batches before use. Conclusion: iMSV is a promising approach to monitoring and improving uptake of new products and quality of care of the programme. Close monitoring and re-strengthening of the HCWs had a positive impact on the overall performance of the programme.
Keywords: Integrated Monitoring and Supportive Visit; Antiretroviral Treatment; Antiretroviral Drugs; Viral Load; Quality of Care; Health Care Workers
