On December 21, 2013, HTH/AED hosted its first ever year-end conference, which summarized the work done in 2013 and provided a forum for discussion on how to improve the quality of care provided by HTH/AED. Over 50 people were in attendance, including HTH/AED’s entire staff, the president of AED and other members of the board, administrators and doctors from local hospitals and other NGOs, a university professor, and interested patients of HTH/AED. The conference was organized by Dr. Spero Houndenou, HTH’s new medical director, who hopes one day to establish HTH/AED as a well-known model for high-quality HIV care on a national or even global level. The day-long conference was comprised of a mix of presentations from individual departments and two panel discussions on broader topics: improving the quality of clinical care and evaluating community-based approaches to care.
The audience listens attentively to speakers during the first ever HTH/AED Year-End Conference
Dr. Houndenou gave the first presentation, explaining retention rates and treatment adherence using the analogy of water flowing through leaky pipe – HTH/AED tries its best to capture a large volume of patients, but there are steps along their path to health where some of the patients are lost. For example, a couple patients “leak out” every time their pastor encourages them to stop taking their HIV medication or when they don’t have the means to get to the clinic pharmacy once a month. One goal for the new year is to better identify and plug up those leaks so that every patient who starts their treatment with HTH/AED continues to benefit fully from HTH/AED’s services. This process is already underway at HTH/AED for patients on lifesaving antiretroviral therapy (ART). As Dr. Houndenou reported, less than 1% of the more than 880 patients on ART at HTH/AED were “lost to follow up” according to national standards, in 2013.
By contrast, the medical team raised a concern about how well HTH/AED is monitoring pre-ART patients. In Togo, ART is distributed free of charge, but due to a national shortage, is only given to registered patients below a certain threshold of health (CD4 count under 350). HTH/AED assumes the role of being both an ART-prescriber and an ART-dispensary, meaning that the clinic keeps strict records and follows a set of nationally-mandated protocols in exchange for the privilege of providing ART to their eligible patients in-house. It is relatively easy to monitor the patients on ART; each new medical consultation and test result is recorded in a standardized, government-issued blue notebook, and whether patients come to the dispensary on time to pick up a new month-long supply of ART is a proxy indicator of whether or not patients are taking their medicine (it also ensures that they visit the clinic and get a check-up once a month). However, for patients who are not yet on ART, their medical records are much less standardized and they come into the clinic much less often (once every three months, and sometimes more if they are in poor health). It is harder for the medical staff to monitor how well these patients are managing their own health and dealing with opportunistic infections (infections that take advantage of the weakened immune systems of people living with HIV and can be very dangerous), and it is difficult to distinguish between patients who stay away because they are healthy and patients who stay away even when they are in need of care. The non-standardized forms make it more difficult to keep track of these patients, and it’s harder for the clinic to monitor when they should reach out to see how they’re doing. Hopefully, with the help of the new database we are building, in 2014 HTH/AED will make progress towards improved monitoring of pre-ART patients.
In addition to hearing statistics that summarized the year from various departments (highlights: 44 babies were born and all tested HIV-negative at 18 months, less than 1% lost-to-follow-up of ART patients, new preventative campaigns were deployed in churches and hotels), there were panel discussions which led to interesting conversations and open exchanges among all participants.
Later in the day, I was even asked to sit on the community health panel as one of the “experts” to present my work from last summer shadowing HTH/AED’s community health workers (you can read more about that project here)! It was pretty exciting but I was also nervous to present (in French no less) to a group of people with so much experience and wisdom when it comes to HIV care. Below you can see a picture of the white board diagram I drew during my presentation, spelling mistakes and all. The basic summary of my presentation was that, based on my experience shadowing 6 community health workers on approximately 30 home visits, HTH/AED is succeeding right now in using their CHWs as “arms,” extending the reach of the clinic out into the community, but could benefit from re-conceiving the CHW program as a bridge between the clinic and patients, bringing medical care out to the patients and also allowing for information flow back into the clinic. For those of you who can’t read French, the purple describes what I noticed the CHWs doing well: explaining their disease and treatment in an accessible way, encouraging patients to advocate for their own health, promoting treatment adherence, and filling prescriptions for bed-ridden or hospitalized patients. Currently, the only information coming back into the clinics is in the form of non-standardized notebooks that very few people at the clinic look at other than the CHWs. I’m excited to see how our mobile health app project this winter (look out for a blog post about it soon!) can facilitate information flow back to the clinic to be used by the medical staff to get a more complete picture of their patients’ health as a whole.
At the end of the conference we all ate together and people who were interested stayed in the room to hang out and chat about all the information that had been presented. Despite some bumps in the road (we had a power outage all day long, meaning that no one could use the projector to display the slides made for their presentations), the conference did a great job of grounding HTH/AED as a site of research, learning, and innovation as well as being a fantastically successful health care provider. The conference also emphasized that HTH/AED is always looking for constructive criticism and open to new ideas, in an effort to try to improve their quality of care.
-Alicia, MIT Student Volunteer, GlobeMed at MIT Member
For more posts from GlobeMed at MIT please visit: http://globemed.mit.edu/category/iap2014grow
