Monitoring, Evaluation & Research
Quality Improvement
TEXT NOT AVAILABLE. Lighthouse through its Community Health Services organizes an annual get-together function for its volunteers from 19 Community Based Organizations (CBOs) that it works with in Lilongwe City. This function brings all the volunteers to one place as one body.
The aim of the function is to give them room to showcase and publicize activities which they do in their respective communities whilst delivering quality community home based care services to patients. This function also helps them to check the progress of their activities and re-plan for the future. This is one of the many ways through which CBOs provide feedback to their partners who include Lighthouse and the communities at large.
t’s time for action and moving forward – the Lighthouse executive Director Prof. Sam Phiri sets the motion during the Big Walk.
Previous functions have been held at various places such as Masintha ground in Kawale, and Chipala Primary School ground in Area 50. The themes change annually, and are usually in line with the AIDS Day theme of the previous year and activities include: a sensitization Big Walk, viewing of volunteer exhibitions and open air activities.
Annually, CBOs compete for a trophy as part of promoting growth among them. The winner for 2015 was Chilumba CBO who went away with the trophy and MK500 000.00 cash prize.
Monitoring
TEXT NOT AVAILABLE The Lighthouse Trust piloted “Nurse-led Community ART Program (NCAP)” initiative aims to encourage long term retention to care of stable patients on ART by using outreach facilities identified by PLHIV support groups. This intervention aims to serve patients that are; registered with Lighthouse at Kamuzu Central Hospital (KCH) or Martin Preuss Centre at Bwaila hospital, adult (i.e. 18 years old and above), on the same first or second ART regimen for at least 12 months, cleared as a stable patient by a clinical officer: without serious complications or other related infectious diseases, Viralogically suppressed, and live within Lighthouse Community Health Services (CHS) catchment areas.
Clients that meet the above enrollment criteria are given an option of seeing a health care provider at a pre-selected outreach location identified by Lighthouse Community Health Services team. Once a client has been registered in the NCAP initiative, he/she will continue receiving HIV services, including ARV refills, at the outreach point in the community (except in special circumstances where referral to the clinic is necessary). This means that patients are provided 3 months ART supply and that they will be required to meet their next appointment in the community at the outreach point. The approach assures that patients see a health care provider every three months as recommended by the national guideline, receive limited essential services at a place convenient to them, and have the opportunity to come to Lighthouse Clinics to receive specialist care whenever appropriate.
Services provided at an outreach location include, but not limited to; adherence monitoring (pill count), refill of prescriptions, documentation of current status on patient passport and patient chart (that will later be entered into EMR), issuing of next appointment date, provision of condoms, screening for comorbidities such as tuberculosis, hypertension, among others.
Back to Care
In 2006, The Lighthouse Trust launched a patient tracing intervention designed to improve long-term retention in ART care by reducing lost to follow-up (LTFU) ( called Back-To-Care program). The B2C team, using the electronic medical record system, promptly generates a list of ART patients who miss a scheduled ART clinic appointment by 3 or more weeks.
Five trained extension workers are responsible full-time for verifying the status of patients on the list to rule out data errors and for tracing patients who miss scheduled appointments by phone, short message service (SMS), home visit. Motorbikes are used for home visit tracing. Patients who are identified as LTFU are contacted by the B2C staff to ascertain true ART outcome status. Status was recorded as either dead, transfer to other ART facility, alive and on ART (uninterrupted therapy or treatment gaps), stopped ART (stopped or never started ART), tracing rejected, refused comment and LTFU. Patients who are found alive and not transferred to other ART facilities are asked to return to the clinic and a clinic appointment is made. Tow further attempts are made for patients who do not realize these appointments before they are classified as “LTFU”
Our previous evaluation showed that the B2C program not only results in a marked increase in ART patients who return to the clinic for ART refills (especially in cases of treatment failure) but it also helps identification of reasons for missing ART clinic appointments among ART patients and how better to assist them. Approximately 74% of the patients who promised to return after being traced, returned to the clinic.
In recent years, the B2C teams has also been involved on tracing ART patients with high viral load and newly identified HIV-infected infants to facilitate patient management.