Health strengthening systems is a critical component in Zambia and HIV has been recognised as one of the major public health problems in the country. HIV treatment has continued to scale up in most health facilities which has led to an increase in demand for HIV services thus leading to congestion in health facilities.
Fast tracking HIV stable patients has decongested ART clinics
In order to decongest ART clinics, Centre for Infectious Disease Research in Zambia (CIDRZ) with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and partnership of U.S. Centers for Disease Control and Prevention (CDC) has been implementing Differentiated Service Delivery (DSD) models which include the Community Adherence Groups (CAGs) which has benefited 12, 558 people, the Urban Adherence Groups (UAGs) with 1, 741 people, Health Post/Fast Track Dispensations with 37,640 beneficiaries, Scholars’ model which has 2, 073 people and the newly introduced community pharmacy dispensation model which has 237 people.
In achieving this, the six months drug dispensation model to stable patients has been introduced, where stable patients are identified from the pharmacy then sent to a separate room that is away from the ART clinic for their drug refill. Fast Track Dispensation model had been giving the three months drug dispensation to the patients in the past.
ART Pharmacist In-Charge Mrs. Nhoma Hachizo expressed happiness that the six months dispensation has been introduced, “I am glad that we now have the six-month dispensation, this will enable us work more effectively where we will have enough time to enter information in the daily report register and also interact more with the patients and deal with problems they are facing with the drugs they are taking. Previously we never had enough time to do our reports due to the congestions we used to have at the facility, we used to have more than 150 patients per day. Mostly you will be attending to the patients and not have enough time to interact with them on how they are coping with the drugs they are taking.”
CIDRZ Senior Research Pharmacist Muhau Mubiana explained how the dispensations will be done during the orientation for the stable patients at Chilenge 1st Level Hospital.
“The six months drug dispensation is one of the ways under Fast Track to decongest the ART facility and also to increase work efficiency among workers. Stable patients should be identified, isolated and referred to the fast track dispensing point where the pharmacy technologist assigned shall prepack and deliver the prepacked medicines to the patients in order to decongest the facility.
“We are using the Standard Operating Procedure (SOP) in the model which describes how stable client are enrolled into fast track model and how the ARVs are pre-packed for patients and dispensed to the patient at the Fast track.”
He further explained the process of how patients get enrolled into Fast Track, were the clinician identifies stable, and prescribes the six months drug dispensation then refers the patient to the ART Fast Track pharmacy. The pharmacy then dispenses drugs for six months and DSD focal point person enters the patient details in the DHIS2 tablet or enrollment register within the pharmacy.
“An identifier is put on the patient ART card or clients SMARTCARE card where the fast track coordinator monitors DSD enrollments in the appointment register. The day before, a list of clients expected on the following day is generated and clients are contacted to remind them of the clinical visit and pharmacy refill. After 6 months, the clients return to the clinic for their clinical appointment visit, during this visit clinical procedures are done on the patient then later the patient is referred back to the fast track pharmacy for drug dispensation, adherence counseling, record pharmacovigilance issues and viral load monitoring.” Mubiana said.
He added that responses of the clients are documented in the missed appointment register during preparation of the list. The fast tract coordinator checks for client’s latest Viral Load and clients with high VL are removed from Fast Track and the list of names is given to the high viral load focal point person for follow ups.