ICAP South Sudan_CoTQIC_Baseline Stakeholder Meeting_02.02.2022.pptx

IRIS SLIDES

1. Gillian Dougherty PMHNP, MPH, RN Senior QI Technical Advisor ICAP Columbia University ICAP South Sudan QI Collaborative to Improve Continuity in ART Baseline Stakeholder Meeting Feb 2022 Onyekachi Ukaejiofo MD, MSc Senior QI Technical Advisor ICAP Columbia University Habtamu Worku Senior M&E Technical Advisor ICAP Columbia University

2. ICAP South Sudan QI Team- Introductions! QI Officer Mr. Dada Robert QI M&E Officer Mr. Kalisto Angelo Draga

3. Baseline Stakeholder Meeting The purpose of today's meeting is to convene this expert panel of stakeholders:  to present the final QIC design, Including: QIC sites,  aim statement, indicators and Share baseline assessment findings, and  Review implementation phase and next steps

4. Outline The QI Collaborative Approach Design Phase Baseline Assessment Findings Implementation Phase

5. An organized network of sites (districts, facilities or communities) that work together on a focused program topic area For a limited time, typically 12 to 18 months Shared aim statements, indicators, and measurement processes Regular forums (quarterly) for data review, shared learning and spreading successful changes

6. Design Phase- Sept 2021 to Feb 2022 Hire ICAP SS QI staff (1 QI officer and 1 QI M&E officer) Key leadership engagement- MOH, CDC, State, County MOH Health Teams- ART program and QI POCs MOH letter of approval for QIC Notification of HF leadership staff Notification of selected QIC team members 12-month Baseline Data Analysis on run charts Develop reporting and tracking tools Aim Statement Finalization Baseline stakeholder meeting – February 2022 Project Timeline Implementation Phase- Feb 2022 to Jan 2023 First Learning Session- Feb 2022 Second Learning Session- June 2022 (Feb, Mar, April , May data) Third Learning Session- Sept 2022 ( June, July, Aug, Sept data) Forth Learning Session- Feb 2023 (Oct, Nov, Dec, Jan data) Change package development Final Stakeholder Meeting

7. QIC Site Selection Criteria and Considerations PEPFAR Priority Status: Sites with high patient volume, combinations of high and lower performing sites.   Selected HFs contributed 75% (22,374/ 30,166) of total TX_Curr  by FY21 Q4 Contributed an estimated 90% (8,182/ 9,114) of total losses (TX_ML) by FY21 Q4 Sites selected have between 2% and 50% of unexpected client loss for FY21. Know-do gap: Sites that have previously received ICAP training and support, and have tracking systems in place but, consistent and high-quality implementation is lacking  QI Teams: Generally, HF admin should commit to keep staff in same location for at least a year if they are chosen to participate on QIC teams.  During the last QI training, 2 officers were trained from each HF, respectively Location and travel logistics of sites: Considerations include costs of bringing sites together every quarter and monthly sites visits by ICAP staff.   Virtual Capability : All select 15 HFs are fitted with ECHO model and can transition to a virtual model as needed

8. ICAP South Sudan CoT QIC 15 Health Facilities HF Name   County FY20Q4 TX_CURR FY21 Q4 TX_CURR FY21 T X_NEW TX_NET_NEW FY21 Unexplained Loss FY21 cum.  % Unexplained Loss /Gain FY21   Al Sabah child Hosp. Juba 465 548 221 83 -138 -20% Juba Teaching Hosp. Juba 4038 4233 1081 195 -886 -17% Yei Hospital  Yei 1289 1196 165 -93 -258 -18% Kapoeta Hosp Kapoeta Sou 475 675 310 200 -110 -14% Nimule Hospital Magwi 1154 1454 334 300 -34 -2% Torit State Hospital Torit 845 795 90 -50 -140 -15% Rumbek State Hosp. Rumbek Center   1560 2040 513 480 -33 -2% Aluak luak Yirol West 134 526 253 392 139 36% Mapourdit Hospital Yirol West 1311 927 630 -384 -1014 -52% Yirol Hospital Yirol West 2087 1432 960 -655 -1615 -53% Wau Teaching Hosp. Wau 1062 1096 313 34 -279 -20% Ezo Hospital   Ezo 1634 1459 71 -175 -246 -14% Nzara Hospital Nzara 1956 1551 96 -405 -501 -24% Yambio PHCC Yambio 1210 1264 196 54 -142 -10% Yambio State Hosp. Yambio 3141 3180 246 39 -207 -6%

9. Process Mapping Exercise for Indicator Development

10. S/N QIC indicators  Numerator Denominator Source document Responsible person Reporting frequency comments 1 % of Newly Enrolled clients linked to COVs in the reporting period # of clients linked to COV in the reporting period Number of clients newly enrolled in the reporting period  COV linkage logbook Community Liaison Officer (CLO) Daily This refers to the percent of clients who were newly initiated on ART today and linked to a community outreach volunteer (cov) 2 % of clients due for ARV refills provided with reminder services (phone call, SMS and or home visit) # of clients provided with reminder services (phone call, SMS and or home visit) # of clients due for ARV refills in the next 3-28 days Reminder call log, appointment logbook Front desk officer/call clerk Daily This refers to the total number of clients who were due for ARV refill and provided with reminder calls, reminder SMS or reminded through COVs within the reporting period 3 % of clients who missed their appointment  in the reporting period # clients who missed their appointment # of clients appointed in the reporting period  Appointment logbook Appointment logbook Daily This refers to  the percent  of clients who failed to show up on their appointment date/clinic visit date 4 % of missed appointment who received calls  in the reporting period # of missed appointment who received calls today # of missed appointment clients who were called today Missed appointment call log Missed appointment call clerk Daily This refers to the percent  of clients who missed appointment, have phone numbers and has successfully received/answered the phone call 5 % of missed appointment who received calls and with dates of return  in the reporting period # missed appointment who received calls and with dates of return # of clients who received calls   in the reporting period Missed appointment call log Missed appointment call clerk Daily This refers to the number of clients who missed appointment, have phone numbers and has successfully received/answered the phone call and provided a date of return/ appointment for refill. 6 % of Clients returned through phone calls and refilled  in the reporting period    # clients returned through phone calls and refilled  in the reporting period Reached, booked and returned  in the reporting period Missed appointment and IIT client tracking register/Daily attendance Missed appointment call clerk/CLO Daily This refers to the percent of clients who missed appointment, have phone numbers, has successfully received/answered the phone call, provided a date of return/ appointment for refill, and has come for refill; this includes clients from previous days/ weeks/ months 7 % of clients traced back by COVs   # clients traced back by COVs  in the reporting period # clients who missed their appointment given to COVs  in the reporting period Community Client tracking log Community Liaison Officer (CLO) Daily This is the percent  of missed appointment clients who are traced back by COVs in the reporting period 8 % of clients with missed appointment returned by COVs and ARV refilled (All sources: HF and Community) Sum of the # clients with missed appointment returned by COVs and ARV refilled   (a). at the facility (b). in the community # of clients who missed their appointment and given to COVs Community drug refill log Community Liaison Officer (CLO) Daily This refers to the percent of missed appointment clients who were traced back by COVs and had their drugs refilled from the facility and community Facility QIC Indicator List- Additional to MER

11. Proposed CIT QIC Aim Statement From March 1, 2022 to May 31, 2023,  15 HF in South Sudan will decrease the p ercent of Interruption in Treatment (IIT) by 60% on the aggregate and individual site levels

12. IIT baseline and target for each QIC site by May 2023  S/N State County Facility TX_ML FY21 Q1 TX_ML FY21 Q2 TX_ML FY21 Q3 TX_ML FY21 Q4 FY21 TX_ML numerator [baseline] Target by May 2023 60% reduction  1 Central Equatoria Juba County Al Sabah child Hospital 54 48 47 37 186 74.4 2 Central Equatoria Juba Juba Teaching Hospital 232 268 325 300 1125 450 3 Central Equatoria Yei Yei Hospital 154 30 64 55 303 121.2 4 Eastern Equatoria Kapoeta South Kapoeta Hospital 32 38 74 60 204 81.6 5 Eastern Equatoria Magwi Nimule Hospital 36 25 56 40 157 62.8 6 Eastern Equatoria Torit County Torit State Hospital 55 11 4 3 73 29.2 7 Lakes Rumbek Center Rumbek State Hospital 321 320 216 184 1041 416.4 8 Lakes Yirol West Aluak luak PHCC 53 86 139 55.6 9 Lakes Yirol West Mapourdit Hospital 345 280 287 301 1213 485.2 10 Lakes Yirol West Yirol Hospital 628 521 504 394 2047 818.8 11 WBG Wau Wau Teaching Hospital 98 83 76 121 378 151.2 12 Western Equatoria Ezo Ezo Hospital 60 63 188 131 442 176.8 131 Western Equatoria Nzara Nzara Hospital 101 50 102 74 327 130.8 14 Western Equatoria Yambio Yambio PHCC 60 23 145 72 300 120 15 Western Equatoria Yambio Yambio State Hospital 48 61 113 25 247 98.8 Five States  11 counties 15 facilities 2,224 1,821 2,254 1,883 8,182 3,273

13. Examples of Site Level QIC Data Tools Missed appointment daily tracking  sheet  MMD and TLD transition sheet 

14. Baseline Data Assessment Baseline data collection at a HF

15. PEPFAR MER Indicators: TX_ML and TX_RTT FY 21

16. QIC 1: Percentage of newly enrolled clients linked to COVs Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

17. QIC 2: Percentage of clients due for ART refills provided with reminder services through call, SMS or home visit Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

18. QIC 3: Percentage of clients who missed appointments Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

19. QIC 4: Percentage of clients who missed their appointment and received calls Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

20. QIC 5: Percentage of clients who missed their appointment, received calls and returned to facility Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

21. QIC 6: Percentage of clients who missed their appointment, returned through phone calls and refilled Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

22. QIC 7: Percentage of clients who missed their appointment and returned to facility through COV tracing Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

23. QIC 8: Percentage of missed appointment clients traced and refilled through facility or community settings Community TOT for Community Liaison officers and Community HIV service officer- Dec 2020 Community Outreach Volunteer training- Jan 2021 Quality improvement training for HCWs- July 2021 Cell phones for appointment reminder and tracing distribution: June/ July 2021 Back to care plus campaign- May-Sept 2021 M&E for CHSOs- Sept 2021 COV supervisors and CHSOs Index testing and VL sample collection training- Sept 2021

24. Service Delivery Assessment – Key Findings (January 2022)

25. QIC Driver Diagram of Change Interventions

26. QIC Driver Diagram Continued

27. Implementing a QI Collaborative Training site-level QI teams (LS1) Launching QI activities at each site Monthly supportive supervision visits Quarterly Learning Sessions (LS2-LS5) Ethical /IRB reviews for non-research determination (from CU IRB, donor and country boards 27

28. Learning Session 1 2022February Develop learning objectives based on MOH and national QI strategies Develop and/or adapt curriculum  to include Continuity in Care strategies Training evaluation plan (pre/posttests)  Each facility team leaves with a well-constructed QI plan to implement their first change idea  Pre and Post testing evaluates knowledge improvements 

29. Launch of site-level QI projects Root cause analysis Identification and prioritization of change ideas Rapid, iterative tests of change Monthly data collection Charting progress on Run Charts

30. QI teams test changes to improve delivery of care using PDSA cycles QI Teams collect the same data using the same indicators and SOPs Implementing Changes

31. Monitoring Progress Using Run Charts

32. Quarterly Learning Sessions Shared learning – teams report on progress and indicators, using templates provided by ICAP Review of successful change ideas

33. Joint Monthly Supportive Supervision Review data on run charts and change ideas via PDSA worksheets Provide QI coaching and mentorship Data quality verification

34. Data Quality Assurance

35. Harvesting Best Practices for Spread and Scale-Up

36. Thank You

37. Geographic prioritization Know-Your-Client Reminder Services Case linkage management 1 2 2 1 2 1 2 Spotlight high-volume loss (Missed appointment) Mid-long term TDY (Embed) Client contact detail COV linkage management Reminder services platform HRH: Engagements and capacity building CLM: Service package COV geographic saturation QIC Overall Key Strategies for Improvement