3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

DEVELOPMENT OF A PAEDIATRIC HIV CHRONIC CARE MODEL TO IMPROVE QUALITY OF CARE AND ACCELERATE THE PROVISION OF ANTIRETROVIRAL THERAPY IN SOWETO, SOUTH AFRICA

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WeOa0102

Moultrie H.¹, Meyers T.², Barker P.^3
1 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, ² Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa, ³ Department of Pediatrics, University of North Carolina, Chapel Hill, United States of America

INTRODUCTION: An operational research project to accelerate the provision of paediatric antiretroviral therapy (ART) and improve the chronic care of children on ART was initiated in collaboration with the Institute for Healthcare Improvement (IHI) at the paediatric HIV clinic at Chris Hani Baragwanath hospital. The clinic currently manages more than 400 children on ART. Results from the first 3 months are described.

METHODS: A chronic care team consisting of senior clinicians, nursing staff, adherence counsellors and parents was formed. The IHI's chronic care model was utilised to identify areas needing improvement and their evidence based system of rapid cycle assessments introduced to measure the impact of interventions. A paediatric chronic disease management tool was developed and clinical and process data captured at the time of their visit. The data is continually utilised to improve patient management.

RESULTS: Improvement in patient flow and clinic design have reduced mean consultation times from 36 to 19 minutes per visit (visits assessed = 743). Clinic capacity has increased 170%, without increasing clinic hours or additional staff being employed. Patient cycle time has decreased by 31%. Roles of staff have been redefined and 90% of children's main complaints are now taken by nursing staff. Self-management plans to improve adherence have been implemented. 91% of children with results available (n=107) achieved viral suppression at 3 months on ART and median CD4% increased from 7.5% to 13.6% (n=107, p<0.0001). Weight-for age Z-scores increased from -2.05 to -1.74 (n=162, p<0.05) between baseline and 3 months on ART.

CONCLUSIONS: Efficiency of the clinic has substantially improved and patient clinical outcomes are excellent. The feasibility and value of implementing chronic disease management and quality improvement systems in a government sector clinic in a resource poor setting is evident. The model is now being implemented at 2 primary care ART sites in Johannesburg.

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