System failures identified | Changes |
Early identification and referral for HAART initiation | |
Limited number of patients testing, stigma and lack of information or misinformation about HIV/testing, lack of time for individual counselling, loss of patients after testing not returning for CD4 count results or wellness care, patient bumping around system leading to patient loss, initiation sites turning patients away for not having correct tests/results at appointment |
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HAART initiation and chronic care | |
Misinformation about treatment and adherence, long waiting times leading to patient loss, missed appointments and poor retention, overcrowding, long time from diagnosis to treatment, loss of patients with low CD4 counts |
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↵* Denotes changes that require no additional resources (equipment, supplies, staff, etc.); can be implemented through better use of existing resources.
↵† Up-referral defined as referring a patient to a higher level of care (ie, from PHC to secondary/tertiary initiation site for more specialised treatment).
↵‡ Down-referral defined as referring a patient to a lower level of care requiring less specialisation (ie, from initiation site to PHC for nurse management).
CHC, community health centre; HAART, highly active antiretroviral treatment; PHC, primary healthcare clinic; STI, sexually transmitted infection; TB, tuberculosis.