During , the MoHCC has specifically highlighted human resource challenges in meeting the needs of a maturing HIV program throughout the HIV clinical cascade, a trend which continues through doctors and nurses strikes. Districts were classified into high, medium and low gap based on the Spectrum generated number of PLHIV needing treatment.
Throughout FY19, the proportion of new positives identified through index testing increased over time and a higher proportion of new positives came from index testing in low gap districts compared to high and medium gap districts. Through index testing efforts, 10, new positives were identified. Figure 5 shows the proxy retention estimates from Quarter 3 to Quarter 4 at CDC supported sites in five provinces.
In the past year, CDC developed a novel strategy for site improvement. This site monitoring model involves half day site visits to health facilities by CDC staff to work with teams including facility, district, provincial and implementing partner staff. During this visit, 11 technical areas are assessed including those assessed through SIMS with deeper dives into the index testing cascade, Tuberculosis TB preventive therapy TPT cascade, and additional modules related to case-based surveillance and receny testing.
ZIMS focuses on monitoring, supportive supervision, and capacity building exercises using medical registers and records routinely collected at HIV service delivery facilities to both assess the program and provide capacity building during the visit. The exercises allow the entire team to look at the quality of care in a group setting and facilitate on-the-spot mentorship to make corrections and address challenges in HIV case-finding and patient care.
When a health facility is found to need improvement across multiple program areas, the site is revisited after about two months. Two facilities in need of improvement were identified in the first round of ZIMS. The revisits showed marked improvement including a focus on improved and optimized staffing and improved performance across HIV program areas.
