Improving adherence to ART for better ART Clinical outcome at Bujubuli HC III,
Kyegegwa District, Western Uganda
Authors: Byamukama Polycarp, Mutegiki Constantine
Setting: Bujubuli Health center III is a government aided health facility located in Kyaka II
refugee settlement, Kyegegwa District in western Uganda. The health center also receives
financial support from UNHCR and serves an estimated catchment population of 75000 people
majority of which are refugees.
Problem: By June 2011, 202 patients were receiving ART at Bujubuli health center with about
41% of them taking more than 95% of their prescribed ARV medicines and a similar proportion
(40.5%) were clinically well as defined by body weight, absence of new opportunist infections
and functional status.
Intervention; Following a quality improvement coaching session in August 2011 the HIV care
team at Bujubuli HC reviewed the HIV care records and discovered that a big proportion of the
clients were taking less than 95% of the prescribed medicines based on self reports and pill
counts. The team decided to initiate quality improvement
efforts targeted towards adherence to ART. During the
month of august 2011 the team started issuing of
adherence cards to all ART clients and taught them how
to use them for self monitoring of adherence.
Individualized ART adherence counseling sessions for
poorly adherent clients were introduced to solve client
specific also adherence problems. Clients were
encouraged to share testimonies about their adherence
problems during health education sessions held during
clinic days.
Client –held ART Adherence monitoring card
Table 1, trend of patient who have 95% adherence to ARVs since June 2011 to
December 2011.
Months
June July
August
September October November December
No of adherent Num 39
client as seen
from the sampled
HIV care cards
49
39
69
81
86
79
Sampled HIV care Den
cards
94
78
78
82
94
94
94
%
41
63
29
84
86
91
84
Results: With the introduction of the above mention changes, the proportion of patients
adherent to ART doubled, increasing from 41% in June 2011 to 84% by the end of 2011,
similarly the proportion of clients clinically well raised by more than 100% in the same period.
While working on improving the process of adherence to ARVs for ART clients the team
discovered that appointment keeping was a problem to some of the clients who were not
adhering well to medicines.
ART clients seen to have good Clinical outcome due to client’s adherence to ART
treatment since June 2011 up to December 2011.
Month
June July
August September October November December
Patients seen with Num 39
good clinical out
come from the
sampled HIV care
cards
49
23
77
88
91
93
Sampled HIV care Den
cards from the
patients
who
were to attend
the clinic that
month
94
78
82
94
94
94
94
%
41.5
62.8 29.5
93.9
93.6
96.8
98.9
Key;
Num= Numerator.
Den= Denominator.
Lessons learnt: Applying QI approaches to a particular process of HIV care is helpful in
identifying problems with other related processes of care.