Laboratory Collaborative Uganda | USAID Health Care Improvement Portal
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Laboratory Collaborative Uganda

Collaborative Profile
Author(s): 
Francis Ocen
Sponsors/partners: 
USAID Health Care Improvement Project, Ministry of Health Uganda

Topics: HIV laboratory services, HIV/AIDS

Region and Country: Africa, Sub Saharan, Uganda

Date improvement activities began: 
August, 2009
Aims/objectives: 

The collaborative seeks to improve the numbers of HIV clients who receive accurate and timely HIV-related laboratory tests and test results. The collaborative is focusing on: 1) Increasing the number of infants and children enrolled in HIV/AIDS care through improved case detection among pregnant mothers and exposed infants; 2) improving sample acceptability for testing and machine functionality to increase numbers of clients able to receive CD4.

Implementation package/interventions: 

Improvement collaborative

Measurement: 

Key Indicators used by participating teams:
• % of predetermined days that the CD4 machine is operational/functional
• % of samples received from other health facilities that are acceptable for testing
• % of samples referred that are acceptable for testing
• % of days in a month when HIV test kits are available
• % of newly identified HIV positive patients who obtain a CD4 test within the same month
• % of patients booked for CD4 sample taking and referral whose samples are taken
• % of scheduled CD4 machine preventive maintenance that is carried out In a month
• % women attending ANC clinic in a month that are tested for HIV
• % infants born to HIV+ mothers whose samples are taken for DBS-DNA PCR between 6 weeks and 6 months of age
• Average monthly turnaround time for DBS results

Spread strategy: 

Best practices emerging from specific areas of the collaborative will be compiled and shared within the lab collaborative as well as the other HCI collaboratives in Uganda to begin with.

Number of sites/coverage: 

The total number of facilities participating in the collaborative is 14 consisting of One Regional Referral Hospitals, Six General Hospitals, Six Health Center IVs and One Health Center III. These facilities are in 12 out of 80 districts and are located in 3 of the 12 Health regions in Uganda.

Coaching: 

At the start of the HCI ART Collaborative, a group of coaches, known as the Core Team, was formed at the national level from Ministry of Health and HCI staff to support sites and develop technical strategy for the project. The Core Team build capacity of MOH regional staff, called Regional Coordinators to conduct trainings and coaching sites in quality improvement and clinical treatment. Regional Coordination Teams were set up in 12 health regions of Uganda with 5 members each representing data, laboratory services, pediatric HIV, and 2 for general HIV care. For the Laboratory Collaborative, sites are being coached by HCI/Core Team/Regional Coordinators once per month except in a few cases when we go for targeted coaching. The physical visits are strengthened by phone and email contacts to sites whenever applicable.

Learning sessions & communication among teams: 

For every facility participating in the laboratory collaborative, usually two laboratory persons attend the learning session. We encourage rotation of attendance so that as many people from the same lab as possible attend at least one. However LS2 was attended in addition by one PMTCT/ANC focal person and the health facility in-charge strategically to buy in their support as some of the activities here cross cut.
The general topics covered usually include Quality improvement principles and approaches as well as technical topics relevant to the collaborative (Early Infant Diagnosis, program and implementation update, the new strategies to improve its smooth running, CD4 test, equipment care and maintenance among others) The facilitation techniques used include illustrative lectures, group discussions and posters.Data and information are got from sites during the physical monthly coaching visits, phone calls and occasionally emails. Data got from sites are entered in a basic database to track performance over time. Improvement changes being tested at sites are also captured; Changes monitored over time and deemed to cause improvements across sites will be compiled and shared with interest groups.
Teams are communicating with each other remotely for now between learning session. through the coaches, a little more directly though with sites having regional coordinators who go out to visit other sites.

Results: 

See graphs in document below.