Historically Black Colleges and Universities (HBCU) Global Health Consortium
(2017 – 2019)
The Historically Black Colleges and Universities (HBCU) Global Health Consortium was launched by the Health Resources and Services Administration (HRSA), HIV/AIDS Bureau, Division of Global HIV Programs in February 2017 with funding from the Office of the U.S. Global AIDS Coordinator and Health Diplomacy. AIHA provided program and financial management, along with logistical, technical, and human resource support to ensure successful implementation of this PEPFAR project designed to transform HIV/AIDS clinical practice at four hospitals in Lusaka, Zambia.
The HBCU Consortium’s key objective was to build the capacity of frontline health workers and hospital leadership to improve the quality of healthcare, clinic workflow, and teamwork as a way to improve health outcomes and support Zambia’s 95-95-95 strategy to achieve epidemic control.
The HBCU Global Health Consortium members included:
CDU’s focus was on supporting and improving linkage and retention in children and adolescents in the Chawama Level 1 Hospital. Zambia’s PEPFAR Country Operational Plan (COP) 2017 outlined a plan to improve linkages to HIV testing, treatment and care for all age and sex bands, through improved connections with community partners, as well as enhanced referral and follow-up processes. In support of this, CDU aimed to improve linkage to and retention in HIV care and treatment for 15-24-year-old HIV-positive females. Intervention activities included partnership with existing HIV testing and DREAMS agencies to implement youth friendly HIV peer navigation services that efficiently link newly diagnosed HIV-positives adolescent girls and young women (AGYW) to HIV care, treatment, and psychosocial support. Improved linkage to and retention in HIV care and treatment for AGYW will result in improvements in both the second and third 90s of the UNAIDS 90-90-90 global targets.
- CDU reached over 1,285 (563 HIV positives and 722 HIV-negatives) unique 15-24-year-old females enrolled in Rise Up!
The First Lady of Zambia, Esther Lungu, personally invited the CDU Principal Investigators to the Zambian State House in Lusaka.
- SmartCare installed at Rise Up! House, linking client information regarding services provided at both Chawama Hospital and Rise Up! House for all providers of clinical services for 15-24-year-old females.
- Pick up days extended from one day in a week to six days for 15-24 years old females.
- The planned activities such as the school clubs, vegetable garden, microenterprise handcraft activities, and movie events are moving forward and productive.
With the Global Health Consortium, HU focused on supporting differentiated ART Care in the Matero Level 1 District Hospital. The COP for 2017 outlined a plan to scale-up differentiated models of HIV care for pediatric and adult patients across 86 districts with the goal of achieving a down-referral of at least 96,783 stable adult HIV-infected individuals and at least 10% of stable pediatric patients into community care and treatment by the end of 2018. Howard sought to improve the quality of ART care for PLHIV by alleviating congestion through suitable differentiated care models and improving community-based ART services. Differentiated delivery of ART services assist with decongesting the hospitals and free up more time and resources to initiate new patients and manage unstable patients and patients at risk of failing treatment. Decongestion allows more enrollment and uptake of ART services contributing to the second 90. Improved and personalized adherence counseling of ART patients contributes to the third 90.
- Identified and engaged 5 community-based health care facilities that can serve as an alternative ART care delivery sites for stable HIV patients from Matero First level Hospital.
- Maintained six community down referral clinics and capacitated them to serve as ART pick-up points for stable ART clients who live far from Matero Hospital- while maintaining a fast-track pharmacy within the facility (patients enrolled in the fast-track DSD model).
- Over 41 healthcare workers and CHWs provided training on DSD and pharmacovigilance; 6 CHWs were provided with ongoing support to monitor linkage and retention in care of down referred HIV patients.
- Identified 1000 HIV patients who are stable on ART and facilitate down referral to preferred community-based health facilities to continue ART care as well as maintained 6,742 stable ART clients for fast track model of DSD, and another 732 to the six community- based down-referral sites.
- Improved detection and management of adverse drug events associated with HIV medicines through routine pharmacovigilance services, 144 cases of ADR were identified; 144 cases of ADR forms completed and reported to ZAMRA.
Meharry focused on quality improvement (QI) planning- particularly rapid cycle quality improvement focusing on early diagnosis of infants and children with HIV in Chilenje Level 1 District Hospital. The overall aim was to implement continuous QI in patient-centered care by assessing the timeliness, initiation of HIV testing, and ART for infants and children, and assessing the retention in care and viral load suppression of patients through quality improvement measures. Performance measures were established with clinic staff for QI in the clinic, especially for infants. Quality improvement and practice transformation assist with identifying infants and children earlier in the care continuum and improve health outcome (first 90). By diagnosing infants within six weeks and improving the clinic flow for patients receiving ART, crowding will be decreased- giving way to an increase in uptake of ART services, which will contribute to the second 90. Improved and personalized adherence counseling for infants, children, and adult ART patients will contribute to the third 90.
- Improved dry blood spotting (DBS) testing by decreasing test results turnaround from 3-4 months to 7-14 days and effectively increased collections from 37% to 96% within the first 6 week’s of the baby’s life.
- Improve by 10% over the current baseline, patient flow and clinic flow to improve the testing and treatment of children and adults.
- Helped to implement a systematic tracking of DBS and viral load assays, coupled with improved coordination among different clinics, now in place.
- Compiled evidence-based data for the facility showing that as of May 2019, 91% of clients know their HIV status (First 90), of these 78% are on ART (second 90), and 67% have achieved viral suppression (third 90).
- Establish QI Processes to ensure that 90% of all tracking appointments, actual visits, missed appointments, referrals, hospitalizations, ART pickup, and viral load are documented.
During the initial phase of the Global Health Consortium project, MOSM’s focus was on optimizing HIV related clinical outcomes with better care coordination in the Kanyama Level 1 District Hospital’s ART Clinic. MOSM sought to increase the 1st 90 for early initiation of ART and improve retention and care for 2nd and 3rd 90s. Also, to improve HIV testing rates, patient retention, anti-retroviral treatment and viral load testing/reporting through workflow re-design; as well as encourage better care coordination and improved integration and reliability of data management related to the SmartCare electronic health record system in Kanyama Hospital and Zambia District ART Clinics. Improving the diagnosis, tracking, notification, and overall engagement of ART patients to increase the utilization of comprehensive ART services. Data collection and management will also be improved to enhance the care continuum for better care coordination and health outcomes.
- Identified and assessed clinic workflow including the collection and analysis of patient data within the Kanyama ART clinic as an initial step toward improving patient flow, data accuracy and data interpretation for optimal clinical outcomes.
- Developed, enhanced and implemented a plan to revise the referral system for optimal care coordination and patient tracking throughout the Lusaka Health District.
- Initiated a pilot patient engagement mobile technology that addresses congestion in the waiting rooms, excessive wait times, lost to follow up clients and improvement of ART initiation rates managed to create the platform and recruitment has commenced with the Hospital WIFI. This successfully allowed and improved staff’s communication, ability to have secure and trusted connectivity for training and learning purposes, and for client educational opportunities onsite.
- Vital signs machines procured and delivered to bridge the gap in vital sign reporting for ART clients in Kanyama; adding capturing of blood pressure and pulse beyond monitoring of vital signs capturing temperature, height and weight.