BZ received a PEPFAR award to implement the ACC grant across 13 districts of the Eastern Cape (EC) and Limpopo Provinces in 2014. Advanced Clinical care management for HIV and TB Patients under the grant entitled “Strengthening capacity of South Africa Government Department of Health to provide quality and sustainable clinical care for HIV Infected patients with complicated HIV and HIV/TB treatment management, including 2nd and 3rd line and other antiretroviral therapy through the establishment of reliable referral networks by adequately trained staff”.
During the project budget period of the ACC CDC Award Number: 5U2GGH001143, BZ established a total of 110 active ACC sites, 58 of these being best performing referral sites for advanced complex HIV and TB/HIV cases.
The BZ ACC Project Team – The BZ ACC Cooperative Agreement (CoAg) has been implemented by a highly skilled and experienced team of HIV clinicians. At the start of the project all ACC teams were intensively trained and upskilled on ACC, facilitation and assessor skills. The DOH doctors were trained and mentored by BZ trained doctors whilst DOH nurses were trained and mentored by BZ experienced nurse mentors. In each district ACC training session, BZ ensured that trainings were co-facilitated by BZ facilitator and DOH specialists to curtail costs and ensure real knowledge and skills transfer thus ACC project sustainability beyond BZ support. To this end, EC districts have established their own training units to train their new incoming doctors and nurses with minimal support from BZ staff.
Development of Training Curriculum – At commencement of the ACC award, BZ developed a comprehensive modular training curriculum towards quality, sustainable and standardised clinical competency to manage complex clients with HIV and TB/HIV in all populations (adults, children, adolescent and pregnant women) and other key populations. The training curriculum focused on immunology and virology; HIV treatment failure, HIV and TB, SRH, management of ARVs, PMTCT, paediatric ART, adolescents and HIV, opportunistic infections and comorbidities, HIV testing services, HIV prevention, adherence counselling and quality improvement (QI).
Training of Health Care Workers – BZ successfully trained 596 medical officers from Limpopo and Eastern Cape provinces to improve their competency in identification, management and referral of complicated HIV and TB. Of the 596 ACC trained doctors who were issued certificates of competence, 50 were further supported to complete the HIV Diploma with the College of Medicine of SA. Similarly, 729 professional nurses were trained on the nurses’ ACC modules, and successfully completed the 5-day training and were issued with certificates of attendance to improve their knowledge and skills in the management of advanced complicated HIV and TB cases.
Strengthening Referral Pathways – To strengthen the referral pathways, BZ ensured registration of all trained clinicians to a WhatsApp group for distant ongoing mentoring and support. The WhatsApp group is composed of ACC trained clinicians and DOH medical specialists, BZ facilitators and HIV specialists from the 13 BZ supported districts in the two provinces. A toll-free phone line was established to encourage PHC nurses to triage patients being referred for specialist and ACC care. ACC trained HCWs were encouraged to send messages to their BZ mentors who would promptly return their calls to discuss their ACC clients. The toll free line has since been integrated to the ECDOH provincial call center in the Eastern Cape.
Establishment of Resource centers – To strengthen referral systems, resource centers were also established as a meeting venue for ‘grand ward rounds’ or multidisciplinary team meetings on ACC clients. The resource centers were geographically established at district hospitals or teaching hospitals that are easily accessible to the PHC HCWs.
Development of Job-Aids – Several job-aids were developed for improved quality management of ACC clients such as case study booklets, referral criteria, CHAT directory, ARV pocket book, CHAMP guide and induction pack.