This document provides a summary of activities at Akesta General Hospital from the previous six months. It includes a list of acronyms, previous action points from catchment area meetings, major transition activities, HIV prevention activities, first 95 performance on HIV testing and ART initiation, second 95 performance on ART optimization and retention, TB/HIV collaboration, pediatric psychosocial support, cervical cancer screening, mental health integration, third 95 performance on viral load testing, and rapid test kit supply status. The document reports on performance indicators and identifies gaps to address in order to improve HIV care and treatment services.

1. CAM Report
Akesta General Hospital
By Awol Kassa
May 10/2022
kombolcha

2. List of acronyms
CAM Catchment area meeting
CEE Core essential element
DQA Data quality assurance
DTG Dolutegravir
FSW Female sex worker
HRST High risk screening tool
KP Key population
MARP Most at risk population
OVC Orphans and vulnerable children
PIP Performance improvement plan
PPSS Pediatric psychosocial support
ASM Appointment spacing model
QI Quality improvement
SIMS Site improvement through monitoring system
ICT Index Case Testing
TPT TB preventive Therapy (INH prophylaxis)
MDT Multidisciplinary team

3. List of acronyms…
HF Health facility
EAS Enhanced adherence support
NACS Nutrition assessment, counseling and support
HEI HIV Exposed infant
DBS Dried blood spot
PLHIV People living with HIV
PMT Performance monitoring team
PrEP Pre-exposure prophylaxis
RHB Regional Health Bureau
STI Sexually transmitted infection
SNS Social network strategy
TAT Turn around time
TLD Combination of Tenofovir , Lamivudine & Dolutegravir
TLE Combination of Tenofovir, Lamivudine & Efavirenz
VL Viral load
ZHD/THD Zonal Health Department/Town Health Department

4. Previous CAM action points
No Action points from the last six
month
Actions taken Remarks
1 Low HIV testing performance Discusion on MDT
meeting .
Monitor it through
Internal mentorship
on progress
2 ICT register was not updated(elicited
contacts was not tested)
work with ACMs
Phone calling.
3 QI project was not designed. NOT done ART focal
and
providers
were not
trained

5. Major Transition Activities
S. N Activity #/Yes/No
1 # of HIV related QI project/s implemented in the last
quarter/six months
0
2 If yes, briefly discuss the QI project outcome/s
3 # of DQA conducted by zone at the facility in the last
quarter/ six months
0
4 Is SIMS visit conducted at your facility in the last quarter/six
months
NO
5 If yes, have you developed performance improvement plan
(PIP) /rescored? -----
6 Briefly discuss the challenges associated with infection prevention
and control (IPC) activities in the last quarter/six months including
the 4 IPC project sites (FHCSH, GUH, WCSH & DCSH)

6. Major Transition Activities…
No Activity six
months
plan
Perfo
rman
ce
%/#
9 # of external mentorship conducted in the
last quarter/ six months (For mentoring HFs
only)
23 10 Mentoring was
not conducted
in the 1st Quar
10 # of report submitted to cluster
hospital/ZHD/RHB in the last quarter/six
months (For mentoring HF only)
1 1
11 # of internal mentorship conducted in the
last quarter/six months
3 3
12 # of MDT meeting conducted and minute
archived in the last quarter/six months
3 3
13 # of PMT meeting conducted and minute
archived in the last quarter/six months
3 3
14 # of supervision received from Woreda
health offices or ZHD/THD /RHB
(Specify)
2 3 100%

7. HIV prevention

8. HIV prevention…
No. Activities Quarter/
6
months
plan
Performance in #
(%) in 3/6 months
1
# of condoms distributed for MARPs 0 0
2
# of condoms distributed for the general
population
2514 1850
3
#of PLHIV addressed with positive living
education
1665 984
4
# of FSW reached with HIV test and other
package of services at KP friendly clinic (For
KP friendly sites only)
0 0
5
# of high risk FSW reached with HIV test and
other package of services through SNS (For
SNS sites only)
0 0

9. HIV prevention…
No. Activities Quarter/s
ix months
plan
Performance
in # (%) in
3/6 months
6
# of PLHIV received at least 1 type of care and
support from 3C’s*
0 0
7
# of OVCs received at least 1 type care and support
from 3C’s
0 0
8
# of clients put on PrEP 05 02
9
# of clients lost from PrEP 0 0
10
# of clients currently on PrEP 05 02

10. First 95 performance

11. Status of HIV risk screening tool (HRST) utilization at HFRisk
Screening Tool (HRST)
No. Activities Quarter
/six
months
plan
Performanc
e in # (%)
in the
3/6
months/Y/N
1 Is there HRST available ? YES
2 If yes,
2.1
# patients visited HFs in the last quarter/six months 22455 25959
2.2 # Patients screened in the last quarter/six months 22455 8211
2.3 # Eligible for HIV testing in the last quarter/six months 2100 1780
2.4
# Tested for HIV in the last quarter/six months 2100
1009 kit
shortage

12. HIV testing services
No. Activities Quarte
r/six
months
plan
Achive
ment
Performa
nce in #
(%) in
3/6
months
1 Total # of individuals tested for HIV in the
last quarter/six months
1.1 adult
1.2 children
2570 1570 61.1%
2226 1501 67.4%
344 69 20.%
2 Total # of HIV positive clients identified
2.1 adults
2.2 children
30 18 60%
25 17 68%
5 1 20%
3
# of HIV +ve clients received from other
facility/community based organizations
(CBOs)
03 01 33.3%
4
# of HIV +ve clients linked at HIV
positive tracking register
43 19

13. Index case testing status at ART and PMTCT clinic
No. Activities Quarter/si
x months
plan
Performanc
e in # ( %) in
3/6 months
1 # of clients newly started ART in the last quarter/six
months
30 16
2 # of spouse/non-spouse ,children and parent of
newly started ART clients registered at index case
register
30 16
3
# of spouse/non-spouse ,children and parent of
newly started ART clients registered at index case
register with unknown status
10 9
4
# of spouse/non-spouse ,children and parent of
newly started ART clients tested for HIV
4.1 # tested positive
4.2 # linked and started ART
10 7
05 02
05 02

14. Index case testing for high viral load (VL) clients
No. Activities Quarter/
6 ms plan
Performance
in # (%) in
3/6 ms
1 # of PLHIV on ART with high VL results in
the last quarter/six months
0 0
2
# of spouse/non-spouse and children of high
VL clients registered at index case register
0 0
3
# of spouse/non-spouse and children of
PLHIV with high VL tested for HIV
3.1 # tested positive
3.2 # linked and started ART
0 0
0 0
0 0
0 0
0 0

15. HIV Exposed Infants HIV testing
No
.
Activities Quarte
r/6
months
plan
Performance
in # (%) in
3/6 months
1
# of HEIs identified in the last quarter/six months
13
2 # of HEIs who received ARV prophylaxis 13
3 # of DBS samples sent to testing site in the last
quarter/six months
8
4
# of HEIs tested HIV positive with DNA PCR in
the last quarter/six months
0
5
# of HEIs tested positive, tracked and started within
with in 7 days
0
6 Average DBS TAT in the last quarter/six months
3hr

16. CBS implementation
No. Activities Quarter/6
months
plan
Performance in #
(%) in
3/6 months
1
Total # of newly identified HIV positive
individuals with completed CRF (Case
Reporting Format)
30 18
2
Total # of HIV positive clients tested for
recency testing
25 12
3
Total # of individuals with recent infection
01

17. Sexual transmitted infection (STI) and HIV testing
No. Activities Quarte
r/six
months
plan
Performance
in # (%)
1 # of STI cases diagnosed in the facility in the last
quarter/six months
45 43
2
# of clients treated with syndromic approach in the last
quarter/six months
45 43
3
# of partners of STI cases notified , diagnosed and
managed for STI in the last quarter/six months
35 29
4
# STI clients tested for HIV in the last quarter/six
months
45 43
5
# STI clients tested HIV positive in the last
quarter/six months
03 01
6
# of clients tested HIV +ve linked to ART clinic in the
last quarter/six months
03 01

18. Post GBV/sexual violence (SV) service
No. Activities Quarter /6
months
plan
Performanc
e in # (%)
in 3/6
months
1 # of GBV/SV survivors who visited facility in the
quarter
5 27
2
# of GBV/SV Survivors who got Post GBV/SV
clinical care
5 27
3
# GBV/SV survivors provided with PEP 5 0

19. Second 95 performance

20. ART initiation performance
Activities Quarter/six
months plan
Performance in
# ( %) in
3/six months
1
# of clients linked to care (# of clients registered
on HIV positive tracking register)
30 19
2
# of clients initiated ART with in a week including
same (rapid initiation) day in last quarter/6
months
2.1 adults
2.2 children
30 16
25 16
05 0
3 # of clients initiated ART after a week
3.1 adults
3.2 children
0 0
0 0
4 # of clients referred to other HFs
0
03
5 # client with confirmed referral 0 03

21. Not yet started clients status
Activities Quarter/six
months plan
Performance in #
(%) in the
3/6 months/Y/N
1 # of total clients not yet started ART 0
2 Reasons for not yet started clients
3 Does the facility monitor and follow not yet
started clients with not yet started checklist
yes

22. ASM and NACS performance
No Activities Quarter/6m
months plan
Performance
in # (%) in 3/6
months
1
Currently on ART
4.1 adult
4.2 Children
1057
1028
29
2 # of stable ART clients 967
3 # of stable clients ever enrolled in to appointment spacing
model (ASM)
606
4
# of stable clients ever enrolled in to Fast Track ART Refill
(FTAR)
96
5 # of stable clients refused to be enrolled in to differentiated
service delivery model (DSD)
207
6 Total # of PLHIV assessed and diagnosed as undernourished 34
7
Total # of PLHIV who received therapeutic/supplementary 0

23. ART optimization
No. Activities Quarter/s
ix months
plan
Performance in
# (%) in
3/6 months
(Y/N)
1
Does the facility have any clients who are on NVP
based regimen (if yes specify the reason )?
NO
2
# of existing pediatric clients aged < 10yrs & >
20kg ) shifted to ABC/3TC/DTG
0
3
# of existing pediatrics clients aged< 10yrs & <20kg
shifted to ABC/3TC/LPV/r
0
4
# of existing pediatrics clients aged > 10yrs &
>30kg shifted to TLD/TLE
3

24. ART client retention
No. Activities Quarter/six
months plan
Performance
in # (%) in
3/6 months
1 TI in the last quarter/six months 4
2
TO in the last quarter/six months
8
3
Lost to follow up/Drop/ in the last quarter/six
months
5
4
# of clients traced back in the last
quarter/6months
4
5 # of total deaths in the last quarter/ six months
6
6
# of deaths for which death audit is done in the
last quarter/six month?
6
7
Net treatment current increment (treatment
current in last quarter/6 months - treatment
current in the previous quarter/6 months)
-6

25. TB/HIV collaboration
No
.
Activities Quarter 6
months
plan
Performance in #(%)
in 3/6 months
1
# of patients diagnosed for TB in the last
quarter/6 months
8 10
2
# of patients diagnosed for TB and tested for
HIV in the last quarter/6 months
8 10
3
# of patients diagnosed TB and tested HIV
positive for HIV in the last quarter/6 months
tested HIV positive
3 0
4
# of TB patients diagnosed in the last quarter/6
months tested HIV positive and started CPT
3 0
5
# of TB patients diagnosed in the last quarter/6
months tested HIV positive and started ART
3 0

26. TB/HIV collaboration…
No. Activities Quarter/
6 ms plan
Performance in
# (%) in 3/6
months
6
Proportion of ever started TPT (TPT started/TX-
CURR)
100% 98%
7
Proportion of clients completed
TPT(completed TPT/started TPT)
95% 92%
8
Existing ART clients who were screened for TB at
the end of the quarter/six months
1057 1057
9
Screen negative existing clients who started TPT
in the quarter
0 18
10
Proportion of newly enrolled in HIV care who
started TPT during the last quarter/six months
30 11

27. Pediatric psychosocial support (PPSS)
No
.
Activities Quarter/
six
months
plan
Performanc
e in # (%)
in 3/6
months
1 # of children on ART disclosed their HIV status
in the last quarter/six months
05 2
2 # of children disclosed their HIV status and
enrolled to the PPSS in the last quarter/six
months
05 2
3 # of children currently participating in the PPSS
program
53 57

28. Cervical cancer screening and management
N
o.
Activities Quarter
/ six
months
plan
Performance
in # (%) in
3/6 months
1
# WLHIV aged 15-49 screened for cervical cancer
with VIA for first time in the reporting period
335 21 (only on
october)
2 # found positive with VIA for dysplasia
0
3 # of clients treated with cryotherapy
0
4
# of clients who received follow up after treatment in
the reporting period
0

29. Mental health integration (MHI)
No
.
Activities Quarter/
six
months
plan
Performance
in # (%) in 3/6
months
1 # of eligible clients screened for mental health
problem
1063 1057
2
# of clients who have symptoms of MH illness
0 02
3 # of clients referred to clinician for mental health
evaluation
0 02

30. Third 95 performance

31. Viral load test performance
No. Activities Quarter
/six
months
plan
Performanc
e in # (%)
in 3
/ 6 months
1 Total viral load specimen sent in the last quarter/six
months
520 305
2
Total viral load result received in the last quarter/six
months
149
67-Reject
3
# of viral load results > 1000 copies/ml in the
quarter quarter/6 months
0
4
Average VL turnaround time (TAT) in the quarter/6
months
29 days

32. Viral load test performance …
No. Activities Quarter
/six
months
plan
Performanc
e in # (%)
in 3/6
months
5 # of high VL clients enrolled in EAS in the last
quarter/six months
0 0
6
# of high VL clients completed EAS in the last
quarter/six months
0 02
7
# of high VL clients completed EAS and 2nd VL test
done in the last quarter/six months
02
8
# of clients with 2nd VL viral load results > 1000
copies/ml in the last quarter/6 months
0
9
# of clients switched to the second/3rd line ART in
the last quarter/six months
0

33. Rapid test kit supply
S.|
N
Activity Stat
pack
Abon SD
Bio
line
1 Total # of rapid HIV test kits at the
beginning of the last quarter/6 months
0 1 box 0
2 Total # of rapid HIV test kits received last
quarter/6 months
96box 1box 2box
3 Total # of rapid HIV test kits expired /
damaged last quarter/6 months
3box 0 0
4 Total # of rapid HIV test kits utilized last
quarter/6 months
80box 2box 1box
5 Total # of rapid HIV test kit currently stock
on hand last quarter/6 months
13box 0 1box
6 Total tests reactive /positive in the last
quarter/6 months
60 34 34

34. Pediatrics ARV drug stock status
Activity
ABC
+
3TC
(120+60)
AZT
+3TC
(60+30)
Lop/r
pellet
Lop/r
125mg
1 Total # of packs at the
beginning of the last
quarter/6 months
70 20 0 100
2 Total # of packs received
last quarter/6 months
200 16 50 0
3 Total # of packs expired /
damaged last quarter/6
months
0 0 0 0
4 Total # of packs utilized last
quarter/6 months
270 0 50 68
5 Total # of packs currently
stock on hand last quarter/6
months
0 36 0 32

35. ARV drugs & rapid test kit supply…
S.
N
Activity Yes (List) No If yes, for
how long?
1 Was there rapid test kit interruptions in last
quarter/6 months?
 . 2 month
2 Was there DBS kit interruption in the last
quarter/6months?
 . 3month
3 Was there Pediatrics 1st,2nd & 3rd ARV drugs
interruptions in last quarter/6 months?
 DTG
50mg.
1month
4 Was there Adult 1st,2nd & 3rd line ARV drugs
interruptions in last quarter/6 months?
 .
5 Was there INH/ CPT interruption in the last
quarter/6 months?
 .
6 Was there interruption of VL test tube in the
last quarter/six months?
Yes
ppt/EDTA
test tube
3month

36. Challenges
No Challenges Actions undertaken
1 Stock out of Nutirtional supplement Counseling on nutrrition
2 Stock out of ABC/3TC, RTKs and
EDTA/PPT tubes
communicate with EPSA
3 Stockout of CD4 cartilage communicate with EPSA

37. Promising/Best practices

38. Thank You!!!