The project focused on the expansion services to People Living with HIV/AIDS (PLHA) by its multi-disciplinary team recording remarkable achievements throughout the year under review. Capacity building for the project staff to improve the quality and delivery of services was provided through several trainings .The project’s Community Home Based Care (CHBC) unit has extended its services to 9 Local Government Areas (LGAs) within Kano state and the Prevention of Mother- to -Child Transmission (PMTCT) unit now supervises and supports 15 PMTCT sites across Kano, Jigawa, Katsina and Bauchi states.
2443 new patients were enrolled into the program out of whom 1141 were placed on ARVs (1071 adult and 70 paediatric) .By the end of December 2009, a total of 10,846 patients (9120 adult and1726 paediatric PLHA) had been recruited into the programme since inception in 2004, with a total of 6110 (5605 adults and 505 children) patients placed on various ARV regimens.
The general trend for patient’s recruitment by year for both adult & paediatric.
Adult A.R.T. Services:
The services at Adult ART clinic continued to improve in quality with increased supervision and training of staff of the clinic. Clinical services by a multi-disciplinary team in the clinics, wards, emergency room and the ART day-care unit were offered throughout the year without major constraints.
A total of 9120 adults (3947males; 5173 females) have been enrolled into the programme, of whom 5605 (2432 males; 3173females) were placed on various ARV regimens. The integration of the management of TB-HIV Co-infection continued to improve throughout the year under review. The interruption of anti-TB supply from the Federal Ministry of Health continued but with lesser frequency compared to the previous year and was eased out by the provision of some drugs from the management of AKTH. HIV counselling and testing (HCT) service was established in the TB-DOTS clinic and was offered to all patients who accessed treatment there. Out of the1167patients that attended the clinic in 2009, 257 patients (23.6%) were co-infected with HIV & TB.
Paediatrics A.R.T. Services:
By the end of 2009, a total of 1726 paediatric patients were recruited for care, support and treatment. Five hundred and five (276 males; 250 females) were placed on various ARV regimens. Early infant diagnosis with the PCR machine was accessed by 56 Health facilities in the North-West region. A total of 3324 samples from this region were analysed and 370(11%) turned out to be +ve, while a total of 529 samples from AKTH were analysed and 48(9.1%) turned out to be +ve. The majority of the mothers of the infected babies didn’t attend Ante-natal care / PMTCT services in this hospital and rate of transmission of HIV infection in babies of mothers who attended ANC was about 3 %.
HIV Counseling and Testing (HCT) Services:
HCT services recorded a 5741(3731-ve & 2010 +ve) new clients in 2009, with the continued provision qualitative services including provision of basic information on HIV/AIDS, sexually transmitted disease and Tuberculosis (HAST) to clients.
Linkages of HCT, ART,TB-DOTS, Care & Support and PMTCT services continued to be fortified during the year. By the end of December 2009, the cumulative number of clients counselled and tested has reached 32,993(11906+ve; 21,087-ve) and of those that tested +ve for HIV, 7462 were males while 4444 were females.
Community Home Based Care Services: (CHBC)
CHBC services since its inception in 2006, has expanded its services to 9 LGAs currently in Kano state. It has recorded remarkable successes in the areas of social rehabilitation of PLHA ,stigma reduction, home based care, tracking of defaulters, confliction resolution, inter-marriages referral of clients to hospital and community advocacy and mobilization.
The unit operated with 35 volunteers and has visited 445 homes distributing over 75 CHBC kits and educating 1178 people affected by AIDS (PABA). Over 400 orphaned and vulnerable children were cared for during the year under review.
The unit also conducted community advocacy visits, sensitization and radio programs at least twice a month. It also collaborated with community based organizations (CBOs) and Faith based organizations (FBOs) to strengthen linkages & referrals of PLHAs to access care and support. Skill acquisition programs were also provided for 22 PLHA.
Its activities during the year under review included strengthening PMTCT services by enhancing linkages to AKTH and collaborating with a new PMTCT support group (Mother-to-Mother) formed in 2009.
In the support & care unit 2642 clients were seen in 2009. Nutritional assessment and support was offered in addition to psychosocial and preventive education.Tracking of patients lost to follow-up was strengthened by the unit with the returning of 636 patients lost to follow-up to clinic in the year under review.
Prevention of Mother To Child Transmission (PMTCT) Services:
This unit continued to provide qualitative PMTCT services to clients with the support of AKTH management and IHVN during the year under review. It provided services to all obstetric patients attending ANC in AKTH and also mentored and supported 15 PMTCT satellite sites across Kano, Jigawa, Kastina and Bauchi states using the IHVN HUB and SPOKE model.
Early infant diagnosis of HIV infection during the year have shown the transmission rate from mother to child amongst those who accessed PMTCT services to be about 2-3 %.
Over 3730 ANC clients were counselled and tested in 2009 with 372 HIV infected pregnant women detected and placed on ARVs. The uptake for HCT was 100% and all HIV-Infected pregnant women were given counselling on infant feeding.
Provision of comprehensive laboratory services to all PLWHAs was steady. These services include HIV screening(5028 tests), CD4 count (12,401 tests), Blood chemistry (11,241 tests), Pregnancy test, Haematology(14,257 tests), Chest X-Ray, Sputum examination for TB, early infant diagnosis ( 3324 HIV-DNA tests,11% +ve) and 548 Viral Load (HIV – RNA) assays.
Adherence Counselling Service:
This unit provided adherence counselling to over 2642 patients at various service points within the hospital. It also offered regular group health talks on adherence to ARVs, TB-DOTS, prevention among positives, nutrition, PMTCT, positive living and personal hygiene. These services were offered on a regular basis by well trained and experienced counsellors in collaboration with peer educators.
Monitoring And Evaluation: (M&E)
Qualitative M&E was provided and sustained by the Department of Community Medicine. Data management with minimal errors was provided with adequate quality control measures in place. Steady provision of patient monitoring and management (PMM) tools and a change in computer server by IHVN improved efficiency in services discharged. The introduction of Quality Improvement measures by the ACTIONQUAL committee ensured better data documentation and management.
This unit recorded successes over the year with reactivation of the Axios Integrated Information system (AIIMS) leading to better documentation of all drugs dispensed to patients and proper verification of patients’ drug regimen. Continued supply of ARVs, ACTION Meal and OIs drugs was ensured during the review period. The unit also received breast milk substitute supply from the Kano state zakkat commission to alleviate the shortage of this commodity for effective PMTCT services. The Hospital management employed additional staff who manned the pharmacy efficiently during the review period.
Capacity building for staff members in various units of the project continued throughout the year through trainings and re-trainings on thematic areas.