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[Malawi Core] ART Clinic Visit #1159

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Gental-Giant opened this issue Mar 22, 2022 · 0 comments
Open

[Malawi Core] ART Clinic Visit #1159

Gental-Giant opened this issue Mar 22, 2022 · 0 comments
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Documentation Improvements or additions to documentation Malawi CORE

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@Gental-Giant
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Background.
The ART Clinic serves HIV positive clients on ART. These services are provided through one of the following approaches:

  • The Point of Care System: This is when the EMR is used to provide care to a client in real time.
  • The eMaster Card System: This is when all visit information is written on the client’s yellow master card and entered into the EMR after a visit is completed.

The services are provided to the clients regardless of age or sex. However, there are some instances in which ART services are specially provided to an age group or a gender as displayed below.

  Specialized Clinics Description and Beneficiary
1 Men’s Health Clinic A men’s only clinic with men receiving their ART care at the ART clinic.
2 Antenatal Care Clinic Pregnant women who have gone to the Antenatal Care clinic for their antenatal services and are being screened for HIV testing services and receiving their ART care if they are HIV positive.
3 Teen Club A meeting for children 10 – 19 years old who have been disclosed to (are knowledgeable of the fact that they are HIV positive) and are receiving their ART care services with their peers.
4 *Child Care Clinic This is a clinic for children 5 – 9 years who have not yet been disclosed to (do not know that they are HIV positive) but are receiving their regimen.Note: This is not yet an official clinic. It runs concurrently with the regular ART Clinic only that when the parents come in to get their care, the children are pulled aside and given general information about how viruses work in the body and other information relevant to their age group.
5 Mother Infant Pair Clinic This is a clinic for mothers and children 2 years old and below. In this clinic, the mother receives her regular ART services while the child receives preventative services and gets tested for HIV at set intervals.

Services Provided include:

  • The Health Talk is not a compulsory activity. It is provided at the start of the clinic day but only clients who have arrived when the clinic is starting are able to hear it. There is a list of topics that are shared; however, the content of the health talks differs on each ART clinic day until the list is done and the cycle begins again.

  • Vitals are compulsory for every client. However, adults will get only their weight collected unless they are a newly diagnosed client, their master cared is missing or they are signs of malnutrition at which height is also needed in order to calculate the adults Body Mass Index (BMI) and categorize their malnutrition. Children however will have their weight, height and MUAC checked at each visit.

  • Pre-screening is compulsory for every client but the screening questions may differ due to age and gender. In this process, clients are sifted through the clinic using the ART HCC Triage Screening Tool to see what services they may need that day.

  • Assessment is another compulsory activity and it follows after the pre-screening. In this, the client receives a thorough assessment and required services available at the facility or referred to another facility. Some assessments such as cervical cancer screening, viral load sample collection and BP checks are routinely done whether or not the client is feeling healthy. Other services such as Intensive Adherence Counselling and Family Planning are triggered by a client's health and need.

  • Regimen Provision is at the center of the ART clinic. Clients will receive their regimen per month if they are new clients as they need close observation or as Multi Months Dispensation (MMD) if the client qualifies for MMD. For MMD, clients may be given 3 – 6 months’ worth of regimen depending on the regimen available at the clinic, the client’s past adherence and the client’s age. Children are provided with regimen based on weight up to 30kg’s, as such, have to come more frequently to the clinic.

  • The Next Appointment date is provided at the end of the clinic. The next appointment date depends on several factors:

    • New clients come to the clinic monthly for the first 6 months after enrolling in the ART clinic. This depends on a clients’ adherence, it is possible for a new diagnosis to come to the clinic on months 1,2, 3 and 6 only.
    • Children’s visits will be spaced out with not more than 3 months from the last visit as their regimen or medication is calculated based on their weight.
    • Clients with a high viral load will be closely followed for 3 months after being assessed as an HVL client.
    • Client availability to return to the clinic.
    • The kind of regimen is available, whether monthly or multi-months dispensation. This last reason is not the main determining factor however, as sometimes a clinic may have only 3 months dispensations to give to a new client but the new client still has to come in a month.

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