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Quality Improvement Handbook
Figure 10. Patient Flow for HIV Counseling and Testing for Suspected and Confirmed TB Patients in Chervonograd
Flowchart illustrating the patient flow for HIV Counseling and Testing for Suspected and Confirmed TB Patients in Chervonograd, across four stages: TB dispenser, TB hospital, Infectious diseases unit, and AIDS center.
TB dispenser: Patient enters TB dispensary. Decision: Is TB suspected? If Yes, Patient is referred for sputum test and X-Ray. Potential loss point: Can get lost with no escort. Decision: Complicated active form of TB? If No, May refer for HIV testing. If Yes (or after referral for HIV testing), patient proceeds to TB hospital (Hospitalized to the center). If No (TB suspected), flow proceeds to May refer for HIV testing. Potential loss point: Can get lost with no escort. Patient proceeds to TB hospital.
TB hospital: Patient is Hospitalized to the center. Offered HIV test. Decision: Found HIV positive? If Yes, Treated for TB and HIV. If No, Potential loss point: Can get lost with no escort.
Infectious diseases unit: Pre test and consent. Blood sample withdrawal. Blood sent to Central Lab. Potential loss point: Never given certain data for results. Decision: Found HIV positive? If Yes, Patient is informed about the result of the test and asked to provide blood for confirmatory result. Blood sample withdrawal. Decision: Found HIV positive? If Yes, proceeds to AIDS center. If No, Potential loss point: Can get lost with no escort.
AIDS center: Enrollment in care.
Several aspects of the patient flow depicted in Figure 10 created a substantial risk of patient loss (flagged in the blue boxes):
- When suspected (or confirmed) TB patients reached a TB doctor, the TB doctor prescribed tests to confirm TB, but was reluctant to provide HIV counseling for several reasons: a lack of certified HCT training, a lack of job aids, and a lack of resources for HIV rapid tests at the TB facilities.
- If a patient had the complicated active form of TB, the patient was referred to a regional TB center; HIV testing was offered only at this secondary level.
- TB doctors could potentially refer a patient to a primary care center's infectious disease unit, which has a mandate to provide HCT and a laboratory for drawing blood. However, some referred patients did not go to the infectious disease unit, which is part of a separate primary health facility.
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QUALITY IMPROVEMENT HANDBOOK