Ntui is the divisional head quarter of “Mbam et Kim” in the Center Region of Cameroon. With a surface area of over 430 km2, Ntui is host to over 28,000 inhabitants. The fertile land of this plateau attracts migrants from different parts of the country and beyond, making it a booming city with several businesses and agricultural activities. Like any other community, the people of Ntui are exposed to health challenges like malaria, cholera, Non-Communicable diseases and HIV and AIDS amongst others. To guarantee the wellbeing of the inhabitants, over 10 health facilities are planted in the District with the District Hospital (DH) as reference hospital in the locality.
With the advent of the HIV-Free project in 2018, the team offered quarterly technical assistance in the delivery of HIV related Care and Treatment services in Ntui health District via supervisions. Notwithstanding this move, implementation of project activities was suboptimal with persistent challenges such as insufficient HIV case identification, Antiretroviral therapy (ART) initiation, high defaulter/Lost to Follow Up rates and insufficient TB/HIV integration. Twelve months’ retention in care was around 70% only in the District Hospital Ntui. With the reorganization of the HIV-Free Centre Project into Teams I & II, several strategies have been put in place to harness and consolidate efforts already implemented by the project.
A Permanent staff was placed at the Ntui District Hospital to offer direct support to the team in place in the implementation of project activities, which include; HIV Testing services, ART initiation of clients who test HIV positive, follow-up of clients on ART, proper use of standard data collecting and reporting tools, and use of data generated to improve quality of services rendered. This strategy yielded fruits almost immediately as ART Registers were formatted properly, DAMA (HIV Management Software) introduced active search of defaulters and lost to follow-up (LTFU) which has become everyone’s concern while clients who test Tuberculosis (TB) positive are followed up for HIV testing and ART initiation. This “volte-face” can be confirmed by looking at the performance of retention for District Hospital (DH) Ntui which moved from 21% in Q2 of FY19 to 81% in Q3 of FY19.
To further improve performance at this site, a team from HIV-Free Centre Team II led by the Manager, Dr. Kum Walters visited the District Hospital Ntui in the month of June 2019 to monitor the implementation of the project activities and provide technical support for improvement.
After a courtesy visit to the Director of the Hospital, the team visited the different entry points of the Hospital which included; ANC, In Patient, Out Patient, Laboratory, Minor Surgery, CDT and the ART (UPEC) units. The team propped in questions to better understand the step by step approach of patient flow at each entry point. While the staff elaborated on their work, the team listened keenly and each time supportively came in to clarify doubts or explain what should be done at each step. The visit to each entry point ended with consultation of registers to ensure that the service providers walked their talks.
After a thorough supervision with the use of a guide developed for the purpose, the following recommendations were made to guide improvement in service delivery so that Ntui can attain 90 90 90 treatment targets by 2020; Ensure Multi Month ART dispensation, reduce turnaround time for HIV testing by separating the HIV Tests from battery of other tests while respecting the national algorithm, follow national protocol on the administration of Nevirapine to HIV Exposed Infants (HEI), properly fill all Patients’ Medical records (adult files and HEI files) and systematically test all patients diagnosed with TB for HIV.
The visit ended with an out-brief with the Director of the Hospital who expressed his satisfaction for such visits which are a learning opportunity for them. He appreciated the support of the CBC Health Board via the HIV-Free project and pledged to work with the District Clinical Mentor to implement all the recommendations made.