Linking CT to care: referral systems and referral tracking "'

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• Linking CT to care referral systems and
  referral tracking -".
• Prisca Kasonde, MD, MMed, MPH
• Associate Director, Technical Support
• Family Health International/ZPCT
• Jan 22, 2008

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Counselling and Testing as an Entry Point For
HIV Prevention and Care
Adapted from UNAIDS, Report on the Global
HIV/AIDS Epidemic July 2002 (www.unaids.org/bar
celona/, accessed July 8, 2002).
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Overview

• CT is an entry point to other services
• Increased accessibility of CT has brought out
  challenges of linkages to care
• - Need to find mechanisms for effective linkages
  from CT to these other services
• With PITC, opportunity for integration of CT
  with other care services
• Where integration of CT with other services not
  possible, need to establish effective referral
  systems.

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Strategies activities for linking CT to care
(1)
Integration

• Factors mitigating against good integration
• Inadequate human resources
• Training packages too long taking away staff
  from service areas
• Shortages of HIV testing commodities

• Addressing these challenges
• Orientation and training of more care providers
  for both CT and ART
• Task shifting (including involvement of non-HCWs
  for CT, nurses for ART etc)
• Development of shorter training packages
• Strengthen commodity management and availability
  of HIV testing commodities

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Strategies activities for linking CT to care (2)

• Referrals
• Intra-facility or inter-facility
• Need to inform client on importance of referral
  and what services they are being referred for
• Some escort patients to point of care (depends on
  workload may not be very practical for most)
• Initiating facility/provider gives clear
  instructions on where the client needs to go for
  further care
• Adequate documentation to receiving
  facility/provider

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Strategies activities for linking CT to care (3)

• Referral tracking through Referral networks
• What is a referral network?
• It is a network of organizations where clients
  are referred to and the referring organizations.
  These organizations regularly meet to discuss
  referrals. If referrals are recorded both at
  origin and destination, they can compare notes
  and discuss ways of strengthening the referral
  systems

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Establishment of referral systems and network

• Situation analysis of existing referral systems
• Stakeholders meeting (all HIV and other related
  service providers)
• Formation of coordinating unit and development
  of referral tools (referral forms, register etc)
• Development of directory of services
• Orientation of service providers in tools
• Regular network meetings

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Referral tracking through Referral networks

• This approach tried in some countries with good
  results e.g. Zambia, Sudan
• Number of clients reaching intended services and
  actually receiving services improved
• Makes providers more accountable for services
  provided
• Acts as a motivating factor to providers for
  proper documentation
• However requires buy in from all stakeholders
  and good coordination

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Standard Referral tools

• Some standardized referral tools that can be
  used
• Client Referral and Feed back form
• Client Referral Tracking form
• Referral Register (Incoming outgoing)
• Client satisfaction survey form
• Directory of service data collection form
• Monthly ,quarterly and annual Report forms

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Appendix 2 KABWE DISTRICT HIV-AIDS RELATED
SERVICES REFERRAL NETWORK

• Cut here------------------------------------------
  --------------------------------------------------
  ---------------------------------------------REFER
  RAL FEEDBACK FORM

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Incoming referral register
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Outgoing referral register
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Conclusion

• Effective linkages from CT necessary for
  continuum of care
• Possible with good integration and referral
  systems
• May require slights shifts in the way services
  have been provided before