Orphan and Vulnerable Children Situation Analysis ... - basics

BASICS PEDIATRIC HIV TOOLKITORPHAN AND VULNERABLECHILDREN SITUATION ANALYSIS:INTERVIEW GUIDE FOR HEALTHCARE WORKERS

U.S.AgencyforInternationalDevelopmentBureauforGlobalHealthOfficeofHealth,InfectiousDiseasesandNutritionRonaldReaganBuilding1300PennsylvaniaAve.,NWWashington,D.C.20523Tel:(202)7120000Email:globalhealth@phnip.comwww.usaid.gov/our_work/global_healthBASICS4245N.FairfaxDr.,Suite850Arlington,VA22203Tel:(703)3126800Fax:(703)3126900Email:basics@basics.orgwww.basics.orgSupportforthispublicationwasprovidedbytheUSAIDBureauforGlobalHealthBASICS(BasicSupportforInstitutionalizingChildSurvival)isaglobalprojecttoassistdevelopingcountriesinreducinginfantandchildmortalitythroughtheimplementationofprovenhealthinterventions.BASICSisfundedbytheU.S.AgencyforInternationalDevelopment(contractno.GHAI00040000200)andimplementedbythePartnershipforChildHealthCare,Inc.,comprisedoftheAcademyforEducationalDevelopment,JohnSnow,Inc.,andManagementSciencesforHealth.SubcontractorsincludetheManoffGroup,Inc.,theProgramforAppropriateTechnologyinHealth,andSavetheChildrenFederation,Inc.

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008, revised versionInterview GuidePediatric HIV Case Identification, Referral and Care at Health Facilities fororphans and vulnerable children (OVC)For interviews with health care providers at provincial and districthospital level and health center and dispensary level providingcare, treatment support for Pediatric HIV, ART, PMTCT, HCT, MCH,IPD and OPDDate:Interviewer(s)Name of DistrictName of Health FacilityInterviewee(s)Team:Contact Person:Phone:GeneralAsk to speak with the person in charge for social center or NGO who is present today.Introduce yourself, briefly explain the purpose of your visit and ask if she/he would be willingto answer few questions about orphans and vulnerable children with HIV and AIDSHello. My name is _______________. My colleagues and I are here on behalf of to conducta joint situation analysis to learn more about your services related to HIV/AIDS and OVCs.The information you provide us is very important and valuable, which will help to informsocial centers, health facilities, care givers, to support and improve OVC related policies andthe delivery of services. We do appreciate your time and responses.THANK YOU2

Interview Guide: Health Facility Assessment of Pediatric HIV Services(for use at provincial and district hospital level and district health center and dispensarylevel)Type of Facility: Referral Hospital Regional Hospital District Hospital Health Center DispensaryType of siteLocation of the site___________________________Linked to:Regional Hospital Name……………………………..District Hospital Name…..……..Health Center (1)……..……………………………..Health Center (2)…..……………………………..Health Center (3)……..……………………………..Health Center (4)……..……………………………..Dispensaries (Number)……………………..……..Site Characteristics Public (government) Private, (NGO) Private, (FBO) Other (specify: _____________)__ Urban__ Rural__ Semi-urban/peri-urbanServices offered at thesite Out-patient MCH ANC TB clinic Labor and Delivery Nutrition Out-patient pediatric In-patient pediatric General/Family practice/OPD Other (specify:______________)ALL OF ABOVE

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionSelected Services StatisticsPopulation of catchment area (adult +children)…………………………………….__________Population of children under 5 years of age ……………………………………….___________Number of hospital beds…………………………………………………………….___________Number of pediatric beds……………………………………………………………___________Number of deliveries (2007)…………………………………………………………__________Number of immunizations (DPT 1) (2007))…………………………………………__________Number of women attending PMTCT (2007)……………………………………….__________Number of women tested in the past year (2007) ……………………………………_________Number of women who tested positive in the past year (2007)………………………_________Number of women receiving NVP (2007)………………………………………..….._________Number of babies receiving NVP ART (2007)………………………………………._________Number of HIV tests done (2007)……………………………………………………._________Number of children tested for HIV (2007)……………………………………………_________Number of children less than 5 years of age tested for HIV (2007)Number of infants or children who tested positive for HIV (2007)………………….._________Number of children seen outpatient (2007)…………………………………………..__________Number of children enrolled in nutritional programs (2007)…………………………__________Number of orphans seen in the health facility (2007) ……………………………….__________Number of orphans less than 5 years of age seen in the facility……………………..__________HIV counseling and Testing(check those that apply)Services Available at Health Facility(Check all that apply)Provider Initiated Testing and Counseling (PITC)____inpatient: ____ adults __ _ children____outpatient: ____adults __ childrenVCT ____ adults ___childrenART Yes NoWhen initiated at this facility(mm/yyyy)PMTCTYes NoRoutine offer of testing for infants and children:__ _inpatient ____outpatientAdults Yes No Start Date: ___/_______Children Yes No Start Date: ___/_______Referral of HIV positive women to ARTIf yes, when? _ __ANC__________(post partum orantenatal) Partner counseling and testing – rare4

Pediatric/MCH/Child Health servicesHealth FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised version___Growth monitoring___Immunization___IMCI___Cotrimoazole for HIV exposed children @ART___Bednets/ITNPsychosocial support to families with HIV? (check all that apply)____Individual counseling ____support groups ___outreach to community Other ______________If outreach workers find a child in the home of a family who is sick/suspected of being HIV infected, whatdo they do?___________________________________________________________________________________________________________________________________________________Psychosocial supportServices and support provided for orphans and ___Screening for health problemvulnerable children at the health facility___Immunization___Nutritional Support___Cotrimoazole for HIV exposed children withHIV___ ART for eligible childrenFor infants and children exposed to HIV, who/whichservice is responsible for each of the followingelements of care:Complete items at right with following codes (more thanone code can apply)• ART at Provincial level hospital (ART-P)• ART at District level (ART-D)• ART at sub-district level (ART-SD)• Dispensaries (Dis)___Bednets/ITN________Identification of HIV- exposed infants andchildren____Prescribe ART___ Monitor ART after 3 months____ Provide adherence support____ Provide CTMZ prophylaxis____ Refer for HIV testing____ Conduct clinical assessment• HBC workers/CHWs/OVC workersIn the MCH clinic, when an infant or child issuspected of being HIV exposed or HIV infected,what does the provider do?______Refer to ART______Refer to OPD______Refer for HIV testing.If yes, to where?__________________________________________Conduct HIV test_____Start cotrimoxazole_____Start ARTWhere are pediatric HIV care services located? MCH OPD CCC Pediatric HIV specialty clinic Other (specify:______________)5

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionCARE AND SUPPORT FOR ORPHANS AND VULNERABLE CHILDREN (OVC)• How do the health providers identify OVCs (indigent, orphan and vulnerable children) in the facility?• What specific services are available for OVCin your facility? Please listoooWho provides these services?When are the services provided?Where are they provided at thehealth facility?• How do OVCs access services at the facility?• How many OVCs are attended to at the facilityeach week/month?o How many of the OVCs are under5 years of age?• What are the common health problems ofOVC that you encounter in this health facility?Please list• What do you do when you encounter a sickOVC at the facility?• What are the barriers to access to healthservices by OVCs? Please list• What challenges do your encounter whileproviding services for OVCs in your facility?oGetting OVC tested for HIV?o Providing treatment for OVCs?• What support do you think should be providedto OVCs who are infected with HIV that visityour facility?• Do you refer OVCs to other services or NGOsin the community? And to where?• Do you follow up OVCs that receive care inyour health facility? And how?• What additional information would you like toprovide on this subject?6

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionORGANIZATIONS WORKING AT THE SITEName:Name:Name:Name:Name: Child Health Maternal Health STI Care and Treatment /AdultsCare and Treatment /Peds PMTCT VCT HBC OVC Child Health Maternal Health STI Care and Treatment /AdultsCare and Treatment /Peds PMTCT VCT HBC OVC Child Health Maternal Health STI Care and Treatment /AdultsCare and Treatment /Peds PMTCT VCT HBC OVC Child Health Maternal Health STI Care and Treatment /AdultsCare and Treatment /Peds PMTCT VCT HBC OVC Child Health Maternal Health STI Care and Treatment /AdultsCare and Treatment /Peds PMTCT VCT HBC OVCGuidelines present on siteGuidelines for Clinical Management ofHIV/AIDS (ART, OIs)GuidelinesResponse Yes, specify:________________ N/ANo Observed TOLD AT NEARBY OFFICEGuidelines for PMTCT Yes, specify:________________ N/A No Observed TOLD AT NEARBY OFFICEGuidelines for counseling and testing for adults Yes, specify:________________ N/A No ObservedGuidelines for care and support for orphans and Yes, specify:________________ N/Avulnerable children No ObservedHandbook on Pediatric Yes NoAIDS in Africa (ANECCA)Told it is In a Medical Officer’s office – did not observeOther relevant guidelines…………………………………………………………………Are there information, education andcommunication (IEC) materials available forthe patients……………………………………………………………… General HIV education General ART issues ARV side effects and their management Opportunistic infections Medication use Adherence support Pediatric HIV and AIDS7

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionSTAFFING AND CAPACITY FOR PEDIATRIC HIV CARE AND TREATMENTTotalNumber# of each typeprovider providingpediatric HIV Care# trained in IMCI-HIV # trained inpediatric HIVcareMedical Officers(1 ENT, 2 surgeons,1 phyisican, 1pediatrician, 1gynecologist)Asst MOClinical officerNursing OfficerNurse MidwifeNurses (all otherlevels)Nurse attendant orhospital assistantHealth AssistantOthersQuestionLABORATORY DIAGNOSIS AND MONITORINGResponseDoes your site havelaboratory facilityLaboratory servicesperformed in this labAre other laboratory facilitiesavailable offsite?If yes, please provide the name(s)Yes No CD4 countCD4 percentage Rapid HIV testElisaDNA-PCRRNA-PCRHemoglobinTotal lymphocyte countLiver Function TestsRenal Function TestsOther (specify:__________)Private or commercial labPublic labNot availableA.____________________________________________B. ______________________________________________8

For the following lab tests, specify asindicated at right:Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionCD4: Lab to which test is sent (A or B) ___________________# days a week specimens are sent outOn site _________# days to receive results_________method of dispatching results (post?, fa?)Others: _____________________DBS-PCRLab to which test is sent (A or B) _________# days a week specimens are sent out_____# days to receive results____method of dispatching results (post?, fa?)Pharmacy PracticeExpiration/supply commentSecond line ordered over 3 weeks ago (10/2565 pts need it; no pedsneeded yet)Zidovir 100mg capsRetrovir Suspension 110 MG/MLEpivir 10 mg/mlViramune 50 mg/5ml (1 bottle on hand) 5NVP 50mg/5mlCotrimoxazole SYRUPCLINICAL PRACTICEQuestionResponseCondition Mode of determining Diagnosis Treat on Site or ReferHIV in childrenHIV in children

QuestionHealth FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionSERVICE STATISTICSResponseNumber of infants born to HIV positive mothers who return to thefacility for follow-upNumber of HIV exposed infants on CT prophylaxisNumber of HIV-infected children who are currently on ART in thefacilityHow many children (

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionPediatric Inpatient Ward Medical RecordUnique patient identifierYes□ NoDate of birth□ Yes□ No – usedAge insteadSex of patientYes□ NoWeight at birth□ YesNoWeight *Yes□ NoHeight *□ YesNoWho is the caretaker? (Mum/dad/family member/institution…)*Yes□ NoMother’s HIV serostatus (PMTCT Status)□ YesChild’s HIV statusNOT REQUIRED BY THE STANDARD FORM but told it is put intonarrative notesDisclosure of HIV status of the child to caretakerONLY IN NARRATIVE NOTESClinical assessment findings and assignment of clinical stage (WHO/CDCstaging) * IN NARRATIVE NOTESActive opportunistic infection* IN NOTESCotrimoxazole prophylaxis*In notesDate of starting cotrimoxazole prophylaxisIn notesTuberculosis treatment*In notesNo□ YesNo□ YesNot requiredon the form□ N/A□ YesNot requiredon the form□ N/A□ YesNot requiredon the form□ N/A□ Yesnot requiredon the form□ N/A□ Yesnot requiredon the form□ N/A□ Yesnot requiredon the form□ N/A11

Antiretroviral therapy (ART)Total lymphocyte count*Hemoglobin *Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionYes□ No□ N/AYes□ No□ N/AYes□ No□ N/ACD4 cell count (cells/L)* DONE AT THE ART SITE □ Yes□ No□ N/ACD4 cell percentage (%)* “ □ Yes□ No□ N/ASevere Rash* IN NARRATIVE NOTES□ Yes□ No□ N/ADocument mother’s death IN HISTORY NOTES □ Yes□ NoDocument father’s death IN HISTORY NOTES □ Yes□ NoSelect 5 random charts of children under 5 years oldCARE AND TREATMENT ON PEDIATRIC PATIENT RECORDUnique patient identifierDate of birthSex of patientWeight at birthWeight at last visitHeight at last visitWho is the caretaker? (Mum/dad/family member/institution…)Mother’s HIV serostatus (PMTCT Status)Child’s HIV statusDisclosure of HIV status of the child to caretaker□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ Yes□ No□ N/A12

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionClinical assessment findings and assignment of clinical stage (WHO/CDCstaging)Active opportunistic infectionCotrimoaxzole prophylaxisDate of starting cotrimoxazole prophylaxisTuberculosis treatmentAntiretroviral therapy (ART)Total lymphocyte countHemoglobinCD4 cell count (cells/L)CD4 cell percentage (%)Severe RashDocument mother’s deathIf yes, date?Document father’s deathIf yes, date?□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ N/A□ Yes□ No□ Yes□ NoComments13

Health FacilityOVC and Pediatric HIV/AIDS Situation Analysis ToolRwandaMay2008 revised versionKey Questions for Health Care Providers at the FacilityProviders at MCH SiteWhat do you do for children who are falling below expected weight on the growth chart?What do you do when a mother you know is HIV infected brings her baby for an immunization?Clinicians in Pediatric Outpatient DepartmentIf you see a six month old with the fourth episode of pneumonia what would you do?Probe: suggest an HIV test?Clinician on Pediatric Inpatient UnitHow many HIV tests have you ordered for children under 5 this past month?PharmacistIn the past three months, how many prescriptions have you filled for Cotrimoxazole forprophylaxis in a child under 5?14