“Better Health Outcomes Through Mentorship and Assessment (BHOMA)”
Grantee Institution:
The University of Alabama at Birmingham
Team Leaders:
- Jeffrey S.A. Stringer, M.D.
Centre for Infectious Disease Research in Zambia
- Namwinga Chintu, M.D.
Centre for Infectious Disease Research in Zambia
Project Summary:
The PHIT Partnership focuses on three rural districts in the Lusaka Province of Zambia. This approach begins with a simple and inescapable fact: good health outcomes are largely the result of good clinical care. A successful HIV/AIDS program has already transformed expectations through clinical mentoring, data collection, and monitoring. This model, applied to the delivery of integrated primary care, will reverse the patterns of the past 20 years in Chongwe, Kafue, and Luangwa districts and produce measurable improvements in Millennium Development Goal health indicators.
The two main components of the intervention are clinic and community based. The clinic intervention is composed of five key components: 1) Introduction of practical tools, protocols and forms to establish clear clinical care standards 2) Intensive clinic implementation that clearly communicates required clinical standards 3) Supportive mentoring that reinforces standards and changes practice through District Quality Improvement Teams 4) Provision of essential resources and tools to enable standards be met and 5) A data feedback system that provides feedback on whether standards are met.
The community intervention is patient follow-up and household assessments by community health workers using automated mobile phone technology that is linked directly to patent information transcribed by clinicians and entered by data technicians into a data capture system. Through this automated system, the sickest and most at risk patents are followed up in the community to intervene where possible and document outcomes. Clinic and community health workers have clear protocols and receive ongoing mentoring, measuring, and performance reviews.
From August 2010 and March 2011 we piloted the intervention at 6 pilot sites in the 3 intervention districts. Between January and March 2011, a total of 9,306 patent encounters were captured by the system. Additionally, 5,180 households were surveyed covering over 27,000 individuals. Of over 300 cases requiring follow up by community health care workers, over 80% of individuals were followed up by community health workers and the time of analysis. Theintervention is being rolled in a randomized step wedge fashion from March 2011.
The intervention will be evaluated through a series of community, household and facility surveys. Our primary end point is age standardized mortality in persons under 60 years.
Zambia AIDS-related Tuberculosis (ZAMBART) project, information, education and communication (IEC) Session