HIV Testing

My day was spent shadowing our clinic lab technician, Abel.  Not only is he a phenomenal technician, he is a great teacher and freely explained how he goes about testing for HIV and malaria.  Since today was Friday, the WE-ACTx for Hope clinic conducts free HIV testing for anyone who wants to be tested.  Today there were 5 patients were tested.  There are a series of 3 different tests that are performed, with the first being the most sensitivity and the last being the least.  

The Screening test is done is Rapid POC (point of care) HIV test labeled "CG" which stands for "Colloidal Gold".  The Confirmatory test is a "Det" which stands for the "Determine HIV 1/2" test.  Lastly, the Tie Breaker test is called "Unigold".

If the first 1 "Screening" test is negative, or the "Screening" and "Confirmatory" tests are both positive, then the third "Tie Breaker" is not performed.  However, if there is a discrepancy after performing all 3, the samples are taken to the national laboratory and an ELISA test is done.

Abel, our lab technician, records the results of the HIV testing for today.

Here's are videos that explains the HIV testing and recording the results on the form that will be given to patients.

Family Needs Assessment

In 2014 and 2015, counselors from WE-ACTx for Hope administered a Family Assessment Survey to individuals who were parents of a child under the age of 18 who was being treated at the clinic.  The counselors orally administered a paper survey in Kinyarwanda, the national language, and the data was input into an Excel spreadsheet for analysis and utilization. The clinic wanted to survey HIV positive parents about their children who were 18 years of age and under to determine what familial or social factors they find amongst participants and possibly draw correlations between these components and ART (antiretroviral therapy) adherence.

I spent a large portion of Tuesday reviewing the data with 2 counselors at the clinic.  It is compiled from a massive Excel spreadsheet into organized graphs based on different components of the survey, including demographics, family and income level.

In other programming...

Here is our self-narrated video of what it's like learning from our amazing cook, Serafine.  Enjoy!

Patient Visits

Today was spent shadowing a nurse while she went through her patient consults (encounters) for that day.  I'm finally starting to figure out the whole process!  Here's what I've determined so far:

1. Patient checks in to the Reception area with their HIV Tracking booklet and insurance card.

2. Patient is given a number and their chart is pulled.

• Each patient chart (Fr: Dossier) contains a colored dot that corresponds to one of the nurses.  Each patient has the same nurse each visit (unless their assigned nurse is on leave).

3. Nurse is given stacks of patient charts in the order that she should see them.  She then calls patients in one by one.

• Depending on the number of nurses present (there are 4 but on average 3 are present each day) and the number of patients, nurses see anywhere from 20-40 patients per day.
• WE-ACTx averages about 1,800 patients per month.

4. Nurse screens for TB and STI's and takes the patients weight to monitor BMI.

• A positive screening for TB is indicated if the patient reports any of the following:
• Productive cough
• Fever
• Weight loss
• Decreased appetite
• Vomiting
• Fatigue

• A positive screening for STI is indicated if the patient reports any of the following: 
• Gential discharge
• Genital itching
• Lower abdominal pain

5. Nurse evaluates patient's adherence and educates them if necessary.

6. Nurse records patients visit in their chart (Dossier).

7. Nurse also records current visit date and next visit date, in addition to any changes in medications, in each patient's HIV Tracking Booklet, Kubonana na Muganga (see below!).

This is where HIV positive patients track their current
medications (prophylaxis, ARV's) and appointment dates.

8. Nurse gives patient a prescription for their ARV's, Bactrim and any other complaints.

• Patients today also complained of sinus infection, cough and possible pregnancy.

9. Patient goes to lab for any tests, pharmacy for medications (including ARV's) and reception to check out.

10. Patient completes a guided research assessment with one of the staff about their family members and whether or not they've all been tested for HIV.

10 Fast Facts about WE-ACTx for Hope Clinic

1.  WE-ACTx for Hope is located in downtown Kigali, the capital of Rwanda.

2.  They only treat HIV positive patients.

3.  Clinic runs from 8am-4pm each day, except for Fridays (8-12pm).

4.  Each clinic day is started with an educational session for all patients in the waiting room where the nurses, doctor or technicians lecture briefly about topics related to patients’ health.

5.  They treats about 80-100 patients per day.

6.  Wednesday is Children’s Day.  This means that only children are treated on Wednesdays each week.

7.  Friday is Screening Day.  New patients can come to be screened for HIV/AIDS on each Friday.

8.  They have has 1 doctor, 4 nurses, 1 lab tech, 2 pharmacy techs, 4 counselors and multiple other staff members that help the clinic function fluidly each day.

9.  The nurse only give out 30 day supplies of medication, including ART’s.  Special exceptions are made in circumstances where children are going away to boarding school and adults are going on business trips.

10.  Patients can send their parents, siblings, significant other or guardians in lieu of themselves.

Nurses Rock!

Nurses play a pivotal role at WE-ACTx.  While the doctors are in charge of starting patients on medication and overseeing day-to-day issues that arise, nurses are each assigned a particular set of patients that they will see 20-40 of each day, depending on how many are scheduled and the number of nurses in the office.  During each visit, nurses evaluate patients for ART adherence by asking them how they are taking their medication, if they have missed any doses and, if so, why that was.  In addition, they perform a nutritional assessment of children under 15 years of age, document patient encounters in paper charts (Fr: Dossier) and address additional concerns related or unrelated to ART.  They are the ones that patients first talk to about their physical and psychosocial needs and determine if the patient needs to see a counselor, talk to the doctor or seek any other lab tests.

Thank goodness for amazing nurses!

Nyacyonga Clinic

                                  

                                       Nyacyonga Clinic

    Located about a 40 minute drive outside Kigali (per private car), we sped past the dwindling villages until we reached this clinic perched upon a hill.  The nurse was very relaxed as patients passed their HIV tracking books (Kubonana Na Muganga) through the metal grates of the open windows and the social worker-in-training typed their names into the Rwandan National Electronic Medical Record (EMR) to check their insurance and registration.  They then passed whichever combination of meds the patient needed back through the window along with their little tracking books.

Here are some of the materials (aside from the computer and EMR) that the clinic used to ARV info:

List and explanation of dosing of ARV's for children under 15yo

Book to track discordant couples, or couples with one
HIV+ partner and one HIV negative partner

Book of Patient records (Dossier) plus a prescription pad

See a brief video of the scenic drive here: