Major Constraints and Solutions during Q3 Sample Clauses

Major Constraints and Solutions during Q3. Viral Load (VL) Suppression: The installation of equipment is completed but the provision of basic supplies (especially micro-tubes and EDTA tubs) are dependent on the GPSL (MOH) and they have had challenges with regularly providing the supplies. After training was conducted by the INLS, AFENET, and HFA in the HFs of Viana, Kilamba Kiaxi, Xxxxxx, and Dispensário, our seven HFs began sending VL samples to their respective laboratories: Esperança, Divina, and Pediátrico to LBM (INLS) and Viana, Rangel, Kilamba Kiaxi and Dispensario to LMC. • One constraint was the transport of the samples, but during this period, the INIS (National Research Institute for Health) made an agreement with the INLS and AFENET to regularly transport all samples from the nine PEPFAR-assigned health facilities. • Another constraint was patient absenteeism. Howerver HFA used a requisition form to collect the samples for VL testing on the day of the consultation for patients who met the requirements for the VL test in the four HFs that send samples to LMC. This activity increased the number of VL tests. In addition, HFA is providing daily supervision through CMs and PAFs to interpret results of VL testing and actively search for patients who have been in ART for more than six months but have not received the VL test. • At the end of the third quarter, our main constraint was the follow-up of patients with a VL test result higher than 1,000 copies/ml, which means that we must consider or suspect therapeutic failure (pharmacokinetic or tolerance reasons) when ART administrated to the patient for six months does not control the HIV infection. As a result, virologic failure (>1,000 copies/ml), immunological failure (diminish CD4) and clinical failure (WHO clinical states) can occur, together or isolated. Following the criteria of the national guidelines, the last-resort decision is to change from first-line to second-line ART, which is a decision made by the ART Institutional Committee and managed by a medical doctor. • Because of issues mentioned previously, during the next quarter HFA will strengthen collaboration with the INLS, AFENET, and DPSL to improve the follow up of these patients (VL test >1,000 copies/ml) and their second-line ART. This includes registration (data collection), reinforced adhesion, human resources (medical doctors), medicaments availability, access to VL testing, training on second- line ART, and logistic provision. Figure 12. Viral Load Suppression in the Seven...
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