Overview
The Clinical Services Department is among the founding departments of the ACTION program at its inception in 2005 with quality of all ART services as its catchword. The foundation in clinical care by the Clinical Services department is to focus on a sustainable high quality clinical care outcomes for all recipients of services at our points of care. The Clinical department in collaboration with over 70 points of care is responsible for putting and maintaining treatment to the over 50,000 cohort of adults and children throughout Nigeria with presence of services at all levels of the public health care system.

In order to effectively decentralize facilitatory supervision, the department has focused on mentorship through practical training and consultation that fosters ongoing professional development through participation. Currently the department has 3 divisions for technical oversight: Adult treatment, Paediatric treatment and Pharmacy with an overarching quality Improvement unit that is cross-cutting and that keeps track of patient-related benchmarks of quality care.

GOAL:
To engender at all supported sites and Nigeria global best practices in ART care and treatment by enabling a learning culture. The Department in line with the strategic objectives of ACTION has been supporting the Government of Nigeria as well as supporting the decentralized delivery of HIV treatment, care and prevention in many treatment sites across the county. This has been done through the development of local capacity from development of National ART training curricula as well as job aids at various levels of the health care system in Nigeria. Training is synergized across facilities and levels of care through cross-training and adaptation of materials. Curricula training and mentoring techniques are continuously being improved based on evidence as well as QIP processes derived from a routine quality of care assessment (ACTIONQUAL) based on operational research PDSA cycle of Shewart.

Current Activities

• Development of curricula, and manuals in all relevant thematic areas some of which have been adapted for National use

• Direct treatment support in 75 sites at various levels of care

• Gwagwalada Model Care and Treatment Center – a built facility that allows IHVN staff as well as other experts to provide ongoing medical and consulting services, provide clinic for patient-based trainings and preceptorship as well as conduct research on best practices and models of care

• Professional development-orientation training for all new staff engaged in the treatment of HIV/AIDS, participation in National training courses, organizing international preceptorship for Physicians at sites/staff, CMEs through clinical meetings at sites as well as organizing retreats, and conference updates for lead ART providers in Nigeria

ACHIEVEMENTS

• At the end of COP08, 72,351 patients on ART (87,279 as of July 31, 2009)

• Additional 8 ART service sites have been opened as satellites or hubs strengthening the hub and spoke (total of 46 sites) model of delivery

• Action trained Master Trainers using the IMAI curriculum facilitated this using a decentralized training structure based at the 5 regions

• Training on Clinical QIP across all service areas and formation of clinical quality working groups across all supported service areas

• Carried out second round of quality of care assessment using modified HIVQUAL assessment tools across all service areas that have been offering care and treatment for longer than one year, results being analyzed

• Continuous mentoring of all hubs on best clinical practices has been decentralized with hubs being supported to mentor satellites under their purview

• Posting of clinical Associates to some hubs with high client load

• Task shifting piloted at selected sites with high client load

Contact Address:
Clinical Services Department
Institute of Human Virology, Nigeria