Introduction
Methods
Setting
Care models
Standard of care
Standard of care | CCC model | ||||||
---|---|---|---|---|---|---|---|
P
|
CO
|
N
|
P
|
CO
|
N
|
CCC
| |
Clinical monitoring
| |||||||
Monitor and support ART adherence |
□□□
| ■■■ | ■■■ |
□
| ■ | ■ | ■■ |
Take weight | ■■■ | ■ | ■■ | ||||
Take vitals | ■■■ | ■ | ■■ | ||||
Determine functional status | ■■■ | ■■■ |
□
| ■ | ■■ | ||
Request CD4 count and viral load |
□□□
| ■■■ |
□□□
| ■■■ | |||
Identify ART side effects |
□□□
| ■■■ |
□
| ■ | ■■ | ||
Manage ART side effects |
□□□
| ■■■ |
□□□
| ■■■ | |||
Identify OI symptoms |
□□□
| ■■■ |
□
| ■ | ■■ | ||
Manage OIs |
□□□
| ■■■ |
□□□
| ■■■ | |||
Dispense and arrange follow-up visits
| |||||||
Dispense ART and drugs for OI prophylaxis | ■■■ | ■ | ■■ | ||||
Arrange follow-up visits | ■■■ | ■ | ■■ | ||||
Manage substitutions or switch of ART
| |||||||
Switch to alternative first-line regimen |
□□□
| ■■■ |
□□□
| ■■■ | |||
Switch second-line regimen |
□□□
| ■■■ |
□□□
| ■■■ | |||
Choose appropriate third-line |
□□□
|
□□□
| |||||
Supervision
| |||||||
Clinical officers |
X
| X | X |
X
| |||
Nurses | X | X | |||||
Community care coordinators | X |
CCC model
Population
Training and mentoring
Personal digital assistants
-
New cough since last visit?
-
Vomiting within the last 48 hours?
-
Diarrhea within the last 48 hours?
-
New headache since the last visit?
-
Has the patient had any of the following occur since the last visit? (Answers: inability to walk, inability to talk, weakness on one side of the body, weakness on one side of the face)
-
Over the last week, has the patient or a family member skipped a meal because of lack of food in the house?
-
Has the patient reported or is there any evidence that there has been domestic violence in the household?
-
Does the patient (if female) believe that she may be pregnant?
-
Are there more than six pills in any of the antiretroviral bottles than there should be?
-
Does the patient report significant difficulty with adherence?
Evaluation
Data sources, management and analysis
Results
CCC evaluations
Study year | Score | Vitals No. (%) | History taking No. (%) | Use of PDA No. (%) | Clinical judgment No. (%) | Humanistic qualities No. (%) | Interaction with staff No. (%) | Summary No. (%) |
---|---|---|---|---|---|---|---|---|
1
st
Year
|
Superior
| 109 (90.8) | 113 (91.9) | 106 (90.6) | 103 (83.1) | 114 (86.4) | 115 (89.1) | 118 (88.7) |
Satisfactory
| 11 (9.2) | 10 (9.1) | 10 (8.5) | 20 (16.1) | 18 (13.6) | 14 (10.9) | 15 (11.3) | |
Unsatisfactory
| 0 (0) | 0 (0) | 1 (0.9) | 1 (0.8) | 0 (0) | 0 (0) | 0 (0) | |
2
nd
Year
|
Superior
| 88 (100) | 87 (98.8) | 88 (100) | 87 (98.8) | 84 (95.5) | 81 ((92) | 83 (94.3) |
Satisfactory
| 0 (0) | 1 (1.1) | 0 (0) | 1 (1.1) | 4 (4.5) | 6 (6.8) | 5 (5.7) | |
Unsatisfactory
| 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (1.1) | 0 (0) |