STREAMLINED CARE
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STREAMLINED CARE

  • 01/27/2022

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  • Description:
    Streamlined Care is a differentiated service delivery model conducted within the SEARCH (Sustainable East Africa Research in Community Health) study, a cluster-randomized, universal test-and-treat trial in rural Kenya and Uganda. Streamlined Care improves patient-provider relationships and increases patient and provider HIV-related knowledge and skills. In addition, the intervention addresses structural barriers including long wait times, fixed clinic hours, lack of efficient appointment reminder and tracing mechanisms, and transportation cost and inconvenience associated with accessing care. A nurse-driven triage system is implemented to efficiently tailor clinic visits to what patients need to reduce wait times. Scheduled visit intervals and ART pick-up are lengthened to every 3 months for stable patients to decrease wait times by reducing patient volume and increase convenience associated with less frequent clinic visits. The intervention integrates multidisease care for hypertension and diabetes and includes appointment reminders and phone access for health-related questions or appointment rescheduling. Off-hours clinic access is also offered. For patients who missed an appointment, re-engagement efforts of increasing intensity are offered, including an initial phone call followed by physical tracing and facilitated transportation to return to care. Streamlined Care also includes provider and staff training on providing care. Individuals identified as HIV positive in both the intervention and control group receive baseline CD4 and viral load testing, are introduced to a clinic staff member in person or by phone, are scheduled for an appointment at the local HIV clinic within 1 week or, if pregnant, within 2 days or with CD4
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