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Root Cause Analysis of Low Performance in Percentage of People Living with HIV (PLHIV) given Isoniazid (INH) Preventive Treatment (IPT) Against Total Eligible PLHIV

Low performance means the eligible PLHIV are not getting the INH preventive therapy as desired. The data is available with National AIDS Control Organisation (NACO) and analyse it in terms of: 

  • Who is not getting INH chemoprophylaxis? (Person Analysis) - Are people of any specific age group or is there any gender difference?
    • This may indicate certain stigma, beliefs, or awareness problem in certain category of people - the approach to solution may be different.
  • Whether they are from specific geography? (Place Analysis) - Any specific Antiretroviral Therapy (ART) centre or some specific area or a population or occupation group?
    • There may be training issue with certain providers, or accessibility issues with certain groups - a separate strategy may be needed to address them.
  • Whether the low performance is specific to any time period? (Time Analysis)
    • This analysis, for e.g., may indicate certain supply chain issues during a sepcified period - then the strategy may be different for addressing the same.

 

The process of IPT implementation in a patient visiting the ART clinic is as follows: 

  1. TB symptom screening 
  2. IPT assessment for those who are SS negative and IPT card, if eligible
  3. IPT collection from the ART pharmacy
  4. Recording and reporting in IPT register

A breach/ delay in any of the above process will cause delayed or non-initiation of INH.

Collecting information from ART centre staff, PLHIV, source records will help in analysis of each case.

 

  Possible Causes Suggested Solutions
Was the symptom screening for TB done and the decision on IPT made? if No
  • Deficient knowledge of health care provider
  • Proxy attendance to collect ART/ collecting drugs from Link ART / lost to follow-up
  • Capacity building of the healthcare provider, periodic refresher training
  • All cases registered at ART centre should get the symptoms screened and decision on IPT at the first visit itself
  • Arrange for transportation facilities/ reimbursement

Was the patient started on INH? If No,

 

Was there a delay/ non initiation in children and elderly?
  • Resistance from patient due to inadequate knowledge, stigma, or fear of pill overload or adverse effects
  • Shortage of drugs

 

  • Adequate knowledge of ART centre staff
  • Apprehensive patients/ parents 
  • Alcoholism/ comorbidity of the patient 
  • Proper counselling of the patient 
  • Demand generation
  • Peer group support
  • Proper supply chain management to ensure continuous supply of drugs
  • Capacity building and periodic training
  • Patient/ caregiver counselling
  • Facilities for deaddiction/ comorbidity management
Was there an information gap?
  • Non-maintenance of details entered IPT register and monthly IPT report
  • Training and capacity building of the ART centre staff and proper monitoring.

 

Note: This page describes only an approach for analysis of low performance and has not captured the entire list of problems or solutions. The root cause analysis may be modified according to the local context.

 

Resources

 

Assessment

Question Option 1 Option 2 Option 3 Option 4 Correct answer  Explanation Page id Pretest Post-test
What are the possible reasons for PLHIV not getting IPT as expected? Deficient knowledge of the provider Resistance from patient Lack of drugs All the above  4 All the mentioned reasons can be the possible cause for PLHIV not getting IPT as expected.      

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