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Histoires D' Amélioration Histoires Amélioration du Taux de Survie des Patients d' Amélioration Vivant avec le VIH dans les Régions Sud du Sénégal Leçons Apprises Septembre 2016 de l’ utilisation Karim Seck Mohamed Coulibaly Isseu Toure du Modèle Bruno Bouchet Collaboratif Saiba Cissokho d’ Amélioration de la Qualité Leçons Apprises de l'Utilisation du Modèle Collaboratif d’Amélioration de la Qualité Remerciements Ce travail n’ aurait pas été possible sans les efforts de nombreux acteurs et institutions suivants : • La Division de la Lutte contre le SIDA et les Infections Sexuellement Transmissibles (DLSI). • Les Régions Médicales de Kolda, Sédhiou et Ziguinchor. • L’ Unité de Traitement Ambulatoire (UTA) de Kolda. • Le Pavillon de Traitement Ambulatoire (PTA) de Ziguinchor. • Les centres de santé de Bignona, Bounkiling, Diouloulou, Goudomp, Sédhiou, et Vélingara. • L’ Etablissement Public de Santé (EPS) de Sédhiou. • L' équipe technique de FHI 360. Ont contribué à la rédaction de ce document • Dr Ousseynou Cissé PTA de Ziguinchor • Dr Thierno Cherif Sy UTA de Kolda • Dr Aminata Thiam FHI 360 Mention Légale : Ce document est rendu possible grâce au généreux soutien du peuple Américain à travers l’ Agence des Etats-Unis pour le Développement International (USAID), sous les termes de l’ accord Numéro 685-A-00-06-00059-00 avec FHI 360. Le présent document et ses conclusions n’ engagent que les auteurs et ne reflète aucunement la position de FHI 360, de l’ USAID ou du Ministère de la Santé et de l'Action Sociale du Sénégal. Citation Recommandée : Seck K., Coulibaly M, Toure I. & Bouchet B. 2016. Amélioration du Taux de Survie des Patients Vivant avec le VIH dans les Régions Sud du Sénégal. Quality Improvement Stories. Washington, DC : FHI 360. Amelioration du Taux de Survie des Patients Vivant i avec le vih dans les Regions sud du Senegal Leçons Apprises de l'Utilisation du Modèle Collaboratif d’Amélioration de la Qualité Table des Matières Remerciements .................................................................................................................................................................i Acronymes et abbréviations ............................................................................................................................... iv Résume exécutif .............................................................................................................................................................2 Introduction ....................................................................................................................................................................5 Contexte et justification de l’ initiative qualite ................................................................................... 6 Présentation du Sénégal .................................................................................................................................. 6 Système de santé du Sénégal ......................................................................................................................... 6 Situation epidémiologique du VIH/SIDA au Sénégal .........................................................................7 Le dispositif de prise en charge du VIH au Sénégal ......................................................................... 9 Le modèle collaboratif d'amélioration de la qualité et sa pertinence pour les services VIH au Sénégal ......................................................................................................................11 Description du modèle d’ amélioration ...................................................................................................11 Situation initiale de la prise en charge des PVVIH dans les 3 régions sud ...................14 Mise en place du collaboratif pour l'amélioration du taux de survie à 12 mois des PVVIH dans les régions sud ........................................................................................................15 Les principales phases de mise en œuvre du collaboratif .......................................................15 Phase de préparation et planification ...................................................................................................15 Phase de démonstration du collaboratif ......................................................................................... 20 Phase D’ extension du collaboratif ......................................................................................................24 ii Amelioration du Taux de Survie des Patients Vivant avec le vih dans les Regions sud du Senegal Leçons Apprises de l'Utilisation du Modèle Collaboratif d’Amélioration de la Qualité Résultats et interprétation ...............................................................................................................................25 Taux de survie à 12 mois des PVVIH ............................................................................................................25 Niveau d’ atteinte des objectifs d’ amélioration ............................................................................27 Bonnes pratiques, problèmes rencontrés et leçons apprises du collaboratif VIH au Sénégal.......................................................................................................................38 Bonnes pratiques.................................................................................................................................................38 Problèmes rencontrés ....................................................................................................................................39 Leçons apprises et recommendations .....................................................................................................41 La pérennisation des initiatives d'amélioration.....................................................................................43 Conclusion .................................................................................................................................................................... 44 Annexes ............................................................................................................................................................................45 Annexe 1 : Matrice d'indicateur d'amélioration ................................................................................45 Annexe 2 : Diagramme détaillé du processus de recherche des PVVIH perdus de vue ..................................................................................................................................46 Annexe 3 : Les Equipes d’ amélioration ..................................................................................................47 Amelioration du Taux de Survie des Patients Vivant iii avec le vih dans les Regions sud du Senegal Leçons Apprises de l'Utilisation du Modèle Collaboratif d’Amélioration de la Qualité Acronymes et abbréviations AgHBs Antigène Hépatite B ALAT Alanine aminotransférase AmQ Amélioration de la Qualité ANRS Agence Nationale de Recherche sur le SIDA (France) ARV Antirétroviraux CDT Centre de traitement de la Tuberculose CMT Comité Médical Technique CNLS Conseil National de Lutte contre le SIDA CTA Centre de Traitement Ambulatoire DFT Diagrammes Fréquence-Temps Division de la Lutte contre le SIDA et les Infections DLSI Sexuellement Transmissibles EAQ Equipe d'Amélioration de la Qualité Enquête Démographique et de Santé à Indicateurs Multiples EDS-MICS au Sénégal ENCS Enquête Nationale de Surveillance Combinée EPS Etablissement Public de Santé EDS Enquête Démographique et de Santé GDD Gestionnaire de données IDE Infirmier d’ Etat MCA Médecin-Chef Adjoint MCD Médecin Chef de District iv Amelioration du Taux de Survie des Patients Vivant avec le vih dans les Regions sud du Senegal Leçons Apprises de l'Utilisation du Modèle Collaboratif d’Amélioration de la Qualité MCR Médecin Chef de Région MSAS Ministère de la Santé et de l’ Action Sociale MCD Médecin-Chef de District NFS Numération Formule Sanguine OCB Organisation Communautaire de Base PDV Perdu de vue PEC Prise en Charge PNDS Plan National de Développement Sanitaire PNMLS Plan National Multisectoriel de Lutte contre le VIH/SIDA PSN Plan Stratégique de Lutte contre les IST, le VIH et le SIDA PTME Prévention de la transmission Mère Enfant PTT Plan de travail trimestriel PVVIH Personnes vivant avec le VIH RGPH Recensement Général de la Population et de l’ Habitat SFE Sage-femme d’ Etat SIDA Syndrome de l’ Immunodéficience Acquise TATARSEN Tester, Traiter et Retenir au Sénégal TB Tuberculose USAID United States Agency for International Développement UTA Unité de Traitement Ambulatoire VIH Virus de l’ Immunodéficience Humaine Amelioration du Taux de Survie des Patients Vivant 1 avec le vih dans les Regions sud du Senegal Leçons Apprises de l'Utilisation du Modèle Collaboratif d’Amélioration de la Qualité Résume exécutif Au Sénégal, FHI 360 met en œuvre la composante VIH/SIDA et Tuberculose (TB) du Programme santé de l’ USAID dans 8 régions (2011-2016) à travers un appui technique et financier aux axes stratégiques du Ministère de la Santé et de l’ Action Sociale. Parmi ceux- ci, l’ amélioration de la qualité de la prise en charge médicale et sociale chez les Personnes Vivant avec le VIH est une priorité, afin d’ atteindre l’ objectif national des 3 « 901 » à travers la stratégie TATARSEN2. Bien que le taux de séroprévalence VIH reste stable à 0.7% au Sénégal, la carte de séroprévalence montre des disparités importantes
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