Cross-sectional assessment of patient outcomes using a systematic file review process

Background: RHRU provides technical assistance with HIV related clinical services to Department of Health antiretroviral (ARV) clinic in Gauteng, KZN and North-West provinces. These clinics have been struggling with a wide range of operational and data related issues. We have created a systematic file audit process to provide evidence on the quality of care and treatment outcomes.

Methods: We reviewed files of all patients accessing care at the Wellness clinic at Tshepong Hospital (TWC) and the ARV clinic at Johannesburg Hospital (JH). We gathered information on: patients' age and gender, baseline and current CD4 counts and viral loads, treatment regimens, side effects, changes to and interruptions of treatment, and the current status of the patient.

Results: A total of 5750 files were reviewed at the TWC in July 2006, and 3900 files were reviewed at the JH ARV clinic in December 2006. Results from TWC show that the female-male patient ratio was 3:2. Mean age was 38 years. The mean baseline CD4 count was 103 cells/mm3. Out of all patient files reviewed, 41% were still attending the clinic, 23% had defaulted before and 14% after treatment initiation (defined as not having come back to the clinic for more than 6 weeks), 19% had been down-referred, and 2% had died. 69% had initiated on ARVs (96% on regimen 1A, 2% on regimen 1B, 1% on regimen 2 and 2% on other combinations). About 4% of patients experienced side effects. The most common opportunistic infection in the cohort was TB (34%). JH results are being analysed.

Conclusions: The findings have identified key areas in need of programme improvement and have been used as baseline information to initiate defaulter tracing, and improving data systems and quality of care. This systematic audit process has been streamlined and can be adapted to most clinic settings.