SP.783 Jina Kim Jelena Mirkovic Aparna Kollipara Jessica Rhee Project Proposal Draft Background In this portion of our project we would like to work on practical methods that will help HBC workers to become better informed about their patients and thereby provide more personalized, accurate care. We would like to construct a simple chart that will allow the caregiver to make simple diagnoses of patient syndromes that will allow them to make more informed decisions. This form should be simple to use and be clear enough to prevent misdiagnosis, but flexible enough to accommodate a wide range of symptoms and possibilities that could face disease sufferers in Zambia. We feel that changing the system of paper would improve the quality of care offered through HBC. Currently, paperwork related to ART initiation, progress, and termination come in a myriad of forms. One set used in Zambia has nine different forms for each patient: initial history and physical, patient location, ARV eligibility, pharmacy, adherence, unscheduled visit, scheduled visit, referral, and discontinuation. Workers also maintain a daily diary for patients that are maintained in manila folders. The diary asks for an assessment of observed medical problems, but we observed from a sample diary provided that the activities performed to help the patient mostly involve non-medical duties like washing clothes, cooking, and spiritual support. The only hint of medical support was encouraging the patient to go to the clinic. They also make note of domestic supplies that 1are given to the patient for regular livelihood. Although HBC workers are minimally trained volunteers, we believe that they can be more integrated in the continuing medical care of a patient if their role is approached differently. None of these forms provide a space where the home-based care worker would be entrusted to note a patient’s symptoms and make simple diagnosis. The care provider, who probably observes the patient most often, only notes problems; presumably, diagnosis is ultimately left up to the physicians who only occasionally see the patient. For example, if a worker observes certain symptoms simultaneously in a patient, like muscle weakness, vomiting, diarrhea, and nausea, he or she should know that they are the signs of lactic acidosis and immediately refer the patient to a doctor. The new paper form that we propose would allow for the provider to realize trends by looking at the overall progression of patient health over a week, month, or multiple months. We believe that incorporating diagnosis into the forms would help care providers understand how to better assist their patients medically and motivate them fill out paperwork accurately. In order to make simple yet effective diagnosis for common conditions and indicators or disease, we found it necessary to identify the most common issues facing Zambians today. Due to the different health concerns facing Zambians, it was important to do research on what the most common health issues were for them. To date, the most common and significant indicators of disease are: 1) Body mass index (BMI) which is height * weight If the HBC worker finds it easier just to record weight, this is also useful. 2) Diarrhea and vomiting #/times per day 23) Oral ulcers 4) Oral thrush: fungal infection of the mouth which causes a burning sensation in the mouth and throat Symptoms:White, cream-coloured, or yellow spots in the mouth 5)Persistent headache Can be a symptom of meningitis 6) Loss of appetite 7) Persistent cough, chest pain, and shortness of breath These are symptoms of a respiratory infection (e.g. TB, pneumonia) 8) Lethargy 9) Lactic acidosis is a serious problem, but is very difficult to detect at the HBC level. Lab testing is required to determine whether the patient has lactic acidosis. A simple chart measuring these symptoms in patients would aid HBC workers and healthcare providers to make a more accurate assessment of the patient’s health status and provide better overall care. The goal of our project is to help HBC workers caring for ART patients to not only participate in providing basic care and pill counting, but to also make simple diagnosis. The idea is that the access to patient history will help an HBC worker to evaluate patient progress, and recognize problems and emergency situations. The patient history might be represented by a simple chart and might include the start date of ART, adherence so far, progress (most likely in terms of weight gain over a period of time), history of side effects, and history of opportunistic infections. The HBC worker could have specific weight-gain check points as part of their patient evaluation. If the course of patient weight gain is not what is expected the HBC worker could recognize the problem and refer the patient to higher authorities. Another important area to focus on 3would be a diagnosis of lactic acidosis. ART patients commonly experience mild side effects such as nausea and diarrhea, but not uncommonly they may develop a life threatening condition, lactic acidosis. This severe side effect is characterized by nausea and diarrhea, but also includes abdominal pain, muscle weakness, rapid breathing and rapid heart rate. If this condition is not recognized and treated, it can be fatal. Besides providing a starting point to lead to better healthcare on an individual basis, there is another benefit to collecting data from patients at the HBC level. Health data is a necessary to build viable and accurate epidemiological understanding of disease trends and demographic information about sufferers. Understanding of what is happening on the ground is essential to construct effective and reasonable policies and plans that will influence how healthcare is managed and provided on a larger scale. Most of the data that is collected in Zambia specifically for use in epidemiological studies is funded by the government through the Zambian Ministry of Health, which uses the National Health Accounts methodology to track health spending and statistics from major hospitals in Zambia. Although this data and methodology have their benefits, relying only on data from major hospitals neglects to take into consideration the many patients who do not rely on hospital care for their illnesses. The NGOs and smaller-scale private organizations that are responsible for HBC delivery and running private clinics probably