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About CLICQ!
The Clinic-Lab Interface
Continuous Quality Improvement (CLICQ!) program developed as a natural
extension of the Laboratory African Regional Collaborative (LARC). LARC is an HIV service
delivery program that similarly focuses on the interface between clinics and laboratories.
CLICQ! was developed by the U.S. Centers for Disease Control and Prevention (CDC) in
partnership with APIN and piloted in Nigeria.
CLICQ! guides healthcare workers
and laboratory staff through review of their clinic-laboratory data and identifies gaps
within their TB patient cascade. Participants attend learning sessions to receive training
on continuous quality improvement (CQI) practices, data review, and other strengthening
activities. Site-specific improvement projects are developed that target prioritized gaps
for closure. A metric-based monitoring and evaluation plan is developed, in parallel with
the improvement projects, to track on-site progress of improvement projects. The program
aims to build the capacity of national-, state-, local- and facility-level staff for
enhanced data use and to strengthen site-specific gaps that reside at any step within the
patient pathway, or diagnostic cascade.
Our Goals
The primary goals of CLICQ!:
- Improved TB case finding through increased patient retention
- Improved initiation of TB Preventive Therapy (TPT) or treatment among HIV-positive and HIV-negative persons with presumptive or confirmed TB
- Improved time to TB diagnosis, and time to initiation of TPT or TB treatment among HIV-positive and HIV-negative persons with presumptive or confirmed TB.
Secondary goals of CLICQ!:
- Improved communication and coordination between clinic and laboratory facility staff
- Integrated patient monitoring between HIV and TB programs
- Strengthened, CQI skills for on-site, healthcare-worker driven improvement of clinic-lab services.
Total Laboratories
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Countries Involved
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Testimonials
With this TBCLICQI project our case finding has been increased to a reasonable number in our facility as we take our improvement project serious.
Shityo Terhemen
TB CLICQI helped in strengthening TBHIV collaboration activities across facilities, improved the quality of services provided to clients within the facilities with improved documentation and accountability among HCWs
Dr. Gabriel Anefu
It plays a vital role in monitoring, evaluation and scaling up/treatment of the clients. It is a major tool in maintaining accuracy and ensuring that due process is adopted in the practice
Francis Onwuchekwa (Genexpert Lab focal person) NKST Mkar, Benue State, Nigeria
Seamless patient care cascade has been achieved as every client now moves from DOTs office accompanied to the lab without missing on the way. Quality of care is now optimized through quality improvement team meetings Networking system through Whatsapp and other platforms has helped as best practices are shared to enhance quality of care.
John Kwagbor (DOTs Officer) St. Gregory Ikpayongo, Benue State, Nigeria
It has been a wonderful experience for me, as the weekly triangulation between the TB presumptive and laboratory register has been satisfactorily concurrent. This has led to improved service delivery and client satisfaction.
Rosemary Ngunan Gande (TB DOTS Volunteer) General Hospital, Wannune, Benue State, Nigeria
TB CLICQI has been a very exciting and fulfilling process. The game changer for us is the triangular journey escort of clients from clinic to TB DOTS and then laboratory. We no longer record missed opportunities in addition to ensuring all laboratory results are returned to the clinic and filed in the client folders. Overall outcomes are improved patient care/treatment as well as a quality assured TB process at the facility.
Agaba Agaba Geoffrey (TB Laboratory Focal Person) General Hospital, Wannune, Benue State, Nigeria
With TB-CLICQI there is greater consciousness about routine data review and triangulation with a view to identifying gaps and applying QI methods to fix them. This is about building an army of ‘Quality Ninjas’ who see every problem as an opportunity for improvement.
Chima P. Chima (TB Laboratory Focal Person) St. Vincent’s Hospital, Aliade, Benue State, Nigeria
TB-CLICQI project has brought tremendous improvement in our TB program at St. Vincent’s Hospital, Aliade. There is no disparity now between the number of clients captured in the TB presumptive register and the number of samples tested at the laboratory on a weekly basis. We have equally applied the QI strategies in improving other programs in our facility
Dr. Ogbeyi.G. O (ART Clinician and Facility Project Coordinator) St. Vincent’s Hospital, Aliade, Benue State, Nigeria
Before now, quality was an uphill task, but with TB-CLICQI it became a staircase that a step at a time takes you to heights of improvement you may never imagine.
Mrs. Eronini. E (TB Laboratory Focal Person) Federal Medical Centre, Benue State, Nigeria
TB CLICQI is unique at pointing out shortcomings. 27% of our patients were not submitting sputum samples for TB testing, with attendant implications to morbidity, mortality and transmission. With appropriate intervention we were able to reach 99% sample collection! Case detection, treatment and prevention are ensured. We hope to do even better with health worker participation and ownership.
Dr. Kpamor (ART Clinician and Facility Team lead) Federal Medical Centre, Benue State, Nigeria
This is one of the most fulfilling, result oriented exercise we have engaged in in recent times. I must say it was timely & well organized. The level of success recorded was largely due to the sacrifice & commitment by the team & the understanding to improve the quality of TB services, barring prevailing challenges, in our health facility. CLICQI strengthened our teamwork spirit, opened our eyes to the possible gaps and missing cases along TB diagnostic cascade. It was indeed tasking, but the end result was worth the trouble.
CHRC Team COCIN Hospital Rehabilitation Center (CHRC) Mangu, Plateau State, Nigeria
TB-CLICQI lead to an overall improvement of the quality and performance of TB healthcare environment, in addition to sensitization, awareness and increase in identification of TB cases among health care workers by consciously looking out for quality. It helped providers to generate reliable data, cost effective and sustained TB health care processes which enabled them to achieve their goal of improving care delivery and enhancing patient outcomes.
Onyekachi Awa Agbai (TB/HIV Lab Focal Person, APIN Benue State)
“TB-CLICQ! is a sneak peek into what is the future of TB programs in Nigeria and other countries still grappling with the burden of Tuberculosis. A bit more commitment from critical stakeholders will see this initiative conquer the scourge”.
Dr. Isa S. D. – TBCLICQ! Trainer, APIN Nigeria
“The TB-CLICQI project was a huge learning and productive process which was quite exceptional and unique in promoting interdisciplinary teamwork and collaboration. Working closely with the supported facilities, the project afforded me the opportunity to hone my CQI coaching skills”.
Eke Ofuche (CLICQI Master Trainer, APIN Nigeria)
Quality indicators are useful objective tools aimed at directing and improving processes across program indicators. The TB CLICQI project fostered a sense of ownership, improved TBHIV collaboration and communication among HCWs while providing quality services to patients and improving TB diagnostic cascade
Dr. Faith Ushie
“The height attained by the teams was not reached by sudden flight rather the toiling with Continuous Quality Improvement essentials. CLICQI is hard work, it does not expect one to become a quality ninja overnight. The MoH, program, and facility teams mastered the skills, competencies, and tools, step-by-step and put them into action. TB CLICQI is the key to TB/HIV service delivery improvement”
Laura Madukaji (CLICQI Master Trainer, APIN Nigeria)
“TB-CLICQI improved the TB/HIV diagnostic cascade by bringing together key players in the clinic and laboratory to be responsible and accountable for their patients throughout the entire cascade at facility level. The programme has improved my CQI skills and broadened my knowledge in the aspect of CQI implementation in TB/HIV disease setting.”
Emmanuel Adewale Ojo (CQI Expert, APIN Nigeria)
TB-CLICQI is a welcome development in the diagnosis of all TB cases, it is currently the best approach to TB diagnosis in Benue state. This is possible as the DOT providers, clinic and laboratory staff now work together to ensure that samples are collected, tested and results reach the DOTS/Clinic in a timely manner to facilitate quick commencement of patient care/treatment.
Mr. Abege Maurice (Director of Laboratory Services, MoH Benue State)
“TBCLICQ! is a wonderful initiative brought to us by APIN. It is quite commendable as it has helped strengthen the TB cascade in the selected sites. However we will request for a scale up to other facilities as we believe it will help lower missed opportunities to the barest minimum.”
Dr. Bunan Mafwalal (Director of Public Health, MoH, Plateau state)
Ready to get started?
For information on how to begin implementing CLICQ! at the national-, state-, local-, or facility level, click below. Resources include training materials on continuous quality improvement (CQI), tools for data abstraction and review, other strengthening activities.