ART Patient Monitoring
Document Sample
ART Patient Monitoring
Abdikamal Alisalad
WHO, Country Office, Uganda
TAP/RAP, Maputo, 19-23 June 2006
Scaling up Prevention, Care & ART
Universal Access to
From 3x5,
2, 7, 10
prevention, care,
and treatment
Scaling up Prevention, Care & ART
Different Care & treatment are live-
approach long interventions
Scaling up Prevention, Care & ART
Different treatment are live-long
approach interventions
Decentralization To health centre level and
closer to communities
Scaling up Prevention, Care & ART
Different treatment are live-long
approach interventions
Decentralization To health centre level and
closer to communities
Feasible & for Free services for those who
all can’t afford
Scaling up Prevention, Care & ART
Different treatment are live-long
approach interventions
Decentralization To health centre level and
closer to communities
Feasible & for Care & treatment are live-
all long interventions
Monitoring Adherence, switch 2nd line,
system and resistence
Scaling up Prevention, Care & ART
Different
approach
Decentralization
Adequate human
and financial
Feasible & for
all resourses
Monitoring
system
Interim Patient Monitoring
Guidelines for HIV Care and ART
• Based on the HIV patient ART monitoring
meeting
• WHO, UNAIDS, USAID, CDC, HRSA, GFATM
and:
– AIDS institute, EPICENTRE/MSF, ESTHER, FHI,
infectious diseases institute, JSI/DELIVER,
JSI/MEASURE, lighthouse, MCART association,
MTCT-plus initiative, office of the US global AIDS
coordinator, pan African treatment access movement,
partners in health, PHARMAccess, SATELLIFE, St
Camille medical Centre, VOXIVA, MSH, UNICEF,
university of Brescia, university of cape town, USAID
• March 31, 2005 draft and subsequent drafts:
http://www.who.int/3by5/
Countries Using the Patient
Monitoring System
• Uganda
• Zambia
• Ethiopia
• Tanzania
• Lesotho
• Malawi
• India
• Dominican republic
• And others…
TB Experience
• Standardized treatment card and
register
• Globally standardized definitions
• Deliberate limitation of data collected
• Based on long experience
• Recently, new TB-HIV indicators
• Disease-specific (vertical)
ART Patient Monitoring System
Patient monitoring system fills several
roles:
• For clinical team- to manage individual
patients and groups of patients
• For programme management: data for a
few very important indicators
Patient monitoring can be:
• Paper-based system
• Electronic system
• A combination of both
What is the Patient Monitoring
System?
Facility-based paper system has 6 items:
1. A patient-held card
2. A facility-held chronic care card
• HIV Care/ART Card or
• Same data elements in another format (ex.
Clinical record)
Kept at 3. HIV Care Pre-ART register
facility
4. ART Register
5. Quarterly (or monthly) report
6. Cohort analysis report
HIV+ patient
Patient-held card
enrols in
chronic HIV
care
Side 1: Summary card
Update from Encounter card
HIV care / ART as needed
patient card
Side 2: Encounter card
Updated with each
outpatient visit for patients
in HIV care/ART
New patients
entered into
pre-ART
register
Pre-ART register
Monthly or Quarterly HIV
Care/ART Report
When ART
starts, transfer to
ART register
Number enrolled and eligible but not
yet started on ART
New and cumulative number enrolled
ART register in ART and HIV Care
Number receiving each ARV regimen
at end of reporting period
Electronic entry
using PDA or ART Cohort Analysis Report:
laptop by
district team
At 6 mo, 12 mo, yearly
District electronic database
Treatment regimens
for cohort analysis Treatment outcome
disaggregated by sex and age Functional status
CD4
ART Monitoring at Different
Levels of the Health Care System
LEVEL TOOLS PURPOSE QUANTITY
Global/Regional Summary 3x5, PEPFAR, Less
indicators UNGASS..etc
National Summary National planning &
indicators evaluation
District Summary District planning &
indicators reporting
Facility Registers/logbook QoC, drug supply,
clinical team
building
Patient Patient Case management
card/records More
Policy guidelines for ART NATIONAL
ART coverage DISTRICT
ARV stock outs
Training HWs for ART
Health systems for ART
FACILITY
Comprehensive care coverage
Eligible pts receiving ART
PATIENT
Continuation of treatment
Survival @ 6, 12, 24 months
Indicators
1. Indicators related to patient access to HIV care and ART
• Number currently on ART
• Proportion of people with advanced HIV infection
receiving ART (UNGASS)
2. Indicators related to success of ART (national core
indicators)
• Continuation of first-line regimens at 6, 12 and 24
months after initiation
• Survival at 6, 12, 24, 36, etc. Months after initiation of
treatment
3. Other indicators
• HIV drug resistance early warning indicators
• Other indicators for facility-level programme monitoring
• TB/HIV indicators
• Prevention indicators
Core national ART programme indicators
Core 1 Existence of national policies, strategy and guidelines for ART programmes
Core 2 Percentage of districts or local health administration units with at least one health facility providing
ART services in line with national standards
Core 3 Percentage of ARV storage and delivery points experiencing stock-outs in the preceding 6 months
Core 4 Number of health workers trained on ART delivery in accordance with national or international
standards
Core 5 Percentage of health facilities with systems and items to provide ART services
Core 6 Percentage of health facilities with ART services that also provide comprehensive care, including
prevention services, for HIV-positive clients
Core 7 Percentage of people with advanced HIV infection receiving ARV combination therapy
Core 8 Continuation of first-line regimens at 6, 12 and 24 months after initiation
Core 9 Survival at 6, 12, 24, 36, etc. months after initiation of treatment
Source: World Health Organization (WHO). National AIDS programmes: a guide to indicators for
monitoring and evaluating national antiretroviral programmes. Geneva, WHO, 2005.
Pre-ART Register
Information for one patient
• Chronic care register v. acute care register
• Each row is one patient
• Collect information on a group of patients
• Lists ALL patients who enrol in HIV care
ART Register
ART start-up groups Each page (A3-
based on month/year A3) has only
Unique
start ART in one ART start-
patient ID
programme up group
COHORT: Year _______ Month ________ ART Register 2004-2005
Each row is one patient
Records patient Supports
status at 6, 12, 24, cohort analysis
etc. months
2004 January
Jan Feb M A M J Jul
In
Month 6
Minimum standardized essential
data elements
I. Demographic information
II. HIV care and family status
III. ART summary
IV. Patient encounter information
Source: Patient monitoring guidelines for HIV care and ART
ART Summary
• ART history prior to entry
• ART START date/ treatment cohort:
• Date medically eligible to start ART
• Why medically eligible; baseline CD4, clinical stage
• Date medically eligible AND ready to start ART
• Date medically eligible, ready AND selected to start ART
• Functional status and weight at ART start
• First line regimen
• Original first line regimen (list drugs)
• If SUBSTITUTE within first-line regimen: dates, reasons, new
regimens
• If SWITCH to or SUBSTITUTE within second-line regimen or more:
dates, reasons, new regimens
• ART interruptions: dates, reasons
• STOP ART: dates, reasons
• ReSTART: dates
• Transfer In, Transfer Out: date, facility transferred from or to
• LOST (temporary): dates
• DROP/Lost to follow-up: dates
• DEAD: date
ART Cohort analysis:
at 0, 6, 12, 24, etc. months
In
National Core 8
Treatmen ART Indicator
t
regimens
Treatmen National Core 9
t ART Indicator
outcomes
CD4
Functiona
l status
Adherenc
e
Quarterly Report: Table 4
• Core 7
• 3 by 5
• UNGASS
Total currently
on ART
Other indicators for facility-level
programme monitoring
Benefits of Building an ART Monitoring System
as a HealthMapper Application Extension
Use HealthMapper's existing geographical data
Use HealthMapper – DataManager common functionalities to
append additional geographical and health data
Real time map production of ART data
Have access to additional mapping functionalities
– Maps showing aggregated/disaggregated data over time
and/or geography
– Display additional geographical data in correlation with ART
data
HealthMapper ART Monitoring Extension
Data Entry
Monthly or Quarterly HIV Care/ART Report ART Cohort Analysis Report
Data entry can be customized for each country
User-defined validations can be created
New calculated fields can be added
Customizations are automatically applied on both the Report & Data Exchange
functionalities
HealthMapper ART Monitoring Extension
Data Reporting and Analysis
Monthly or Quarterly HIV Care/ART Report ART Cohort Analysis Report
Can generate batch reports for each selected features of a given level
– Disaggregated: at Health Facility level for a single time period
– Aggregated: at Health Facility or above level for a given time range
Can generate aggregated reports for all selected features of a given level
HealthMapper ART Monitoring Extension
Data Reporting and Analysis: OUTPUT
All Health Facility Monthly Reporting form data Aggregated
Country specifics are automatically applied on reports output
HealthMapper ART Monitoring Extension
Data Reporting and Analysis: OUTPUT
All cohort data of all Health Facilities
Aggregated – Grouped by Outcomes
Country specifics are automatically applied on reports output
HealthMapper ART Monitoring Extension
Data Reporting and Analysis:OUTPUT
All cohort data of all Health Facilities Aggregated
Grouped by Outcomes and sorted by Cohorts
Country specifics are automatically applied on reports output
ART SITES & NUMBER OF PATIENTS ON ART BY DISTRICT, Northern Region, March 2006
= 1 ART SITE
< 105
105 – 491
492 – 879
879 – 1265
HealthMapper ART Monitoring Extension
Data Reporting and Analysis: MAPS
All ART Indicators are directly
connected to the HealthMapper
database
– all ART indicators can be
shown on maps
– all HealthMapper GIS
functionalities are available
Thanks for Listening
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