ART Patient Monitoring

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ART Patient Monitoring

• Abdikamal Alisalad
• WHO, Country Office, Uganda

TAP/RAP, Maputo, 19-23 June 2006
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Scaling up Prevention, Care ART
From 3x5, 2, 7, 10
Universal Access to prevention, care, and
treatment
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Scaling up Prevention, Care ART
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Scaling up Prevention, Care ART
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Scaling up Prevention, Care ART
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Scaling up Prevention, Care ART
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Scaling up Prevention, Care ART
Adequate human and financial resourses
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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/

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Countries Using the Patient Monitoring System

• Uganda
• Zambia
• Ethiopia
• Tanzania
• Lesotho
• Malawi
• India
• Dominican republic
• And others

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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)

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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

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What is the Patient Monitoring System?

• Facility-based paper system has 6 items
• A patient-held card
• A facility-held chronic care card
• HIV Care/ART Card or
• Same data elements in another format (ex.
  Clinical record)
• HIV Care Pre-ART register
• ART Register
• Quarterly (or monthly) report
• Cohort analysis report

Kept at facility
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ART Monitoring at Different Levels of the Health
Care System
Less
More
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Indicators

• Indicators related to patient access to HIV care
  and ART
• Number currently on ART
• Proportion of people with advanced HIV infection
  receiving ART (UNGASS)

• 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

• Other indicators
• HIV drug resistance early warning indicators
• Other indicators for facility-level programme
  monitoring
• TB/HIV indicators
• Prevention indicators

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Core national ART programme indicators
Source World Health Organization (WHO). National
AIDS programmes a guide to indicators for
monitoring and evaluating national antiretroviral
programmes. Geneva, WHO, 2005.
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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

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ART Register
ART start-up groups based on month/year start ART
in programme
Each page (A3-A3) has only one ART start-up group
Unique patient ID
Each row is one patient
Supports cohort analysis
Records patient status at 6, 12, 24, etc. months
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January
2004
Jan
Feb
M
Jul
A
J
M
In
Month 6
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Minimum standardized essential data elements

• Demographic information
• HIV care and family status
• ART summary
• Patient encounter information

Source Patient monitoring guidelines for HIV
care and ART
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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

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ART Cohort analysis at 0, 6, 12, 24, etc.
months
In
National Core 8 ART Indicator
Treatment regimens
National Core 9 ART Indicator
Treatment outcomes
CD4
Functional status
Adherence
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Quarterly Report Table 4

• Core 7
• 3 by 5
• UNGASS
• Total currently
• on ART

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Other indicators for facility-level programme
monitoring
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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

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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

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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

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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

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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

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HealthMapper ART Monitoring Extension Data
Reporting and AnalysisOUTPUT
All cohort data of all Health Facilities
Aggregated Grouped by Outcomes and sorted by
Cohorts

• Country specifics are automatically applied on
  reports output

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ART SITES NUMBER OF PATIENTS ON ART BY
DISTRICT, Northern Region, March 2006
1 ART SITE
lt 105 105 491 492 879 879 1265 gt 1266
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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

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Thanks for Listening