Transcript date ART start

Sub module 5
Monthly report
Part 6: Enrolment in HIV care

Cumulative number ever
enrolled at the beginning
of the month


New patients enrolled
during the month

Previous report
(cumulative number ever
enrolled at the end of the
month)
Pre-ART register:



Cumulative number ever
enrolled at the end of the
month


date of 1st visit
‘monthly cohort’
SEX and AGE
Sum of previous
indicators
Part 7: Medical eligibility for ART

Number of patients
eligible for ART but
have not been started
ART at the end of the
month

Pre-ART register:




Count those whose



date of medical eligibility
date ART started
SEX and AGE
date of eligibility is informed
and
date of ART started is empty
Check all pages of the
register
Part 8: Enrollment on ART


Cumulative number ever
started on ART at the
beginning of the month
New patients started on
ART during the month


Previous report
(cumulative number ever
started on ART at the end
of the month)
ART register:




+patients transferred in
Cumulative number ever
started on ART at the end
of the month



date ART start
‘monthly cohort’
SEX and AGE
ART register (all pages)
Sum of previous indicators
Part 9: Outcomes on ART





Cumulative number of deaths reported at the
end of the month
Cumulative number of patients transferred out
under ARV at the end of the month
Number of patients missing or lost to follow-up
at the end of the month
Number of patients stopping ART at the end of
the month
Number of patients on ART at the end of
the month
Part 9: Outcomes on ART



ART register: monthly visits, 1st row
(outcome)
As patients are registered by month of
starting ART, all those recorded in 1 page
should have the same number of monthly
follow-ups
Count the last outcome recorded by
checking each page in the ART register
Example: Checking the outcomes in 1
page of the ART register
Monthly visits: ● 1st row, write patient outcome: on treatment (OT)
if patient picked up ART drugs, stopped (ST) if ART was stopped by the
doctor, missing (MIS) if the patient missed the appointed visit, lost to
follow-up (LFU) if the patient is missing >3 months, restart (RS) if ART
we. 2 mo. 1 mo.2 mo.3 mo.4 mo.5 mo.6 mo.7 mo.8
OT
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
A
OT
OT
ST
ST
ST
RS
OT
A
A
A
OT
OT
OT
OT
OT
OT
ST
A
B
B
A
A
B
B
OT
OT
OT
TR
A
A
A
A
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
OT
OT
OT
OT
A
A
C
C
A
MIS MIS
6 patients in the page
All started 6 months ago
Eg. Checking the outcomes in 1 page of
the ART register
Monthly visits: ● 1st row, write patient outcome: on treatment (OT)
if patient picked up ART drugs, stopped (ST) if ART was stopped by the
doctor, missing (MIS) if the patient missed the appointed visit, lost to
follow-up (LFU) if the patient is missing >3 months, restart (RS) if ART
we. 2 mo. 1 mo.2 mo.3 mo.4 mo.5 mo.6 mo.7 mo.8
OT
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
A
OT
OT
ST
ST
ST
RS
OT
A
A
A
OT
OT
OT
OT
OT
OT
ST
A
B
B
A
A
B
B
OT
OT
OT
TR
A
A
A
A
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
OT
OT
OT
OT
A
A
C
C
A
MIS MIS
Last outcome
Eg. Checking the outcomes in 1 page of
the ART register
Monthly visits: ● 1st row, write patient outcome: on treatment (OT)
if patient picked up ART drugs, stopped (ST) if ART was stopped by the
doctor, missing (MIS) if the patient missed the appointed visit, lost to
follow-up (LFU) if the patient is missing >3 months, restart (RS) if ART
we. 2 mo. 1 mo.2 mo.3 mo.4 mo.5 mo.6 mo.7 mo.8
OT
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
A
OT
OT
ST
ST
ST
RS
OT
A
A
A
OT
OT
OT
OT
OT
OT
ST
A
B
B
A
A
B
B
OT
OT
OT
TR
A
A
A
A
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
OT
OT
OT
OT
A
A
C
C
A
MIS MIS
2 on treatment
1 stop
1 transferred out
1 missing/1 LFU
Number of patients on ART at the
end of the month


By counting the ART register (on treatment +
restart)
Verification:
Cumulative on ART
=cumulative ever started ART
-(death, transferred out + missing/LFU + stopped)
Number of patients whose treatment
was substituted or switched




Among patients on treatment,
Check the entire ART register to
Review the information in the columns
“switch” and “substitute” to count how
many changed regimen
The remaining are on original 1st line
Part 10: Treatment adherence


In the ART register, review the columns
monthly visit
Check the adherence status in the 2nd
row in the last monthly visit
Eg. Checking the adherence in 1 page of
the ART register
Monthly visits: ● 1st row, write patient outcome: on treatment (OT)
if patient picked up ART drugs, stopped (ST) if ART was stopped by the
doctor, missing (MIS) if the patient missed the appointed visit, lost to
follow-up (LFU) if the patient is missing >3 months, restart (RS) if ART
we. 2 mo. 1 mo.2 mo.3 mo.4 mo.5 mo.6 mo.7 mo.8
OT
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
A
OT
OT
ST
ST
ST
RS
OT
A
A
A
OT
OT
OT
OT
OT
OT
ST
A
B
B
A
A
B
B
OT
OT
OT
TR
A
A
A
A
OT
OT
OT
OT
OT
OT
A
A
A
A
A
A
OT
OT
OT
OT
A
A
C
C
A
MIS MIS
6 patients in the page
All started 6 months ago
3 assessed
for adherence
• 2 A, >95%
•1 B, 80-95%
Drug dispensing and stock
monitoring

Part 11: regimen at the end of the month

Part 12: drug stocks
Drug dispensing and stock
monitoring

2 indicators:

Regimen at the end of the month



Drug stock


Document the frequency of the different regimens
prescribed
Identify the 2nd line regimen prescribed
Describe the drug consumption and balance
Used for drug planning, request and
budget
B- PHARMACY
11. REGIMEN AT THE END OF THE MONTH
Regimen
No. of patients on ART
Is stock enough for existing
patients for 6 months? Y/N
specify
D4T30/3TC/NEV
D4T40/3TC/NEV
ZDV/3TC/NEV
ZDV/3TC/EFV
D4T30/3TC/EFV
D4T40/3TC/EFV
Total= cumulative no. of
patients on ART at the end of
this month (=9.6)
12. DRUG STOCKS
Was there a stock-out of antiretroviral drugs this month?
Yes 0
Was there a stock-out of drugs for opportunistic infection this month?
Yes 0
Name of the
drug (list ARV
and OI drugs)
Stock at the
start of the
month (A)
Stock received
during the month
(B)
Stock
dispensed
during the
month ( C)
No 0
No 0
Stock
Stock at the
expired/
end of the
Amount
discarded
month
requested
during the
(A+B)-(C+D)
month (D)
Regimen at the end of the month

ARV drug dispensing register



Check all pages corresponding to the month
Count the number of the different regimens
prescribed for the total patients receiving ARV
drugs during the month
For a patient receiving twice in the month,
report only the regimen received at the last
visit
Group work: Exercise 3
5 persons / 1h30



The clinic CL opened in Oct 2004 for HIV
care and ART
We are at the end of January 2005, and
you are preparing the monthly report
Materials


the pre-ART and ART registers,
Dec 2004 report
Answer to exercise – January
2005 report
6. Enrollment in HIV care (PLWHA seeking
care at the treatment center)
6.1 Cumulative no. of patients ever enrolled in
HIV care at beginning of this month
6.2 New patients enrolled in HIV care during this
month
6.3 Cumulative no. of patients ever enrolled in
HIV care at the end of this month
7. Medical eligibility for ART*
7.1 No. of patients medically eligible for ART but
have not been started on ART at the end of this
month
adult male
adult female
child.<14 yo
total
37
23
4
64
13
8
2
23
50
21
6
87
adult male
adult female
child.<14 yo
total
5
3
1
9
Answer to exercise
8. Enrollment on ART
adult male
adult female
child.<14 yo
total
13
7
1
21
4
4
0
8
8.3 No. of patients on ART transferred in this month
1
0
0
1
8.4 Cumulative no. of patients ever started on
ARTat the end of this month
18
11
1
30
8.1 Cumulative no. of patients ever started on
ARTat the beginning of this month
8.2 New patients started on ART during this
month
Answer to exercise
9. outcomes on ART
9.1 Cumulative no. of death reported at the end
of this month
9.2 Cumulative no. of patients transferred out
under ARV at the end of this month
9.3 No. of patients missing/lost to follow-up at
the end of this month
9.4 No. of patients stopping ART at the end of
this month
9.5 No. of patients on ART at the end of this
month
● 9.5.1 Among them, no. on original 1st line
regimen
adult male
adult female
child.<14 yo
total
2
0
2
1
25
23
● 9.5.2 No. on substituted 1st line regimen
2
● 9.5.3 No. switched on 2nd line regimen
0
Answer to exercise
10. TREATMENT ADHERENCE
Total
10.1. No. of patients assessed for adherence during this month
20
10.2. Of those assessed for adherence, level of adherence in the last month
10.2.1. < 3 doses missed in a period of 30 days
> 95%
19
10.2.2 =3 to 12 doses missed in a period of 30 days
80-95%
0
10.2.3. >12 doses missed in a period of 30 days
<80%
1
Answer to exercise
11. REGIMEN AT THE END OF THE MONTH
Regimen
D4T30/3TC/NVP
D4T40/3TC/NVP
ZDV/3TC/NVP
ZDV/3TC/EFV
D4T30/3TC/EFV
D4T40/3TC/EFV
+ D4T/3TC/NVP junior 12 mg
Total= cumulative no. of
patients on ART at the end of
this month (=9.6)
No. of patients on ART
9
11
1
0
1
2
1
25
Is stock enough for existing
patients for 6 months? Y/N
specify
Trend analysis of the monthly report

To calculate 2 cores indicators:



Proportion who did not start ART among
patients medical eligible
Proportion on treatment among patients who
started
To present each month (table and figure)
the trends in performance


Enrolment, eligibility and start of ART
Outcomes on ART
Enrolment in Clinic CL since Oct 2004
Jan-05
Dec-04
Nov-04
Oct-04
enrolment
100
90
cumulative no. of
patients starting ART
no. of patients medically
eligible for ART but have
not been started on ART
no. of persons enrolled in
HIV care not eligible for
ART
9
5
21
21
5
38
30
9
48
60
50
40
30
20
10
0
64
87
50.0 31.3 19.2 23.1
Jan-05
37
Dec-04
17
Nov-04
Proportion eligible who
did not start treatment
4
11
70
no. of patients medically eligible
for ART but have not been started
on ART
cumulative no. of patients starting
ART
Oct-04
cumulative no. of patients
enrolled in HIV care
4
no. of patients
80
no. of persons enrolled in HIV care
not elligible for ART
Outcomes on ART in clinic CL
since Oct 04
0
1
0
35
Cumulative no. on ART
2
0
no. stopping ART
0
1
1
1
Cumulative no. on ART
4
9
17
25
Proportion on ART
100 81.8 81.0 83.3
cumulative no.of death
20
15
10
5
0
Jan-05
2
25
Dec-04
2
no. stopping ART
no. missing/lost to follow -up
Nov-04
1
30
Oct-04
0
no. of patients
0
0
Jan-05
0
Dec-04
cumulative no. transferred
out
no. missing/lost to followup
Nov-04
cumulative no.of death
Oct-04
outcomes on
ART
Limitations of monthly report
analysis



Cross-sectional information
Enrollment and outcomes at one time
point in the facility program
No information on the duration of followup on ART
 Cohort analysis is required

Thank you