Transcript UNAIDS

UNAIDS Extended MERG Workshop
Subnational and Concentrated
Epidemics
Geneva
October 28, 2004
Paul De Lay
Director, Evaluation
UNAIDS
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Linking patient monitoring and program monitoring-seeking duplication!!
• Concerns about complexity and density of data. Need more field
experience.
• Too much data vs not enough (drug procurement/good quality clinical
care)
• What are costs of this?
• Similarities/dissimilarities with TB, and “true” chronic diseases
o TB invested in vertical staffing
o Mobile patients
• Concerns about staffing and training
o Assigning responsibilities, such as data aggregation and analysis
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Public versus private services-will this work for
both?
• Confidentiality
• Especially in concentrated epidemics, ? get info on
modes of transmission, etc
• This data set contains early warning signs for ARV
resistance (adherence, stockouts, changing
regimens, deaths)
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Evaluation of projects (Track One proposal)
• Harmonizing 3X5, PEPFAR, Track One (Indicators, reports, reporting
timelines, etc)
• Pt clinical monitoring, health facility, subnational, national-what do we
need?
• Standardizing demographic data, especially age cohorts (0-2, 3-4,5-14,
15 and above)
• ? Value of CD4 and weight gain (other laboratory and clinical) for
program monitoring
• Need long term survival
• Program management requires #staff per pt, staff trained, coverage,
costs
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Need start-up, current, survival, coverage, % on first line
and second line Rx (How much of this can be done at
subnational levels)
• Need to cap national level indicators
• Balance the need to provide guidelines and the need to
learn and revise
• Need to draft an “operations manual” based on the draft
operational framework (May need two versions-one to
organize technical issues and one for country guidance.
Consider including in the “Fundamentals” document)
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• A lot of good work has been done to
build on...
• Now the work needs to focus on the
country level