Transcript Andreas Jahn

Integrated Monitoring and
Evaluation of HIV Programs in
Malawi
Dr Andreas Jahn 1,2
1 Dept. for HIV and AIDS, MOH, Malawi
2 I-TECH Malawi
Malawi Context
• July 2011: Integration and Innovation
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preART
Exposed Infant follow-up
ART
PMTCT
STI
TB
Family Planning
HTC
• Data Collection tools, reporting, Supportive
Supervision and now Clinical Mentoring were and are
the foundation of the successful HIV program
M&E: An iterative process…
Quarterly
Supportive
Supervision
to EVERY
site
Data
Collection in
integrated
M&E tools
Clinical
Mentoring for
select sites
Comprehensive
Quarterly Report
disseminated
Integrated M&E for HIV Programs
ANC Integrated
Register
5 ANC visits
Labour and Delivery
• Line Register: Mother on left; Infant on right of page
ART Patient Card
Status at ART Initiation
WHO
clinical conditions
Clin Stage
1
2
3
4
CD4 / TLC
Age at Init.
TB Status at Initiation
% KS
Pregnant / Lactating
CD4/TLC Date
Height, Wt.
PSHD
cm
kg
Ever taken ARVs
Last ARVs (drug, date)
Never/
>2yrs
N
Last
2yrs
N
Preg
N
Curr
Y
Lact
Y
Patient Cards
THYOLO DISTRICT
HOSPITAL
48 Arch Back Files
containing 2,400
patient cards
Quarterly Supervision Visits to all Sites
• Prevent protocol drift
• Rapid chart review – identify and discuss irregular cases
• Consultation & mentoring on complex cases
• Physical drug stock check
• Assess clinic infrastructure, staffing
• Review and discuss data (content and quality)
• Disseminate program and protocol updates
• Provide constructive feedback & encouragement
Logistics for ART Supervision
• Visits to all 650 PMTCT/ART sites each quarter
• 20 Teams of 3 supervisors (Pool of 75)
– MOH HIV Dept. staff
– Experienced ART clinicians & nurses
– Quarterly supervisors training
• USD 110,000 (transport, accommodation,
allowances)
Integrated HIV Service Supervision
Form
1.
2.
3.
4.
5.
Contact details of staff at each site
Quality of service checklist
Follow up on previous action points
Next visit date
M&E reports from HTC, ANC, maternity, exposed
child and pre-ART follow-up, ART and TB
6. Physical drug stock count
7. Award of Certificate of Excellence / Book for clinical
mentoring
Feedback & Encouragement
Formal assessment on supervision form
• No problems on quality check list
• Few errors on cohort analysis
Outcomes from Supervision Round
2012 Q1
Running the M&E System
Clinic Staff (Clinician, Nurse, Clerk)
– Fill patient card at each visit
– Enter all new patients in register
– Perform quarterly cohort analysis
– Fill report form
Supervision Team
– Review all treatment cards
– Check updating of outcomes in register
– Check cohort analysis (usually repeat tallies)
Quarterly Cohort Analysis
• Tallying of registration details of new patients
• Review of all patient cards
• Tallying of secondary outcomes
(Regimen, Side effects, TB status, adherence)
• Updating of primary outcomes in register
(Alive on ART, Died, Transfer Out, Stop, Lost)
• Tallying of all primary outcomes from register
Updating outcomes for reporting on Exposed Child, preART, ART
Person 1 (Cards):
• Read out loud the
registration numbers of
cards in the ACTIVE file
• Check for new deaths,
defaults, TO, etc.
• Tally secondary outcomes
at the same time on a
separate paper on the side
QI Through Chart Review & Mentoring
• Expected number of new initiations
• Correct determination of ART eligibility
• Identification of ART interruptions
• Patients with side effects on wrong regimens
• Adherence problems
• Review of complicated cases on the ward
QI Through Logistics Support
• Estimation of drug needs at each site
• Monitoring of drug consumption
• Ad-hoc relocation of ARVs
• Communication with DHO about
infrastructure improvements
Closing the communication loop
• Action points from Supervision team given to
the Zonal and District ART Supervisors, and
Implementing Partners
– Plan clinical mentoring follow-up
• Debrief at central level:
– Ongoing and emerging issues
Closing the communication loop (2)
• Comprehensive Quarterly Reports
– Data entry, cleaning, analysis
• Site level data based at MOH
– Report writing
– Dissemination by email and through TWG
– Information feeds into SCM
Thank you!