Participants notes
- 1. Republic of Kenya Ministry of Health Antiretroviral Drug Therapy in Kenya The ART/HMIS Training Materials (Participants’ Notes) National AIDS and STI Control Programme (NASCOP) August 2006
- 2. Objectives of the Course ___________________________________ Familiarise participants with ways of ___________________________________ ART data collection Introduce participants to the concept of ___________________________________ programme monitoring for ART Prepare participants to start using the ___________________________________ new system and replace all local data collection initiatives ___________________________________ ART/HMIS Training Materials Module I 1 ___________________________________ ___________________________________ Objectives of Module III, Part 1: HIV/AIDS ___________________________________ Situation At the end of the module, participants will ___________________________________ be able to understand: The HIV/AIDS Situation world wide ___________________________________ The HIV/AIDS situation in Kenya The measures taken as a response to ___________________________________ the HIV/AIDS Pandemic. The implications of HIV/AIDS in Kenya ___________________________________ ART/HMIS Training Materials Module III - Part 1 1 ___________________________________ ___________________________________ GLOBAL PICTURE ___________________________________ 40 Million living with HIV by end of 2004 ___________________________________ One-third of PLWHA are in 15-24 age group ___________________________________ Majority do not know they are infected Young women are more vulnerable ___________________________________ Sub-Sahara 60% of world’s PLWHA (25.4m) ___________________________________ ART/HMIS Training Materials Module III - Part 1 2 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 1
- 3. ___________________________________ Global epidemiology summary In 2003, 14,000 new HIV infections ___________________________________ occurred daily 2000 in children <15 years ___________________________________ 12,000 in persons of reproductive age (15- 49 years); 50% of this group are women Over 95% of these new infections occur ___________________________________ in the developing world In 2003, between 2.5 and 3.5 million ___________________________________ persons died of HIV/AIDS ART/HMIS Training Materials Module III - Part 1 3 ___________________________________ ___________________________________ AN OVERVIEW OF THE HIV/AIDS ___________________________________ SITUATION IN Kenya HIV/AIDS in Kenya. ___________________________________ National prevalence :7% 1,000,000 – 1,200,000 PLWA of which 200,000 need ART The 2003 KDHS reported that: Adult prevalence rate is 7% ___________________________________ HIV prevalence is almost twice as high in urban as in rural areas (10% urban; 6% rural) HIV prevalence in women: 8.7%, 4.6% in men Annual infections (2003) ___________________________________ 1,100,000 new infections in adults. 150,000 new infections among children Over 50% hospital admissions are HIV/AIDS related ___________________________________ ART/HMIS Training Materials Module III - Part 1 4 ___________________________________ ___________________________________ HIV/AIDS Situation in Kenya ___________________________________ The population of Kenya is ___________________________________ approximately 32 million. At the end of 2004, 1.2 million Kenyans ___________________________________ were living with HIV/AIDS. An estimated 1.5m Kenyans have died of AIDS ___________________________________ Approximately 1.6m children under 15 have been orphaned by the death of ___________________________________ one or both parents from AIDS. ART/HMIS Training Materials Module III - Part 1 5 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 2
- 4. Implications of HIV/AIDS ___________________________________ Sickness ___________________________________ Absenteeism from school by Children (Attend to the sick or Teacher is sick) Loss of man-hour Low contribution to food production (Results in hunger) ___________________________________ Huge cost to pay for medication HIV/AIDS patients now occupy more than half of hospital beds Deaths Mostly, productive of the population are affected ___________________________________ Orphan-hood Widowhood Poverty (Bread winner is affected) ___________________________________ Deaths due to HIV/AIDS affecting the most productive of the population worsens poverty levels ART/HMIS Training Materials Module III - Part 1 6 ___________________________________ ___________________________________ RESPONSE TO THE HIV/AIDS ___________________________________ SITUATION Prevention. ___________________________________ Prevention of Mother To Child Transmission. Voluntary Counselling and Testing. ___________________________________ Condoms. Care. ___________________________________ Home Based Care. Treatment. ___________________________________ Anti Retroviral Therapy. Management of Opportunistic Infections. ART/HMIS Training Materials Module III - Part 1 7 ___________________________________ ___________________________________ Objectives of Module III, Part 2: The ___________________________________ ART Programme in Kenya At the end of the module, participants will ___________________________________ be able to understand: The ART Programme in Kenya ___________________________________ The main goal of the ART Programme Specific goals of ARV therapy ___________________________________ Resource limitations affecting ARV therapy ___________________________________ ART/HMIS Training Materials Module III - Part 2 1 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 3
- 5. Main Goal of the ART Programme ___________________________________ The main goal for any ART programme is ___________________________________ to increase accessibility to antiretroviral therapy with a view of prolonging the ___________________________________ lives of the patients infected with HIV. ___________________________________ ___________________________________ ART/HMIS Training Materials Module III - Part 2 2 ___________________________________ ___________________________________ AN OVERVIEW OF THE ART PROGRAMME IN ___________________________________ Kenya ART programme started with private sector ___________________________________ ART services in Kenya Started with 5 public pilot sites ___________________________________ 15 provincial sites in 2003 48 district health facilities in 2004 Plan to scale to all 72 districts ___________________________________ Related programmes PMTCT. VCT. ___________________________________ Treatment of Opportunistic Infections. Tuberculosis. ART/HMIS Training Materials Module III - Part 2 3 ___________________________________ ___________________________________ GOAL OF THE ART PROGRAMME IN KENYA ___________________________________ Contribution to the 3 by 5 global target ___________________________________ Kenya’s targeted was 95,000 persons to be put on ART by 2005 Reach 78% of eligible clients by 2010 ___________________________________ 70,000 persons currently on ART Currently over 200 public, mission and private sites ___________________________________ offer ART services M+E system for ART designed to meet global and ___________________________________ local requirements ART/HMIS Training Materials Module III - Part 2 4 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 4
- 6. Challenges/resource constraints in ___________________________________ providing ART Initial cost of drugs too high for people ___________________________________ Shortages of health providers in facilities Integrating ART into existing health ___________________________________ structures Ill-equipped labs: difficult to provide ___________________________________ services to monitor ART. ___________________________________ ART/HMIS Training Materials Module III - Part 2 5 ___________________________________ ___________________________________ Introduction to ART: A Conceptual ___________________________________ Framework The purpose of the module is ___________________________________ Highlight standard ART procedures To lay a foundation for the data ___________________________________ management aspect of ART Not to equip participants with clinical skills ___________________________________ to provide ART ___________________________________ ART/HMIS Training Materials Module IV 1 ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ART/HMIS Training Materials Module IV 2 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 5
- 7. ART/HMIS Materials - Participant=s Notes 6
- 8. Initiating ART in HIV+ Adults and ___________________________________ Adolescents Kenyan Recommendations for Initiating ART ___________________________________ in Adults and Adolescents with Documented HIV Infection If CD4 count available: ___________________________________ WHO Stage III when CD4 count < 350/mm3 WHO Stage I, II, disease with CD4 count <200 cells/mm³ WHO Stage IV irrespective of CD4 level ___________________________________ If CD4 count is unavailable: WHO Stage III or IV WHO Stage II disease with total lymphocyte count <1,200c ells/mm³ ___________________________________ Source: National Training Curriculum on ART, Comprehensive HIV/AIDS Care ART/HMIS Training Materials Module IV 3 ___________________________________ ___________________________________ Objectives of the Presentation ___________________________________ Rationale behind the ART data collection ___________________________________ Information System Architecture of ART HMIS ___________________________________ ___________________________________ ___________________________________ ART/HMIS Training Materials Module V 1 ___________________________________ ___________________________________ Rationale of ART/HMIS ___________________________________ A response to the M&E framework ___________________________________ outlined in the National Scale-up Plan for ART ___________________________________ The absence of a reporting system during scale-up ___________________________________ Standardizing data capture tools Meeting international obligations ___________________________________ ART/HMIS Training Materials Module V 2 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 7
- 9. Architecture of ART HMIS ___________________________________ It is a paper-first-based system ___________________________________ Designed to collect minimum standard data elements ___________________________________ It is not a clinical system meant for improving the quality of care ___________________________________ Data flow structures Uses registers, cards, and summary sheets ___________________________________ ART/HMIS Training Materials Module V 3 ___________________________________ ___________________________________ Data Instruments in ART HMIS ___________________________________ Registers/Cards ___________________________________ Pre ART Register ART Monthly Register ___________________________________ HIV Care/ART Card Reporting Forms ___________________________________ Monthly Summary sheet Cohort Summary Sheet ___________________________________ ART/HMIS Training Materials Module V 4 ___________________________________ ___________________________________ Scope of ART HMIS ___________________________________ Provide history of patient visits to the ___________________________________ facility Provide basis for monitoring patient ___________________________________ progress Provide information on adverse drug events ___________________________________ Assists in tracking adherence to treatment ___________________________________ ART/HMIS Training Materials Module V 5 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 8
- 10. Limitations of ART HMIS ___________________________________ Not a Patient Tracking System ___________________________________ Does not provide information on logistics related to ART such as ___________________________________ Staff availability Drug stock levels ___________________________________ Reagents Cannot measure drug resistance ___________________________________ ART/HMIS Training Materials Module V 6 ___________________________________ ___________________________________ DATA COLLECTION ___________________________________ OBJECTIVES: ___________________________________ Understand data collection Learn how to correctly complete: ___________________________________ Pre ART Register Comprehensive Care Clinic Card ART Register ___________________________________ ___________________________________ ART/HMIS Training Materials Module VI, Part 1 1 ___________________________________ ___________________________________ DATA COLLECTION ___________________________________ PURPOSE ___________________________________ provide a record of care given to specific clients. ___________________________________ provide information on health status and service delivery. ___________________________________ provide data for action planning. ___________________________________ ART/HMIS Training Materials Module VI, Part 1 2 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 9
- 11. DATA COLLECTION TOOLS ___________________________________ Pre ART Register ___________________________________ All patients who need HIV Care are entered here. This includes patients identified within the facility ___________________________________ and those that are referred or transferred in before they are commenced on ART Comprehensive Care Clinic Card ___________________________________ It serves as a detailed record of clinical diagnosis and treatment. It is opened immediately a patient enrols in HIV Care ___________________________________ ART/HMIS Training Materials Module VI, Part 1 3 ___________________________________ ___________________________________ DATA COLLECTION TOOLS ___________________________________ ___________________________________ ART Register All patients on ART are entered here. ___________________________________ Information for each monthly visit of individual patients is recorded here. ___________________________________ ___________________________________ ART/HMIS Training Materials Module VI, Part 1 4 ___________________________________ ___________________________________ Document Flow Diagram ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ART/HMIS Training Materials Module VI, Part 1 5 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 10
- 12. ART/HMIS Materials - Participant=s Notes 11
- 13. ___________________________________ Aggregation and Reporting Aggregation Forms ___________________________________ ? Comprehensive Care Clinic Monthly ___________________________________ Summary Sheet • Comprehensive Care Clinic Cohort Summary Sheet ___________________________________ ___________________________________ ART/HMIS Training Materials Module VIII 1 ___________________________________ ___________________________________ Objectives of Module VIII: ___________________________________ Overview of ART Measures After completion of this module, ___________________________________ participants should be able to: Know the ART Measures ___________________________________ Calculate the ART Measures Interpret the ART Measures ___________________________________ ___________________________________ ART/HMIS Training Materials Module VIII 1 ___________________________________ ___________________________________ Overview of the ART Indicators ___________________________________ Basis for selection of Measures ___________________________________ Kenya ART implementation Plan X1 ? X2 International obligations, e.g. WHO, ___________________________________ UNAIDS, PEPFAR, etc. Efficiency, exclusiveness, feasibility, cost ___________________________________ implications ___________________________________ ART/HMIS Training Materials Module VIII 2 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 12
- 14. Overview of the ART Indicators ___________________________________ Measure Categories ___________________________________ Measures of accessibility Measures of programme success ___________________________________ Measures of adequacy in program support areas ___________________________________ Early Warning Signal for drug resistance ___________________________________ ART/HMIS Training Materials Module VIII 3 ___________________________________ ___________________________________ ART/HMIS Materials - Participant=s Notes 13