participants notes

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

ART/HMIS Materials - Participant=s Notes

1

ART/HMIS Training Materials Module I 1

Objectives of the Course

Familiarise participants with ways of ART data collection Introduce participants to the concept of programme monitoring for ARTPrepare participants to start using the new system and replace all local data collection initiatives

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ART/HMIS Training Materials Module III - Part 1 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 KenyaThe measures taken as a response to the HIV/AIDS Pandemic.The implications of HIV/AIDS in Kenya

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GLOBAL PICTURE

40 Million living with HIV by end of 2004One-third of PLWHA are in 15-24 age groupMajority do not know they are infectedYoung women are more vulnerableSub-Sahara

60% of world’s PLWHA (25.4m)

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Global epidemiology summary

In 2003, 14,000 new HIV infectionsoccurred daily

2000 in children <15 years12,000 in persons of reproductive age (15-49 years); 50% of this group are women

Over 95% of these new infections occur in the developing worldIn 2003, between 2.5 and 3.5 million persons died of HIV/AIDS

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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

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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 AIDSApproximately 1.6m children under 15 have been orphaned by the death of one or both parents from AIDS.

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Implications of HIV/AIDS

SicknessAbsenteeism from school by Children (Attend to the sick or Teacher is sick)Loss of man-hourLow contribution to food production (Results in hunger)Huge cost to pay for medicationHIV/AIDS patients now occupy more than half of hospital beds

DeathsMostly, productive of the population are affectedOrphan-hoodWidowhood

Poverty (Bread winner is affected)Deaths due to HIV/AIDS affecting the most productive of the population worsens poverty levels

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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.

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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 KenyaThe main goal of the ART ProgrammeSpecific goals of ARV therapyResource limitations affecting ARV therapy

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4


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.

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AN OVERVIEW OF THE ART PROGRAMME IN Kenya

ART programme started with private sectorART services in Kenya

Started with 5 public pilot sites15 provincial sites in 200348 district health facilities in 2004Plan to scale to all 72 districts

Related programmesPMTCT.VCT.Treatment of Opportunistic Infections.Tuberculosis.

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GOAL OF THE ART PROGRAMME IN KENYA

Contribution to the 3 by 5 global targetKenya’s targeted was 95,000 persons to be put on ART by 2005Reach 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

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Challenges/resource constraints in providing ART

Initial cost of drugs too high for peopleShortages of health providers in facilitiesIntegrating ART into existing health structuresIll-equipped labs: difficult to provide services to monitor ART.

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ART/HMIS Training Materials Module IV 1

Introduction to ART: A Conceptual Framework

The purpose of the module is Highlight standard ART proceduresTo lay a foundation for the data management aspect of ARTNot to equip participants with clinical skills

to provide ART

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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/mm3WHO Stage I, II, disease with CD4 count <200 cells/mm³WHO 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

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ART/HMIS Training Materials Module V 1

Objectives of the Presentation

Rationale behind the ART data collection Information SystemArchitecture of ART HMIS

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Rationale of ART/HMIS

A response to the M&E framework outlined in the National Scale-up Plan for ARTThe absence of a reporting system during scale-upStandardizing data capture toolsMeeting international obligations

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Architecture of ART HMIS

It is a paper-first-based systemDesigned to collect minimum standard data elementsIt is not a clinical system meant for improving the quality of careData flow structures

Uses registers, cards, and summary sheets

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Data Instruments in ART HMIS

Registers/CardsPre ART RegisterART Monthly RegisterHIV Care/ART Card

Reporting FormsMonthly Summary sheetCohort Summary Sheet

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Scope of ART HMIS

Provide history of patient visits to the facilityProvide basis for monitoring patient progressProvide information on adverse drug eventsAssists in tracking adherence to treatment

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Limitations of ART HMIS

Not a Patient Tracking SystemDoes not provide information on logistics related to ART such as

Staff availabilityDrug stock levelsReagents

Cannot measure drug resistance

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ART/HMIS Training Materials Module VI, Part 1 1

DATA COLLECTION

OBJECTIVES:Understand data collectionLearn how to correctly complete:

Pre ART RegisterComprehensive Care Clinic CardART Register

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DATA COLLECTION

PURPOSEprovide a record of care given to specific clients.provide information on health status and service delivery.provide data for action planning.

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DATA COLLECTION TOOLS

Pre ART RegisterAll 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 ARTComprehensive Care Clinic CardIt serves as a detailed record of clinical diagnosis and treatment. It is opened immediately a patient enrols in HIV Care

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DATA COLLECTION TOOLS

ART RegisterAll patients on ART are entered here. Information for each monthly visit of individual patients is recorded here.

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Document Flow Diagram

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ART/HMIS Training Materials Module VIII 1

Aggregation and Reporting Aggregation Forms

? Comprehensive Care Clinic Monthly Summary Sheet • Comprehensive Care Clinic Cohort Summary Sheet

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Objectives of Module VIII:Overview of ART Measures

After completion of this module, participants should be able to:Know the ART MeasuresCalculate the ART MeasuresInterpret the ART Measures

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Overview of the ART Indicators

Basis for selection of MeasuresKenya ART implementation Plan X1 ? X2International obligations, e.g. WHO, UNAIDS, PEPFAR, etc.Efficiency, exclusiveness, feasibility, cost implications

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Overview of the ART Indicators

Measure CategoriesMeasures of accessibilityMeasures of programme successMeasures of adequacy in program support areasEarly Warning Signal for drug resistance

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participants notes

Documents