1、INTRODUCTION OF ART IN COMPREHENSIVE HIV/AIDS CARE AND SUPPORT: MONITORING AND EVALUATION,John A. Adungosi, MB Chb, MSc, MRIT,ACKNOWLEDGEMENTS,Dr. S.K. Sharif, PMOCoast Province Dr. H. Shikely, Chief Administrator, Coast General Provincial General Hospital Staff of CPGH, Port Reitz District Hospital
2、, Mkomani-Bomu Medical Centre and Magongo Health Centre USAID Technical Advisory Partners: Family Health International MSH/RPM Plus Population Council/HORIZONS,Purpose of HIV/AIDS care treatment and support programmes:,To reduce morbidity and mortality from HIV/AIDS and related complications.To impr
3、ove the quality of life of adults and children living with HIV/AIDS and their families.To assure equitable access to diagnosis, medical care, pharmaceuticals, and supportive care.To promote prevention opportunities within care and support service delivery.,PEOPLE AND FAMILIES AFFECTED BY HIV/AIDS,Hu
4、man Rights and Legal Support e.g.: PLHA participation Stigma & discrimination reduction Succession planning,Socioeconomic Support e.g.: Material support Economic security Food support,Medical & Nursing Care e.g.: VCT, Family Planning Preventive therapy OI treatment and HAART Palliative care,Psychoso
5、cial Support e.g.: Counseling Spiritual support Follow-up counseling Community support,Elements of Comprehensive Care and Support,Supportive Policy and Social Environment,Background,Why did the ART program start? Availability of HAART in Kenya: from mid-90s in private hospitals Prohibitive cost of t
6、reatment amidst intense public interest Government responses to improve access Increasing availability of ARV drugs due to progressive reduction in prices and initiatives to improve access,Background (2),National consultative meeting on ART Convened by IMPACT in Sept. 2001 Involved local and interna
7、tional stakeholders, donors, researchers, PLHA and community groups The purpose was to review the ART situation in Kenya and chart the way forward The result was the setting up of a National ART Task Force,Background (3),National ART task force Composed of local and international stakeholders, commu
8、nity groups, PLHA, professional associations,donors and development agencies Acts as an advisory board to the NASCOP and Director of Medical Services Has many sub committees (Drugs, training, Systems development Provides platform for sharing experiences on ART implementation,National Adult HIV Preva
9、lence: 10.2% Project Site: Coastal city of Mombasa Health Facilities Coast General Provincial Hospital: 700-bed tertiary referral hospital with 70% of beds occupied by HIV/AIDS patients. Port Reitz District Hospital: Government referral hospital. Mkomani Bomu Clinic: Semi-private primary health care
10、 clinic. Magongo Health Center: Local government primary health care clinic.,Site Information: Kenya,Where is the program implemented?,Mombasa: Rationale for Site Selection (1) High HIV prevalence and disease burden Sites provide the opportunity to introduce ART at different levels of health care se
11、rvices as well as multiple entry points to ART services within the same catchment area Sites are linked through a referral network system and to some services that provide elements of comprehensive care and support,Rationale for Site Selection (2): USAID supported programs in Mombasa provide element
12、s of comprehensive care and support IMPACT: Prevention activities (BCC, STI management) & care activities (VCT, management of OI, psychological support to PLHA) COPHIA: Home-based care activities PSI: Condom promotion Strong political commitment,Where is the program implemented?,How is the program i
13、mplemented?,Establish the Technical Advisory Partners and define the role of each partner: Partners roles FHI/IMPACT: overall implementation and M&E MSH/RPM Plus: strengthening drug and commodity management Population Council/Horizons: conducting operational research related to the introduction of A
14、RT program,How is the program implemented?,Develop a concept paper describing the implementation of the program Convene a workshop with local stakeholders to discuss the concept paper The TAP described the ART Program Local stakeholders provided recommendations on key programmatic issues and the fra
15、mework for the program Local stakeholders provided their commitment to support and promote the program,How is the program implemented?,Establish the ART program management structure Steering Committee: Composition: Local stakeholders Responsibility: Overseeing program implementation Scientific Commi
16、ttee: Composition: Local and international researchers and scientists Responsibility: Developing realistic minimum package of activities (e.g eligibility criteria, Rx treatment monitoring schedules),How is the program implemented?,Establish the ART program management structure Operational Management
17、 team: Composition: Program coordinator, ART site team leader, partners field officers Responsibility: Daily management of the programTechnical Advisory Partner: Composition: RPM Plus, Horizons, IMPACT, USAID Responsibility: Providing technical support to the program and the different committees,How
18、 is the program implemented?,Conduct assessment of existing capacity for implementing HIV care program including ART Strengthen the capacity based on the findings from the assessment Develop implementation plans Execute, monitor and evaluate the implementation,What have we done so far?,All committee
19、s have been established Scientific Committee has defined eligibility criteria and treatment monitoring schedule, Steering Committee approved Assessment of existing capacity was conducted Based on findings from the assessment, an implementation plan was developed with each facility,What have we done
20、so far? (2),The capacity of the CPGH has been strengthened: Training of 37 clinicians, pharmacists and laboratory staff was completed in April, 2003; Standard Operating Procedures and clinical data collection tools are in place; Procurement of laboratory equipment is underway (CD4 instrument); Drug
21、storage and security at pharmacy have been developed; Nurse adherence counselors were trained in adherence monitoring.,What have we done so far? (3),The CPGH Comprehensive HIV Care Center is operational, providing HIV clinical services, ART, nutritional counseling, TB, STI, and referral to home care
22、, inpatient services, MCH/ANC, PMTCT, and the Pediatric Clinic.On May 23, 2003, patients started ART in accordance with eligibility criteria.,PATIENT DATA,The Comprehensive HIV Care Centre: Began clinical care on April 17, 2003number of HIV infected patients followed:FemaleMale WHO Clinical Staging:
23、 II III IV,PATIENT DATA (2),The First Month of ART at CPGH: Total: HIV Care- 123; ART 11 Gender- =Female/ Male Range of CD4 counts03-201 Adherence counselingall patients participated in a minimum of 3 mandatory adherence counseling sessions prior to starting ARVs Response to ARVs: Incidence of adver
24、se symptoms,MONITORING AND EVALUATION,Objectives: To improve the capacity of HIV/AIDS clinics, laboratory and pharmacy services in selected public health facilities in Mombasa to support the introduction of comprehensive care including ART To provide ART to 300 patients over a period of five years i
25、n accordance with eligibility criteria To sensitize and strengthen communities and PLHA support groups in HIV/AIDS comprehensive care, including ART To explore Operations Research Questions (e.g., What is the effect of DAART upon ARV adherence?),FORMATIVE ASSESSMENT DATA COLLECTION TOOLS,Needs Asses
26、sment Tool: -National Clinical Guidelines -Physical infrastructure Laboratory services Pharmacy -Human resources and staff capacity-Clinical services and referral mechanism-HIV diagnosis-ARV management-Management Information Systems-Cost Issues,STANDARD OPERATING PROCEDURES,Clinical Care and Patient
27、 Flow Adult and Paediatric Post-exposure prophylaxis Drug and Commodity Management Laboratory and Other Investigations,DATA COLLECTION TOOLS (2),Patient Clinical Monitoring Forms:-Comprehensive Care Centre Registration Form-Nursing Assessment for Triage Form-Clinical Management of HIV Patients: Firs
28、t Visit-Follow-Up Review of HIV Patients-Enrollment Form for Adult ARV Treatment-Medical Follow-up of Adult Patients on ART-Referral System Form-Clinic Attendance and Treatment Follow-Up Register,MONITORING AND EVALUATION (3),Indicator Categories:Clinical/biological outcomesARV treatment adherenceOc
29、currence of adverse drug effectsOccurrence of OIs, including TBDrug management and inventory controlLaboratory monitoring and equipment utilizationReferral for community based services, including home care and psychosocial supportTraining and refresher coursesImpact of community outreach on stigma a
30、nd treatment seeking,MOMBASA PROJECT: M&E PLAN SAMPLE,NEXT STEPS,Scale-up project at 3 satellite sites in Mombasa Progressively develop computer-based data entry system at each site November 2003: completion of 6 months of ART at CPGH Collect, analyze and report on key findings Document lessons learned from start-up of ART project Disseminate data and conclusions to key stakeholders and service providers,
