HIV Patient ART Monitoring Meeting: International Conference Centre, Geneva 29-31 March 2004

1. HIV Patient ART Monitoring Meeting:International Conference Centre, Geneva29-31 March 2004 Defining the variables

2. Aims of the meeting • To discuss and identify those core variables to be collected for optimum patient management for ART monitoring in various settings (including PMTCT and Care for Women and Children programs) • some of these would also allow for the evaluation and feedback of programs at various levels of the country’s health care system and harmonization of demands across relevant research or donor organizations operative in resource poor settings

3. Objectives of the meeting (1) 1. to discuss and agree on minimum variables to be collected at patient level for a)      patient management; b)      programme evaluation at facility, regional (provincial), national, and global levels

4. Objectives of the meeting (2) 2. to discuss and agree on patient based variables which will be useful in providing a link with the monitoring and evaluation of other programs: a) ART resistance b) drug supplies c) TB, other chronic care

5. Objectives of the meeting (3) • to discuss and provide recommendations on mechanisms for collecting data at patient level

6. Objectives of the meeting (4) • to discuss and provided recommendations on mechanisms of reporting and providing feedback at the level of • health centre • district • Provincial • national • international

7. Objectives of the meeting (5) • to discuss and provided recommendations on mechanisms systems to be used or developed including • paper or • electronic systems.

8. How do we think we can achieve these objectives? • The meeting has brought together a number of experts in the field • We would like you to split up into 3 work groups Group 1: patient group Group 2: program group Group 3: drug supply group

9. Patient Group • Outcome: consensus on the minimum data set for monitoring clinical care for patients on ART in health facilities • Tasks: to identify and discuss variables for patient management: ideal, minimum and realistic • to identify low level indicators which can also be used for monitoring drug resistance • to discuss how these data could be collected within each clinical unit, including who and how these data will be collected • to discuss and agree on the next steps for implementation at local, country and global levels.

10. Program Group (1) • Outcome: consensus on the minimum data set and system required for ART Program Monitoring at various levels (facility, district, national, and global) • Tasks: identify the variables to monitor the programs, and their relationships with variables collected at health facility level • to discuss how and how often these data should be transferred to higher level facilities including a critical review of the applicability of new technologies (e.g. software, smart cards, cell phones) in addition to paper based systems.

11. Program Group (2) • how and how often these data will be analysed, by whom at which level and including a critical review of the applicability of various methods and means • how and how often result of these analyses will be fed back to relevant levels • to formulate recommendations on integration with the national HMIS with emphasis on records management including security and confidentiality, use and applications for M&E and surveillance. • to agree on the next steps for implementation at local, country and global levels.

12. Drug Supply Group (1) • Outcome: consensus on the minimum data set and system required for ART Drug Supply Monitoring at various levels (facility, district, national, and global) • Tasks: identify the variables to monitor the drug supply programs, and their relationships with variables collected at health facility level • to discuss how and how often these data on drug supplies will be transferred to higher level facilities including a critical review of the applicability of new technologies (e.g. software, smart cards, cell phones) in addition to paper based systems.

13. Drug Supply Group (2) • To discuss how and how often these data on drug supplies will be analysed, by whom at which level and including a critical review of the applicability of various methods and means • to discuss how and how often result of these analyses will be fed back to relevant levels • to formulate recommendations on integration with the national HMIS with emphasis on records management including security and confidentiality, use and applications for M&E and surveillance. • to agree on the next steps for implementation at local, country and global levels.

14. Variables ART Patient Monitoring • demographic, including unique identifiers • clinical, • laboratory, • treatment regimens HIV-related non-HIV , the extent of which may vary • use of services inpatient services, especially inpatient days outpatient services, especially outpatient visits • functional indicators

15. ….so we can evaluate and improve where possible the • Effectiveness • Efficiency • Equity • Acceptability of the ART programs put into place

17. …but this is the only way …we are going to be to assess on an ongoing basis how successful the initiatives have been which have been instituted to contain the HIV pandemic and which additional interventions or systems are required

18. Practical points: • Lists have been drawn up of who will go into which of the three groups • While we are not going to compel you to comply with this, we would like the groups to be of similar sizes • A member of each groups has been asked to act as rapporteur • In addition, can each group please appoint its own facilitator and person(s) who will take extensive notes.

19. Thank you again ….for attending and taking part in this important exercise………

20. That's All Folks!