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Early Warning Indicators for ARV resistance

Early Warning Indicators for ARV resistance. National Health Security Office Bureau of AIDS, TB and STI World Health Organization Thailand MOPH-U.S. CDC Collaboration. National PMTCT Program. National HIV/AIDS ART Treatment Program. National Health Security Program.

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Early Warning Indicators for ARV resistance

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  1. Early Warning Indicators for ARV resistance National Health Security Office Bureau of AIDS, TB and STI World Health Organization Thailand MOPH-U.S. CDC Collaboration

  2. National PMTCT Program National HIV/AIDS ART Treatment Program NationalHealthSecurityProgram National Access to ARV Treatment for PLHA (NAPHA) SocialSecurity Global Fund Civil servant ARV mono and dual therapyunder research settings 2002 2003 2004 2005 2006 2007 1997-1998 2000 2001

  3. More than 140,000 PLHAs accumulatively received ARV in 2007 About 70% are supported by the National Health Security Program Number of PLHA Receiving ARV by Year 2008 UNGASS report

  4. National AIDS Program (NAP)electronic databaseThe National Health Security Office (NHSO) • Disease management information system for HIV/AIDS care and treatment services • An on-line centralized database using web application • Using Patient Identification Number as a unique identifier to link the care & treatment services across settings • Main objectives are to provide information for management and reimbursement of sites • Incentive for ART sites to enter data quickly • The treatment site is reimbursed for drugs dispensed, clinical services, and laboratory tests when the data are entered

  5. Internet connection NHSO Regional Hospital University Hospital NAP Database General Hospital 103 CD4 centers 29 VL centers 10 DR centers Community Hospital LAB Centers Centralized data networking NAP Electronic Database

  6. NAP Electronic DatabaseKey Patient Variables for ART Program Monitoring • Registration • Demographic data • HIV transmission risk • Date of HIV diagnosis • Date of ART start • Follow up visit • Date of attendance • ARV prescription picked up: regimen and # bottles (~pills) • Reason for stop or change in regimen • AIDS defining illnesses • Laboratory (CD4, VL and genotypic mutation): Date and results • Date of next scheduled appointment

  7. WHO Early Warning Indicators (EWI) for ARV Resistance

  8. Information Retrieval from NAP Database Set of cohort data linked by NAP PID Structured query language for information translation Appointment & follow up ARV uptake or prescription VL response Deaths List of EWI # 1-5, 8classified by facilities/provinces

  9. Example: EWI #1 a1 Prescribing practices: Percentage of patients initiating ART at the site during a selected time period who are initially prescribed, an appropriate* first-line ART regimen • Suggested target: 100% *appropriate first line regimens (2 NRTI + 1 NNRTI) defined by the National HIV Drug Resistance Working Group as first-line regimens listed for first-line ART in the national guideline

  10. Example: EWI #1 a1 Among PLHA who started ARV during Oct 1-Dec 31, 2007, Chiang Mai Province NAP Electronic Database Retrieval among 9,341 PLHA initiated ARV during Oct 1-Dec 31, 2007

  11. Among PLHA who started ARV during Oct 1-Dec 31, 2007, Chiang Mai Province Example: EWI #1 a1

  12. Among PLHA who started ARV during Oct 1-Dec 31, 2007, Region 10 Example: EWI #1 a1

  13. Next Step Planning • Calculation of all selected EWI from NAP HMIS • Verification of EWI results • System verification • Comparison with the results when data are entered into EWI tool spreadsheets (WHO) • Data verification and representativeness (site based) • Reliability of NAP HMIS to represent actual NAP patient results from manual record abstraction • Representativeness of NAP patients compared to all patients being treated at representative sites (including those not treated under NHSO)

  14. Next Step Planning (cont.) • Preparation of appropriate software program for data management at site, region, and national level • Building capacity for responsible site staff on interpretation and utilization of results for quality improvement and prevention of HIV drug resistance

  15. Acknowledgement • National Health Security Office • Bureau of AIDS, TB and STI • All hospitals in BMA and 76 Provincial Health Offices • NHSO and Disease Control Regional Offices • World Health Organization • Thailand MOPH-US CDC Collaboration

  16. Thank You

  17. province name hospital name Encrypted Personal ID. NAP number This column is protected by security rules. Only authorized person can see it Distribution is strictly prohibited

  18. Functions • Consists of 4 core modules and 4 additional modules • Cores modules:- • Registration • Follow up • Authorization (2nd line ARV) • Laboratory request &report • Additional modules:- • VCT • PMTCT • PEP • Report • Data in each module can be linked together by NAP PID number NAP PID links all modules together

  19. Among PLHA who started ARV during Oct 1-Dec 31, 2007, Region 10 Example: EWI #3a

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