Representative EWI Monitoring Activities and Results (post-pilot)
1. For any year in which EWI were monitored routinely in all sites or a large number of representative sites:
List the EWIs that were monitored, which version of each EWI for which there is more than one version, period of time selected for each denominator, and the national target for each EWI. WHO provides suggested national targets (Appendix 2). If the national working group defined different targets; this section should include not only the target definition but the rationale for a more stringent target. Each EWI to be monitored should be the same for each site.
a. Definitions This section should include the HIVDR working group definition of standard or otherwise acceptable ART regimens, and any other definitions used for country analysis.
3. If EWI were monitored at all ART sites in the country, state this. Otherwise, describe EWI representative site selection process; that is, the basis on which representative ART sites were selected. This is generally either a formal hierarchical stratified random sampling process, or another less formal process, such as listing each ART site in the country on a grid with relevant characteristics and selecting a specified number of sites representing each relevant combination of characteristics. If some variation on the latter process was used, include the grid in an Appendix.
4. For the year, list the ART sites in which the EWI were monitored, the areas of the country in which the sites are found, relevant demographic information on the patient populations served, and the percentage of patients receiving ART in the country who are treated at each sites. [This information may be provided in table format].
a. Describe the electronic or paper medical records, registers, and pharmacy records systems that were used at each site for the EWI abstraction. (There is no need to describe forms or modules used at a site that were not used for EWI abstraction.)
b. The field(s) or variable(s) in each site's records systems that was used for the numerator and denominator, and the method for abstracting the information. An
example data extraction plan is found in Appendix 3.
As an appendix to the report, include copies of the relevant medical and pharmacy records systems. For sites with electronic records systems, scan a copy of the file structure or data entry screens for electronic medical records, registers, and pharmacy systems into the report, and circle the relevant fields for the numerators and denominators of each EWI. For sites with paper-based systems, include a copy of the relevant paper forms into the plan and circle the relevant fields from which the numerator and denominator were abstracted.
5. Process of EWI Data extraction and Analysis
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Describe composition of data extraction team [list individual names and institutions, and role of each]
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Describe process data were extracted
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Describe when data was extracted
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EWI data analysis methods
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Describe validation exercise used for EWI
6. EWI Results for the year
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Describe challenges, lessons learned
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Assess ongoing feasibility of monitoring of each of the EWI piloted
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For each EWI: summarize results for sites where information was available; report sites for which EWI information could not be collected and which data could not be collected from these sites.
EWI results should be summarized and presented both by site and at the national aggregate site level. Examples of both are provided below. Describe results if available.
B. Progress towards integration of EWI into routine public health activities
Describe if teams implementing other monitoring or supervision are also implementing EWI. Describe planned alterations to routine medical records to facilitate EWI extraction, installation of electronic systems programmed to extract EWI automatically, routine budgeting of EWI extraction and reporting as part of monitoring, surveillance, or other general budget lines, and/or integration of EWI monitoring into routine activities of ART Monitoring, HIV Surveillance, or any unit or department charged with general rather than HIVDR-specific activities.
C. Future EWI Plan
Please provide general summary of next year's plan for monitoring of EWI, and any anticipated alterations to subsequent years' plans. Include planned integration of EWI extraction into routine HIV surveillance and monitoring activities in country and provide plan for expansion of EWI monitoring to a representative system after the pilot year, or any planned changes to the system after representative EWI monitoring has been instituted. Describe how EWI monitoring will support strengthening of national ART medical records systems and general ART monitoring.
VI. Surveys to monitor HIVDR emerging during ART, and related ART site factors, in sentinel ART sites
The WHO protocol for monitoring HIVDR emerging during treatment in sentinel sites utilizes a standardized, minimum-resource prospective survey methodology to assess the success of ART programs in preventing HIVDR emergence during the first year of ART; and to identify factors associated with the emergence of HIVDR that can be addressed at the level of the ART programme. WHO HIVDR monitoring surveys are designed to be integrated easily into a country’s ongoing, routine HIV-related evaluation activities. Performed regularly at representative sites, the data generated will inform the evidence-base for national and global ART regimen selection and minimize the emergence of HIVDR at a population level.
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