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HIV Drug Resistance Early Warning Indicators
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  1. HIV Drug Resistance Early Warning Indicators Dr Mwango Albert National ARV Program Coordinator, MoH-Zambia Dr Shields Mark Epidemiology and Strategic Information Chief, CDC -Zambia The 2nd Global HIV/AIDS Surveillance Meeting, Bangkok, Thailand March 2-5, 2009

  2. Presentation Outline • Part 1 • Introduction & use of SmartCare • HIVDR EWI in SmartCare • Progress to date • Challenges • Use of Results • Part 2 • OLAP • Further analytic ideas • Acknowledgements March 2009 Zambia HIVDR Early Warning Indicators 2

  3. Intro-EHR System SmartCare is an Electronic Health Record (EHR) system Deployed to more than 400 facilities (200 for ART) Captures all patient demographics, clinical and follow up information using ART forms March 2009 Zambia HIVDR Early Warning Indicators 3

  4. Use of SmartCare March 2009 Zambia HIVDR Early Warning Indicators 4

  5. Use of SmartCare March 2009 Zambia HIVDR Early Warning Indicators 5

  6. EWIs in SmartCare 1.a,c pts prescribed/dispensed std 1st line regimen 1.b,d pts prescribed/dispensed std 1st line regimen doses 2.a pts LTFU for >30d at 1 yr 2.b pts LTFU for >90d at 1 yr 2.c pts LTFU for >90d at 2 yrs March 2009 Zambia HIVDR Early Warning Indicators 6

  7. EWIs in SmartCare 3 pts who remain on a std 1st-line ART at 1 yr 4.b pts who picked meds on-time for entire 1st yr 5.b pts attending all their ART clinical appointments on time* during 1st yr 6 pts who had regimen stopped/modified due to stock-outs/shortages in 1st yr 7 pts who report zero missed doses in 7 days prior to each visit *-14d to + 7d March 2009 Zambia HIVDR Early Warning Indicators 7

  8. EWIs in SmartCare 9.a pts who have died at 1 yr 9.b pts who have stopped ART in past 1 yr 9.c pt transferred out in past 1 yr March 2009 Zambia HIVDR Early Warning Indicators 8

  9. Progress to date (1) • 317 ART sites around the country & >220,000 on Rx • 200 are running SmartCare for ART • 2/3 are running version with EWI report • EWI in SmartCare for about 1 year • Able to run report at all levels March 2009 Zambia HIVDR Early Warning Indicators 9

  10. Progress to date (1) • Coordination and Capacity • Recruiting coordinator(s) for HDRSS/PV • Refurbishing HDRSS/PV offices • Procurement of equipment, furniture and vehicles • SOPs Training • Trained 7 districts in phase 1 • 200 HCWs trained • SOPs with EWI included • Trained 3 districts in 2nd part of phase 1 • 45 HCWs trained • Review of EWI reports in SmartCare March 2009 Zambia HIVDR Early Warning Indicators 10

  11. Planned Activities • Phase 1 Trainings • 6 more districts to be trained -March 2009 • Other activities • SOPs at printers • Training and Support Supervision • TOT & orientating CPs • EWI Site Assessment & Support Supervision • 10 facilities in 5 districts– April 2009 March 2009 Zambia HIVDR Early Warning Indicators 11

  12. Use of Results • Influence treatment success factors • Patient related factors • e.g. Appt keeping, meds pick up, adherence • Provider related factors • e.g. Prescriber and dispenser competence • Heath system related factors • e.g. Logistics management systems • Multi- factorial • e.g. Switching; death; quality of care and; quality of life March 2009 Zambia HIVDR Early Warning Indicators 12

  13. Use of Results at Facility • Areas of primary usefulness • ART Resistance prevention (leading to cost savings) • Training decisions (e.g. prescribers or dispensers, ASW) • Fine-tuning appointment policy • Comparing access barriers (site to site) • Quantification & forecasting commodities • Indirect measure of effectiveness of Follow-Up efforts • Other Levels at which data is useful • District, Provincial and National March 2009 Zambia HIVDR Early Warning Indicators 13

  14. Implementation Challenges Full time, full complement of HR required Rolling out of SmartCare to remaining districts Funding for roll out of SmartCare not made available on time Competing innovations –new guidelines across all programmes, HMIS revisions, EWI updates, etc March 2009 Zambia HIVDR Early Warning Indicators 14

  15. Challenge in Use of Results Incompleteness of converted datasets Standard for some indicators (eg, Regimen Line) is not always constant Culture of record keeping; data analysis and review Significance of indicator ‘deltas’ Significance of some of indicators March 2009 Zambia HIVDR Early Warning Indicators 15

  16. Way forward Roll out of SmartCare Ver 4 (for EWI) to remaining sites Use of EWI indicators at all levels Mobilising full complement of HR Further analytic possibilities building on WHO concepts – what if…? March 2009 Zambia HIVDR Early Warning Indicators 16

  17. NOTE: this is test data

  18. Acknowledgements • Dr Ben Chirwa, DG NAC, former DG CBOH • Dr Simon Miti, PS, MOH • Mr Innocent Chiboma, MOH • Mr Noel Masese, MOH • Ms Chanda Mubanga-Chipoya, MOH • Mr David Nelson, CDC • Dr Marc Bulterys, CDC • Mr Derrick Muneene, CDC • Mr Bwalya Chiteba, CDC • Mr Meade Morgan, CDC • Sansan Myint, WHO • Dr Diane Bennett, WHO • Members of the HIVDR working group • And very many more… HIVDR Early Warning Indicators

  19. Using a smart card EHR can be fun. - A Thank-you to all who have helped!

  20. Thank you HIVDR Early Warning Indicators