Thailand Experiences with M&E on ART

Sanchai Chasombat MD.Panumad Yarnwaidsakul MD.

Department of Disease Control ,Ministry of Public Health Thailand

July 1, 2003

Estimated Cumulative Numbers of HIV/AIDS Cases , 2003

  

        HIV infections (adults and children) 1,054,684PLWHA(HIV+AIDS)

603,942        PLWA (AIDS) 62,871 New HIV infections in 2003 21,260        New AIDS cases in 2003 50,415

Source: The Projection for HIV/AIDS in Thailand : 2000-2020

Reported HIV/AIDS cases from 1984 to 2003 As of March 31, 2003

Cumulative AIDS/symptomatic 293,328AIDS 214,129

symptomatic HIV 79,199

Cumulative deaths 67,288AIDS 59,002symptomatic HIV 8,286

PLWA (AIDS) 155,127People living with symptomatic HIV 70,913

Source: Bureau of Epidemiology, Dep.Disease Control ,MoPH, Thailand

Sources of Antiretroviral therapy in Thailand

• MoPH Access to Care [ ATC ] / National Access to Antiretroviral Programs for PLWHA [ NAPHA ]

• Co-payment system • Patients pay out of their own pockets• Patients participating in clinical trials• Health Insurance Programs

Universal health Care Scheme

HIV/AIDS care packages consist of:

- HIV counseling - HIV testing- PMTCT- Common OIs treatment and prophylaxis:

provided in all government hospitals- ARV with 3 drugs regimens [ in the process of integration]

Access to Care [ ATC ]/National Access to Antiretroviral Program for

PLWHA [ NAPHA ]

• Initiated in late 2000• From Clinical Research Network extending to ATC Network• 119 hospitals growth to 460 hospitals

participated ,expected more• Provided quota up to 3,000 cases in the initial phase to

more than 17,000 case so far• From naive cases to experienced and complicated cases• By the end of 2003, aims at 23,000 cases• By the end of 2004, ambitious target is 50,000 cases

35

75

110

295

300

300

250

250

250

250

250

300

800

0 100 200 300 400 500 600 700 800 900

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Budget

Government’s ARV Budget in Million Baht

ATC / NAPHA

• Training and supervision• Protocol management• Drug stock management • Data management• Monitoring and evaluation• Laboratory management

Number of Patients Participated in the Programs, As of May 2003

Programs Allocated quota Total receivers Ongoing receivers

ATC 1, ATC 2 9866 5700 5275

PATC1, PATC2 1954 839 839

Research 2000 1188 1083

Co-payment 624 624 557

PMTCT + 2800 908 908

Total 17244 9259 8662

What is M&E?

• Monitoring is routine, daily assessment of ongoing activities and progress.

• Evaluation is the episodic assessment of overall achievements.

“Things that can change policy and practices”

“Systems development to quality improvement” “Research to service”“Small scale to large scale”“Different level different responsibility”

Monitoring of ART Programs

• “Make it simple and keep it simple”essential markers : weight, CD4, S/E , status of treatment ;continuing on treatment, changing of regimens , terminate, death, loss followed up

• Protocol development-development of standard tools-Registration and reporting systems-Site visit -Bi-annual/annual workshop on monitoring and programs management

• Self and external monitoring

Evaluation of ART programs

• “Do it as much as you can”• Balancing between the aims of improving ways

of management and research questions • Self and external evaluation• Evaluation on all major components of projects

management , drugs adherence , economic implications .

Challenges • M&E is a step by step development• Risk of overwhelming of data and overloaded of works• Sense of belonging of what has been done• No standard of M&E on ART to be used as a model

แบบบนัทึกการติดตามการรกัษาด้วยยาต้านไวรสัเอดส ์สำาหรบัผู้ติดเชื้อเอชไอวแีละ

ผู้ป่วยโรคเอดส ์( ATC data form 1 )

ATC Number __ - __ __ __ __ - __ __ __ __ โรงพยาบาล ______________________

H N ______________________เลขท่ีบตัรประชาชน _ - _ _ _ _ - _ _ _ _ _ - _ _ - _

ท่ีอยู ่ เลขท่ี _____ หมูท่ี่ ___ ถนน ____________ ตำาบล _____________ อำาเภอ _____________

จงัหวดั _____________ รหัส __________ โทรศัพท์ ____________กรมควบคมุโรค กระทรวงสาธารณสขุ

Kaplan-Meier survival estimate

analysis time0 20 40 60

0.00

0.25

0.50

0.75

1.00

Percent of PLHA and relatives expressing satisfaction with the clinic and amount of

information that they received

9977

95

7582

33

0

20

40

60

80

100

Satisfied with clinic Received enoughinformation

%

PLHA taking HAARTPLHA drop outRelatives

Thank you

AcknowledgementDepartment of Disease Control, Ministry of

Public Health Thailand