Definitions

Clinical description

PMTCT site

• A facility is counted as a PMTCT site if they have initiated on ART at least one pregnant or breast-

feeding woman during the reporting period.

• Depending on the mode of integration of PMTCT/ART interventions into the general health

services, ART may be initiated in any of the following service points: ART, ANC, maternity, post- natal or under 5 clinics.

ART site

• A facility is counted as an ART site if they had retained at least one patient alive on ART at the end

of the reporting period.

ART status at registration

• Refers to the patient’s status at the time of first registration at this ART clinic – this status will

never change as long as the patient remains at this clinic.

• First time initiation: Never taken ART (triple ARV combination treatment) in the past. Having taken

ARVs for prophylaxis (PrEP, PEP, single dose Nevirapine, AZT combination prophylaxis for PMTCT)

does NOT count as having taken ART and is ignored for the ART status at registration.

• Re-initiation: Received ART (triple ARV combination for treatment) from another ART site in the

past but has NOT been taking it for 2 weeks or more as of the day of registering at this clinic.

• Transfer in: Received ART from another ART site in the past and is currently taking ART or has

interrupted for less than 2 weeks. Count as Transfer in regardless if the patient brings his old patient card or not (‘official’ or ‘unofficial’ transfer).

Lost to follow-up (‘defaulted’)

• Patients are counted as ‘defaulted’ in the cohort report if they have not returned to the clinic and

are not known to have transferred out, stopped or died.

• The following times apply in the different clinics:

o HCC (HIV exposed children): 2 months after the Next Appointment Date given at the last visit.

o ART: 2 months after the patient is expected to have run out of ARVs.

• Patients may revert to ‘alive on ART’ when the next cohort analysis is done if they return to the

clinic and continue ART.

ART stop

• Patients are counted as ‘stopped’ if they are last known to be alive and have stopped taking ART.

Stop is used regardless:

o Of the reason the patient has stopped (clinician’s or patient’s own decision).

o If the ART interruption is intended to be permanent or temporary.

o Of the duration of the ART interruption at the time of doing the cohort analysis.

• Patients may revert to ‘alive on ART’ at the next cohort analysis if they re-start ART.

Died

• Patients are counted as ‘died’ if there is a reliable report about the death. ‘Died’ is used regardless:

o Of the cause of death (HIV- or non-HIV related disease, accident, suicide or homicide).

o If the patient was on ART or not at the time of death.

ART re-start

• Interrupted ART for more than 2 months while registered at the respective ART site. Update the

number of re-starts in the ART clinic register whenever the patient re-started ART after defaulting or stopping for more than 2 months (i.e., returns after ‘defaulting’).

ART adherence level

• Reporting of adherence levels is based on a classification of the number of doses missed at the last

visit before the end of the quarter evaluated.

• The translation of the number of doses missed into adherence % depends on the number of days

since the last visit. It is practically too complicated to consider varying intervals when analysing adherence. Therefore, 3-monthly visits are assumed for all patients for reporting.

• Patient who are supposed to take 1 tablet per day (e.g., Regimen 13A) and who have missed more

than 5 tablets are classified as ‘less than 95% adherent’.

Monitoring and evaluation

• Patients who are supposed to take 2 tablets per day (e.g., Regimen 4A) and who have missed more

than 10 doses are classified as ‘less than 95% adherent’.

Table 27: Overview of M&E systems for integrated HIV program reporting Service M&E tools Report cycle Report elements Patient card Register New registrations Cohort outcomes Definition of cohort Primary outcomes Secondary outcomes ANC – ANC Clinic Monthly New first visits • Registration group – (Final status at end of ANC)

Register (6 months after first • HIV test status ANC visit) • On ART Maternity – Maternity Register Monthly New deliveries – – – ART ART Patient Card ART Clinic Quarterly Patients newly • Cumulative • Alive on ART • ART regimen / formulation (separate cards for Register registered at ART (all ever registered) • Died • Adherence level paediatric and clinics • Registration group • Defaulted • Side effects adult formulations) (survival analysis) • Stopped ART • TB status

• Transferred out • On CPT
• TPT started / completed
• Using FP

Exposed HIV Care Patient HIV Care Clinic Monthly Patients newly • Birth cohort: children • Alive in exp. child FUP • Age when received DNA- child FUP Card, Exposed Register registered at HCC who (would) have • Discharged uninfected PCR result Child Under 24 turned 2, 12 and 24 • Latest HIV status

• Started ART

Months months of age

• Defaulted
• Transferred out
• Died

Monitoring and evaluation