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Monitoring and Evaluation of the Early Infant HIV Diagnosis Program


Infant diagnosis requires engaging them in care and following them over time, ... Appropriate care for HIV-exposed infant. Cotrimoxazole prophylaxis ... – PowerPoint PPT presentation

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Title: Monitoring and Evaluation of the Early Infant HIV Diagnosis Program

Monitoring and Evaluation of the Early Infant HIV
Diagnosis Program

Learning objectives
  • Identify roles and responsibilities of clinic and
    ME staff
  • Understand new registers and forms for collecting
  • Learn how to assign unique patient identification
  • Practice using ME tools and completing monthly
    summary forms using a case study example

  • Challenges of the Early Infant Diagnosis (EID)
  • Generating patient identification numbers for
  • Paper based systems
  • Data quality
  • Tracking specimens and results
  • Reporting requirements
  • Case study

Goals and objectives of the infant diagnosis
  • Goal
  • Establish a system of care and linkages to get
    HIV-exposed and infected infants into quality
    care and treatment services.
  • Objectives
  • Diagnose HIV-infected infants as early in life as
    possible and provide ART if eligible.
  • Ensure that HIV-exposed and HIV-infected infants
    receive appropriate services and interventions
  • Evaluate the efficacy of PMTCT interventions by
    following infants until their HIV status is
  • Develop effective systems to follow-up infants
    and their families.

Programme challenges
  • Infant diagnosis requires engaging them in care
    and following them over time, usually the first
    12-24 months of life.
  • After the first blood test
  • Families must return for test results
  • Families must return for subsequent testing
    depending on the results of the first test
  • Require 1 test to confirm childs HIV status
  • If the first PCR test is positive, a second test
    should be done for confirmation
  • If the first PCR test is negative, a second test
    (either PCR or antibody) needs to be done after
    the child is weaned from breastfeeding

Why do monitoring and evaluation?
  • To assess how well the program is working
  • To provide feedback to the program and
  • Identify what is working
  • Identify what is not working
  • Identify ways to make the program stronger,
    improve quality of care and service delivery

Roles and responsibilities of staff
  • Various members of the EID program will have
    different roles and responsibilities
  • Provision should be made for absentee staff
    (e.g., if the PMTCT nurse is not in today who
    will collect the DBS specimens?
  • Who is responsible for transporting samples to
    the Lab?
  • Who is responsible for checking missed
    appointments and calling defaulters
  • Who is responsible for completing the HIV-exposed
    infant register?

Paper based systems for ME HIV-Exposed Infant
  • Special registers have been developed for
    monitoring and evaluating programs for infant
  • These registers can also be used to track infants
    enrolled in the programs
  • Attendance at appointments
  • Determination of final infection status
  • Enrollment into care and treatment for infected
  • Quality of care provided

How to use the HIV-Exposed Infant Register
  • HIV-Exposed Infant registers are usually
    completed by nurses and counsellors
  • They should be located at the most appropriate
    station e.g. MCH, Care Treatment Center
  • Each HIV-exposed infant should
  • Be assigned a unique facility Infant Diagnosis
    Identifier (IDID)
  • Should be entered in the register once
  • Results of all HIV tests should be entered on the
    same line in the register
  • Discussion How will these registers be completed
    at each of the sites?

How to assign the Infant Diagnosis Identifier
  • A unique Infant Diagnosis Identifier (IDID) is
    required to identify and track HEI before they
    are referred to the CTC clinic
  • IDID is given at the time of registration of the
    exposed infant
  • Different IDID have been used
  • E.g. In Tanzania
  • The IDID begins with a two letter site code e.g.
    MK for Makongoro Health Centre, ST for Sekou
    Toure Regional Hospital
  • Followed by a 4-digit serial number e.g.
    0001,002, 0003 etc.

Examples of unique IDIDs
HIV-Exposed Infant Register
001 12/04/07 PMTCT ST-0001 18/02/07
Doe John Makonge
Doe Esther

HIV-Exposed Infant Register (2)
1002312 ( ) sdNVP( ) sdNVP
( ) ( )
14/04/07 ( )

HIV-Exposed Infant Register (3)

healthy, EBF, infant DKarysn
Completing the HIV-Exposed Infant Register
  • Other registers that could feed into the
    HIV-exposed infant register in case of missing
  • PMTCT registers MCH, LD
  • Pre-ART register ART register
  • Daily attendance log books (MCH, Care Treatment
  • Laboratory registers

HIV-Exposed Infant Medical File
  • In addition to the HIV-exposed infant register,
    facilities may want to use a patient medical file
    to record information such as clinical signs and
    symptoms of HIV, including growth monitoring, and
    neurodevelopmental assessment at each visit.
  • The patient medical file may include
  • Visit notes
  • Lab results for HIV testing
  • Other investigation results
  • Prescriptions
  • Growth chart
  • Patient files should be organized and filed

Data Quality Assurance
  • Data is complete
  • 80 of fields in register are complete
  • Regular review of registers to make sure clinic
    staff are entering new IDIDs and all information
    is filled in
  • Can be done daily or weekly
  • Data is accurate and valid
  • Compare with other data sources (e.g., lab
    register, patient file) for consistency monthly.
  • 80 of data is within expected range (e.g.,
    date of visit has correct year)
  • Evaluate whether infants remain in follow-up
  • Review register to see if families are returning
    for results, or are due for additional HIV
    testing weekly

Forms for tracking specimens and results
  • PCR lab request form
  • PCR lab request form must be completed for each
    patient by the person drawing the specimen
  • Specimen collection log
  • Specimen collection log must be completed by
    clinic staff and copy sent with specimen batch to
    the lab
  • Laboratory register
  • Laboratory personnel enters all specimens
    received and documents results after tests has
    been performed
  • PCR results delivery log
  • PCR delivery log must be completed by lab staff
    and sent back to the clinic

PCR Lab Request Form
Specimen Collection Log
Laboratory Register
PCR Results Delivery Log
Reporting requirements
  • Monthly summary report and Narrative for
    monitoring the program completed by clinic staff

  • Counseling and testing of the exposed infant
  • PCR tests done
  • Antibody tests done
  • Results of tests
  • Number of families given test results
  • Appropriate care for HIV-exposed infant
  • Cotrimoxazole prophylaxis
  • Referral to Care and Treatment Center for
    HIV-infected children

Monthly Summary Form (MSF)
EID Program Monthly Narrative Report
Lab Monthly Summary Form
Key EID program indicators (1)
  • An indicator is a summary measure that provides
    information on the status of activities related
    to each step of the program cycle
  • Examples of useful indicators
  • Number/Percentage HIV-exposed infants identified
  • Number/Percentage of HIV-exposed infants who
    received DNA PCR by 6 weeks of age
  • Number/Percentage of infants receiving
    cotrimoxazole prophylaxis at 6 weeks of age
  • Results of DNA-PCR tests positive, negative,

Key ID program indicators (2)
  • Number/Percentage of families who receive test
  • Among infants with positive PCR result
  • Number/Percentage who get confirmatory PCR
  • Number/Percentage referred to HIV care and
  • Number/Percentage who get CD4 testing
  • Number/Percentage who initiate ART if eligible
  • Number/Percentage of HIV-exposed infants with
    final HIV status
  • Infant mortality rates
  • Number/percentage of infants lost to follow-up
    (missing all clinic visits in the past 6 months)

Following infants and their families
  • Systems need to be put in place at site to
    monitor families returning for PCR results and
    follow-up testing when child stops breastfeeding
  • Establish formal appointment systems
  • Use appointment books to see if families keep
    their follow-up appointments
  • Establish protocols for reviewing clinic
  • Identifying defaulters
  • Prioritizing active follow-up particularly of
    infants with positive PCR results
  • Engaging all infants in care

Minimizing Lost To Follow-up
  • Keep an appointment book at sites for early
    identification of missed visits
  • Content and style can vary by site
  • Where possible home visits for mother/guardian
  • Linkages with other departments that may come in
    contact with exposed infants or their parents
  • CBOs
  • Outreach clinics
  • Immunization campaigns
  • CTC clinics
  • Update of registers and patient files whenever
    new data become available

Summary of ME
  • Completion of registers and forms should be
    assigned to specific staff members
  • Every infant should be assigned a unique IDID and
    entered into HIV-exposed infant register
  • Information in HIV-exposed infant register should
    be complete and updated regularly
  • If register data is incomplete, or inaccurate,
    cannot evaluate how well program is working

Summary of ME
  • Establish good follow-up systems to identify
    families not returning for test results, or
    infants in need of follow-up testing
  • HIV-exposed infant register data should be
    summarized on monthly reporting forms
  • Reviewing data regularly is critical to success
    of the program
  • Provide feedback to the site in a timely manner

  • Case Study

Case study Baraka
  • Baraka Abdullah is a baby girl who was born on
    18th August 2006 to Molly, an HIV positive woman
    who had attended Makongoro HC for ANC and
    received NVP for PMTCT. She had also been
    enrolled at the CTC clinic and given the CTC
    number 19321265. However, Baraka was born at
    home, and did not receive any NVP. Both Molly and
    Baraka have been sickly in the past months, which
    has prevented Molly from coming to the clinic.
    Today October 14th , is the first visit to MCH
    since Baraka was born.

Baraka (2)
  • What counseling will you give Molly
  • How will you assess Baraka
  • When will you ask her to return to MCH
  • Where will you record this to ensure Baraka is
    followed up ?

Baraka (3)
  • Molly is counseled and agrees that Baraka should
    be tested for HIV
  • You give Baraka the IDID ST-0001 and enter her
    in the HEI register
  • What needs to be done next?
  • What medications does Baraka need at this visit?
  • When will you ask Baraka to come back?

Baraka (4)
  • Molly brings Baraka back 4 weeks later and
    reports that they both have been feeling much
    better since the last clinic visit. You received
    Barakas 1st DNA PCR results two weeks ago and
    they were positive.
  • What do you need to do at this visit?
  • How will you counsel Molly?
  • What other information do you require?
  • Where will you record all this?

Baraka (5)
  • Molly says Baraka is still breastfeeding. You
    give Molly Barakas result and counsel her on the
    importance of exclusive breastfeeding. You take
    another DBS specimen for a confirmatory PCR test.
    You complete a referral form and get her an
    appointment to be seen in the CTC. The PCR
    results for the second specimen is positive.
  • What will you do now?
  • Where will you record?

Baraka (6)
  • You complete the HEI register. Call Molly to
    check on Baraka and remind her the appointment to
    the CTC is due in 1 week. You send the results of
    the confirmatory test to the CTC.
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