Transcript UNAIDS extended MERG workshop - Paul DeLay (UNAIDS) ppt, 165kb

UNAIDS Extended MERG Workshop
Subnational and Concentrated
Epidemics
Geneva
October 28, 2004
Paul De Lay
Director, Evaluation
UNAIDS
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Linking patient monitoring and program monitoring-seeking duplication!!
• Concerns about complexity and density of data. Need more field
experience.
• Too much data vs not enough (drug procurement/good quality clinical
care)
• What are costs of this?
• Similarities/dissimilarities with TB, and “true” chronic diseases
o TB invested in vertical staffing
o Mobile patients
• Concerns about staffing and training
o Assigning responsibilities, such as data aggregation and analysis
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Public versus private services-will this work for
both?
• Confidentiality
• Especially in concentrated epidemics, ? get info on
modes of transmission, etc
• This data set contains early warning signs for ARV
resistance (adherence, stockouts, changing
regimens, deaths)
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Evaluation of projects (Track One proposal)
• Harmonizing 3X5, PEPFAR, Track One (Indicators, reports, reporting
timelines, etc)
• Pt clinical monitoring, health facility, subnational, national-what do we
need?
• Standardizing demographic data, especially age cohorts (0-2, 3-4,5-14,
15 and above)
• ? Value of CD4 and weight gain (other laboratory and clinical) for
program monitoring
• Need long term survival
• Program management requires #staff per pt, staff trained, coverage,
costs
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• Need start-up, current, survival, coverage, % on first line
and second line Rx (How much of this can be done at
subnational levels)
• Need to cap national level indicators
• Balance the need to provide guidelines and the need to
learn and revise
• Need to draft an “operations manual” based on the draft
operational framework (May need two versions-one to
organize technical issues and one for country guidance.
Consider including in the “Fundamentals” document)
Summary and Next Steps
ART patient and program monitoring
ISSUES:
• A lot of good work has been done to
build on...
• Now the work needs to focus on the
country level