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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) 1,054,684
PLWHA(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 293,328
AIDS 214,129
symptomatic HIV 79,199
Cumulative deaths 67,288AIDS 59,002
symptomatic HIV 8,286
PLWA (AIDS) 155,127
People 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
แบบบ�นทึ�กการติ�ดติามการร�กษาด�วยยาติ�านไวร�สเอดส� ส�าหร�บผู้��ติ�ดเชื้��อเอชื้ไอว�และ
ผู้��ป่#วยโรคเอดส� ( ATC data form 1 )
ATC Number __ - __ __ __ __ - __ __ __ __ โรงพยาบาล ______________________
H N ______________________เลขทึ�)บ�ติรป่ระชื้าชื้น _ - _ _ _ _ - _ _ _ _ _ - _ _ - _
ทึ�)อย�* เลขทึ�) _____ หม�*ทึ�) ___ ถนน ____________ ติ�าบล _____________ อ�าเภอ _____________
จั�งหว�ด _____________ รห�ส __________ โทึรศั�พทึ� ____________กรมควบค/มโรค กระทึรวงสาธารณส/ข
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
99
77
95
7582
33
0
20
40
60
80
100
Satisfied with clinic Received enoughinformation
%
PLHA taking HAARTPLHA drop outRelatives
Thank you
Acknowledgement
Department of Disease Control, Ministry of Public Health Thailand