A three-tier framework for monitoring antiretroviral therapy in high HIV burden settings

Hdl Handle:
http://hdl.handle.net/10144/322357
Title:
A three-tier framework for monitoring antiretroviral therapy in high HIV burden settings
Authors:
Osler, Meg; Hilderbrand, Katherine; Hennessey, Claudine; Arendse, Juanita; Goemaere, Eric; Ford, Nathan; Boulle, Andrew
Journal:
Journal of the International AIDS Society
Abstract:
The provision of antiretroviral therapy (ART) in low and middle-income countries is a chronic disease intervention of unprecedented magnitude and is the dominant health systems challenge for high-burden countries, many of which rank among the poorest in the world. Substantial external investment, together with the requirement for service evolution to adapt to changing needs, including the constant shift to earlier ART initiation, makes outcome monitoring and reporting particularly important. However, there is growing concern at the inability of many high-burden countries to report on the outcomes of patients who have been in care for various durations, or even the number of patients in care at a particular point in time. In many instances, countries can only report on the number of patients ever started on ART. Despite paper register systems coming under increasing strain, the evolution from paper directly to complex electronic medical record solutions is not viable in many contexts. Implementing a bridging solution, such as a simple offline electronic version of the paper register, can be a pragmatic alternative. This paper describes and recommends a three-tiered monitoring approach in low- and middle-income countries based on the experience implementing such a system in the Western Cape province of South Africa. A three-tier approach allows Ministries of Health to strategically implement one of the tiers in each facility offering ART services. Each tier produces the same nationally required monthly enrolment and quarterly cohort reports so that outputs from the three tiers can be aggregated into a single database at any level of the health system. The choice of tier is based on context and resources at the time of implementation. As resources and infrastructure improve, more facilities will transition to the next highest and more technologically sophisticated tier. Implementing a three-tier monitoring system at country level for pre-antiretroviral wellness, ART, tuberculosis and mother and child health services can be an efficient approach to ensuring system-wide harmonization and accurate monitoring of services, including long term retention in care, during the scale-up of electronic monitoring solutions.
Publisher:
International AIDS Society
Issue Date:
Apr-2014
URI:
http://hdl.handle.net/10144/322357
DOI:
10.7448/IAS.17.1.18908
PubMed ID:
24780511
Language:
en
ISSN:
1758-2652
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorOsler, Megen_GB
dc.contributor.authorHilderbrand, Katherineen_GB
dc.contributor.authorHennessey, Claudineen_GB
dc.contributor.authorArendse, Juanitaen_GB
dc.contributor.authorGoemaere, Ericen_GB
dc.contributor.authorFord, Nathanen_GB
dc.contributor.authorBoulle, Andrewen_GB
dc.date.accessioned2014-07-03T19:24:53Z-
dc.date.available2014-07-03T19:24:53Z-
dc.date.issued2014-04-
dc.identifier.citationA three-tier framework for monitoring antiretroviral therapy in high HIV burden settings. 2014, 17 (1):18908 J Int AIDS Socen_GB
dc.identifier.issn1758-2652-
dc.identifier.pmid24780511-
dc.identifier.doi10.7448/IAS.17.1.18908-
dc.identifier.urihttp://hdl.handle.net/10144/322357-
dc.description.abstractThe provision of antiretroviral therapy (ART) in low and middle-income countries is a chronic disease intervention of unprecedented magnitude and is the dominant health systems challenge for high-burden countries, many of which rank among the poorest in the world. Substantial external investment, together with the requirement for service evolution to adapt to changing needs, including the constant shift to earlier ART initiation, makes outcome monitoring and reporting particularly important. However, there is growing concern at the inability of many high-burden countries to report on the outcomes of patients who have been in care for various durations, or even the number of patients in care at a particular point in time. In many instances, countries can only report on the number of patients ever started on ART. Despite paper register systems coming under increasing strain, the evolution from paper directly to complex electronic medical record solutions is not viable in many contexts. Implementing a bridging solution, such as a simple offline electronic version of the paper register, can be a pragmatic alternative. This paper describes and recommends a three-tiered monitoring approach in low- and middle-income countries based on the experience implementing such a system in the Western Cape province of South Africa. A three-tier approach allows Ministries of Health to strategically implement one of the tiers in each facility offering ART services. Each tier produces the same nationally required monthly enrolment and quarterly cohort reports so that outputs from the three tiers can be aggregated into a single database at any level of the health system. The choice of tier is based on context and resources at the time of implementation. As resources and infrastructure improve, more facilities will transition to the next highest and more technologically sophisticated tier. Implementing a three-tier monitoring system at country level for pre-antiretroviral wellness, ART, tuberculosis and mother and child health services can be an efficient approach to ensuring system-wide harmonization and accurate monitoring of services, including long term retention in care, during the scale-up of electronic monitoring solutions.en_GB
dc.language.isoenen
dc.publisherInternational AIDS Societyen_GB
dc.rightsArchived with thanks to Journal of the International AIDS Societyen_GB
dc.subjectHIV/AIDSen_GB
dc.subjectModels of Careen_GB
dc.titleA three-tier framework for monitoring antiretroviral therapy in high HIV burden settingsen
dc.identifier.journalJournal of the International AIDS Societyen_GB

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