Patient monitoring
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1. |
Collect a minimum, standardized dataset for patient care. |
Guidance on a minimum dataset for patient monitoring. |
2. |
Transition monitoring to “treat all”: Depending on national guidelines, countries should transition from using the pre-ART register to using the ART register. |
Guidance for this transition. |
3. |
Simplify and standardize tools (cards, registers, and reports) across facilities. |
Generic tools for adaptation. |
4. |
Integrate and link HIV and health reporting; the HIV card should form part of the patient folder or passport integrated with primary health. |
Generic HIV patient card and ART register for country adaptation. |
5 |
Implement regular data quality reviews and invest in data use. |
Guidance on carrying out an annual patient monitoring review and improving quality of care. |
Case-based surveillance
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1. |
Standardize reporting of sentinel events: Standardized sentinel events should be identified to include the 6 key sentinel events (HIV diagnosis, first CD4 test, initiation of ART, first viral load test, viral load suppression, mortality). |
Definitions of six key sentinel events |
2. |
De-duplicate testing and treatment data to support facilities and improve data quality: Case-based surveillance should provide de-duplicated counts of diagnosed persons and people on treatment for reporting and to be shared with facilities. |
Guidance on approaches. |
3. |
Develop case surveillance based on a country situation analysis. Improvements to case-based surveillance should be based on a country situation analysis that identifies and costs incremental improvements, and not introduced as a separate monitoring approach. |
Tool for country situation analysis. |
4. |
Start case surveillance with HIV diagnosis and build on patient monitoring. |
Guidance on HIV case definitions and case surveillance; requires reporting on HIV diagnosis in addition to and linked to treatment data. |
5. |
Ensure confidentiality and security of all data, particularly for key population data. The guidance suggests that risk behavior and key population data be assessed at the point of diagnosis and to support referral to care. However, it is not routinely included in patient monitoring, where there are risks. |
Recommendations on key population data |
Scaling-up unique identifiers for person-centered monitoring
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1. |
Introduce and use unique identifiers for data shared across a program. |
Definitions and examples of unique identifiers. |
2. |
Transition progressively from paper-based to electronic patient information systems. Countries should use a tiered approach starting with high volume sites. |
Example of a tiered approach. |
3. |
Strengthen and differentiate data security: significant investments are now required in databases and policies to protect and differentiate security and confidentiality of key data. |
Guidance on key components of strengthening and differentiating data security |
4. |
Invest in data systems and promote interoperability and open source standards. |
5-10% of program budgets are used to strengthen monitoring and evaluation. |
5. |
Use data to improve programs, to strengthen retention, linkage and transfer. Data use drives data and program improvement. |
Investments in data analysis functions and dashboards, which feedback data and can convene and measure program improvements. |