Updated WHO HIV Patient Monitoring Guidelines
In June 2013, the World Health Organization (WHO) published Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection, providing updated guidance on diagnosing HIV infection, caring for people living with HIV, and treating and preventing HIV.
Consequently, a set of patient care tools that MEASURE Evaluation helped develop are likely to be revised, to be in harmony with current WHO guidance. The WHO guidelines provide current, evidence-based clinical recommendations about HIV prevention, care, and treatment. They also address access to HIV services, incorporating these services into health systems, and strengthening HIV care.
Additionally, WHO is developing a companion guide on strategic information for the HIV health sector response, expected to be published in 2014. By bringing together existing monitoring and evaluation (M&E) information from various program areas into one cohesive strategic information guidance document, countries can better assess the effectiveness of HIV prevention, care, and treatment interventions. The document will also specify a core set of indicators and address gaps in M&E of HIV programs.
The guidelines inform HIV initiatives what aspects of their programs, resources, and tools need to be revised to reflect new standards. One set of tools—which MEASURE Evaluation and other organizations have been helping countries implement—is the Three Interlinked Patient Monitoring Systems for HIV Care/Antiretroviral Therapy (ART), Maternal and Child Health (MCH)/Prevention of Mother-to-Child Transmission (PMTCT), and Tuberculosis/HIV, known as the 3ILPMS. These generic tools and guidelines, released by the WHO in 2010, help countries develop and implement a system that collects patient- and population-level outcomes and assesses the impact of programs. 3ILPMS tools were designed to strengthen linkages among services in order to reflect an integrated, holistic approach to service delivery and patient monitoring.
To review, identify, and discuss what aspects of the current 3ILPMS tools and their content need to be updated to reflect the 2013 and upcoming 2014 strategic information guidelines, the WHO hosted a September 2013 technical meeting with several organizations that have experience with patient monitoring systems. MEASURE Evaluation representatives Upama Khatri and Leontine Gnassou attended, joining about 50 other participants from the WHO, U.S. Agency for International Development, U.S. Centers for Disease Control and Prevention, Office of the U.S. Global AIDS Coordinator, and other organizations from several countries.
Following the meeting, a technical working group and sub-groups were being formed to revise the 3ILPMS tools and draft the patient monitoring component of the 2014 strategic information guidance.
MEASURE Evaluation has been a key collaborator with WHO in developing these tools since the original patient monitoring system and guidelines were introduced in 2006. MEASURE Evaluation has also been heavily involved in training countries on implementing the system and helping them customize and roll out tools, including in Cote d’Ivoire, Rwanda, and Nigeria.
Some of the project’s patient monitoring work has involved helping the Cote d’Ivoire Ministry of Health provide paper-based tools in 2006; as well as adapting 3ILPMS tools in 2011, including a patient card, labor and delivery register, and integrated monthly report. In 2009, electronic medical records were implemented in facilities with more than 100 patients on ART.
Gnassou, MEASURE Evaluation’s resident advisor in Cote d’Ivoire, said it is important for all implementing partners to use consistent guidelines. “They need to be informed and they need to be proactive in this new plan,” Gnassou said.