1. Republic of Kenya
Ministry of Health
Antiretroviral Drug
Therapy in Kenya
The ART/HMIS
Training Materials
(Participants’ Notes)
National AIDS and STI Control Programme
(NASCOP)
August 2006

2. Objectives of the Course
___________________________________
Familiarise participants with ways of
___________________________________
ART data collection
Introduce participants to the concept of
___________________________________
programme monitoring for ART
Prepare participants to start using the ___________________________________
new system and replace all local data
collection initiatives ___________________________________
ART/HMIS Training Materials
Module I 1
___________________________________
___________________________________
Objectives of Module III, Part 1: HIV/AIDS ___________________________________
Situation
At the end of the module, participants will
___________________________________
be able to understand:
The HIV/AIDS Situation world wide
___________________________________
The HIV/AIDS situation in Kenya
The measures taken as a response to
___________________________________
the HIV/AIDS Pandemic.
The implications of HIV/AIDS in Kenya ___________________________________
ART/HMIS Training Materials
Module III - Part 1 1
___________________________________
___________________________________
GLOBAL PICTURE
___________________________________
40 Million living with HIV by end of 2004
___________________________________
One-third of PLWHA are in 15-24 age
group
___________________________________
Majority do not know they are infected
Young women are more vulnerable
___________________________________
Sub-Sahara
60% of world’s PLWHA (25.4m) ___________________________________
ART/HMIS Training Materials
Module III - Part 1 2
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 1

3. ___________________________________
Global epidemiology summary
In 2003, 14,000 new HIV infections
___________________________________
occurred daily
2000 in children <15 years ___________________________________
12,000 in persons of reproductive age (15-
49 years); 50% of this group are women
Over 95% of these new infections occur
___________________________________
in the developing world
In 2003, between 2.5 and 3.5 million ___________________________________
persons died of HIV/AIDS
ART/HMIS Training Materials
Module III - Part 1 3
___________________________________
___________________________________
AN OVERVIEW OF THE HIV/AIDS ___________________________________
SITUATION IN Kenya
HIV/AIDS in Kenya. ___________________________________
National prevalence :7%
1,000,000 – 1,200,000 PLWA of which 200,000 need ART
The 2003 KDHS reported that:
Adult prevalence rate is 7%
___________________________________
HIV prevalence is almost twice as high in urban as in rural
areas (10% urban; 6% rural)
HIV prevalence in women: 8.7%, 4.6% in men
Annual infections (2003)
___________________________________
1,100,000 new infections in adults.
150,000 new infections among children
Over 50% hospital admissions are HIV/AIDS related ___________________________________
ART/HMIS Training Materials
Module III - Part 1 4
___________________________________
___________________________________
HIV/AIDS Situation in Kenya
___________________________________
The population of Kenya is
___________________________________
approximately 32 million.
At the end of 2004, 1.2 million Kenyans ___________________________________
were living with HIV/AIDS.
An estimated 1.5m Kenyans have died
of AIDS
___________________________________
Approximately 1.6m children under 15
have been orphaned by the death of ___________________________________
one or both parents from AIDS.
ART/HMIS Training Materials
Module III - Part 1 5
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 2

4. Implications of HIV/AIDS
___________________________________
Sickness ___________________________________
Absenteeism from school by Children (Attend to the sick or
Teacher is sick)
Loss of man-hour
Low contribution to food production (Results in hunger)
___________________________________
Huge cost to pay for medication
HIV/AIDS patients now occupy more than half of hospital beds
Deaths
Mostly, productive of the population are affected
___________________________________
Orphan-hood
Widowhood
Poverty (Bread winner is affected) ___________________________________
Deaths due to HIV/AIDS affecting the most productive of the
population worsens poverty levels
ART/HMIS Training Materials
Module III - Part 1 6
___________________________________
___________________________________
RESPONSE TO THE HIV/AIDS ___________________________________
SITUATION
Prevention. ___________________________________
Prevention of Mother To Child
Transmission.
Voluntary Counselling and Testing.
___________________________________
Condoms.
Care. ___________________________________
Home Based Care.
Treatment. ___________________________________
Anti Retroviral Therapy.
Management of Opportunistic Infections.
ART/HMIS Training Materials
Module III - Part 1 7
___________________________________
___________________________________
Objectives of Module III, Part 2: The ___________________________________
ART Programme in Kenya
At the end of the module, participants will
___________________________________
be able to understand:
The ART Programme in Kenya
___________________________________
The main goal of the ART Programme
Specific goals of ARV therapy
___________________________________
Resource limitations affecting ARV
therapy ___________________________________
ART/HMIS Training Materials
Module III - Part 2 1
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 3

5. Main Goal of the ART Programme
___________________________________
The main goal for any ART programme is
___________________________________
to increase accessibility to antiretroviral
therapy with a view of prolonging the ___________________________________
lives of the patients infected with HIV.
___________________________________
___________________________________
ART/HMIS Training Materials
Module III - Part 2 2
___________________________________
___________________________________
AN OVERVIEW OF THE ART PROGRAMME IN ___________________________________
Kenya
ART programme started with private sector
___________________________________
ART services in Kenya
Started with 5 public pilot sites ___________________________________
15 provincial sites in 2003
48 district health facilities in 2004
Plan to scale to all 72 districts ___________________________________
Related programmes
PMTCT.
VCT. ___________________________________
Treatment of Opportunistic Infections.
Tuberculosis.
ART/HMIS Training Materials
Module III - Part 2 3
___________________________________
___________________________________
GOAL OF THE ART PROGRAMME IN KENYA
___________________________________
Contribution to the 3 by 5 global target
___________________________________
Kenya’s targeted was 95,000 persons to be put on ART by
2005
Reach 78% of eligible clients by 2010 ___________________________________
70,000 persons currently on ART
Currently over 200 public, mission and private sites
___________________________________
offer ART services
M+E system for ART designed to meet global and
___________________________________
local requirements
ART/HMIS Training Materials
Module III - Part 2 4
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 4

6. Challenges/resource constraints in ___________________________________
providing ART
Initial cost of drugs too high for people
___________________________________
Shortages of health providers in facilities
Integrating ART into existing health
___________________________________
structures
Ill-equipped labs: difficult to provide
___________________________________
services to monitor ART.
___________________________________
ART/HMIS Training Materials
Module III - Part 2 5
___________________________________
___________________________________
Introduction to ART: A Conceptual ___________________________________
Framework
The purpose of the module is
___________________________________
Highlight standard ART procedures
To lay a foundation for the data ___________________________________
management aspect of ART
Not to equip participants with clinical skills ___________________________________
to provide ART
___________________________________
ART/HMIS Training Materials
Module IV 1
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
ART/HMIS Training Materials
Module IV 2
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 5

7. ART/HMIS Materials - Participant=s Notes 6

8. Initiating ART in HIV+ Adults and ___________________________________
Adolescents
Kenyan Recommendations for Initiating ART
___________________________________
in Adults and Adolescents with Documented
HIV Infection
If CD4 count available:
___________________________________
WHO Stage III when CD4 count < 350/mm3
WHO Stage I, II, disease with CD4 count <200 cells/mm³
WHO Stage IV irrespective of CD4 level ___________________________________
If CD4 count is unavailable:
WHO Stage III or IV
WHO Stage II disease with total lymphocyte count
<1,200c ells/mm³
___________________________________
Source: National Training Curriculum on ART, Comprehensive HIV/AIDS Care
ART/HMIS Training Materials
Module IV 3
___________________________________
___________________________________
Objectives of the Presentation
___________________________________
Rationale behind the ART data collection
___________________________________
Information System
Architecture of ART HMIS
___________________________________
___________________________________
___________________________________
ART/HMIS Training Materials
Module V 1
___________________________________
___________________________________
Rationale of ART/HMIS
___________________________________
A response to the M&E framework
___________________________________
outlined in the National Scale-up Plan for
ART ___________________________________
The absence of a reporting system
during scale-up ___________________________________
Standardizing data capture tools
Meeting international obligations ___________________________________
ART/HMIS Training Materials
Module V 2
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 7

9. Architecture of ART HMIS
___________________________________
It is a paper-first-based system
___________________________________
Designed to collect minimum standard
data elements
___________________________________
It is not a clinical system meant for
improving the quality of care ___________________________________
Data flow structures
Uses registers, cards, and summary sheets ___________________________________
ART/HMIS Training Materials
Module V 3
___________________________________
___________________________________
Data Instruments in ART HMIS
___________________________________
Registers/Cards
___________________________________
Pre ART Register
ART Monthly Register ___________________________________
HIV Care/ART Card
Reporting Forms ___________________________________
Monthly Summary sheet
Cohort Summary Sheet ___________________________________
ART/HMIS Training Materials
Module V 4
___________________________________
___________________________________
Scope of ART HMIS
___________________________________
Provide history of patient visits to the
___________________________________
facility
Provide basis for monitoring patient ___________________________________
progress
Provide information on adverse drug
events
___________________________________
Assists in tracking adherence to
treatment ___________________________________
ART/HMIS Training Materials
Module V 5
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 8

10. Limitations of ART HMIS
___________________________________
Not a Patient Tracking System
___________________________________
Does not provide information on logistics
related to ART such as
___________________________________
Staff availability
Drug stock levels ___________________________________
Reagents
Cannot measure drug resistance ___________________________________
ART/HMIS Training Materials
Module V 6
___________________________________
___________________________________
DATA COLLECTION
___________________________________
OBJECTIVES:
___________________________________
Understand data collection
Learn how to correctly complete: ___________________________________
Pre ART Register
Comprehensive Care Clinic Card
ART Register
___________________________________
___________________________________
ART/HMIS Training Materials
Module VI, Part 1 1
___________________________________
___________________________________
DATA COLLECTION
___________________________________
PURPOSE
___________________________________
provide a record of care given to specific
clients.
___________________________________
provide information on health status and
service delivery. ___________________________________
provide data for action planning.
___________________________________
ART/HMIS Training Materials
Module VI, Part 1 2
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 9

11. DATA COLLECTION TOOLS ___________________________________
Pre ART Register ___________________________________
All patients who need HIV Care are entered here.
This includes patients identified within the facility ___________________________________
and those that are referred or transferred in
before they are commenced on ART
Comprehensive Care Clinic Card ___________________________________
It serves as a detailed record of clinical
diagnosis and treatment. It is opened
immediately a patient enrols in HIV Care
___________________________________
ART/HMIS Training Materials
Module VI, Part 1 3
___________________________________
___________________________________
DATA COLLECTION TOOLS ___________________________________
___________________________________
ART Register
All patients on ART are entered here. ___________________________________
Information for each monthly visit of
individual patients is recorded here. ___________________________________
___________________________________
ART/HMIS Training Materials
Module VI, Part 1 4
___________________________________
___________________________________
Document Flow Diagram
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
ART/HMIS Training Materials
Module VI, Part 1 5
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 10

12. ART/HMIS Materials - Participant=s Notes 11

13. ___________________________________
Aggregation and Reporting
Aggregation Forms
___________________________________
? Comprehensive Care Clinic Monthly ___________________________________
Summary Sheet
• Comprehensive Care Clinic Cohort
Summary Sheet
___________________________________
___________________________________
ART/HMIS Training Materials
Module VIII 1
___________________________________
___________________________________
Objectives of Module VIII: ___________________________________
Overview of ART Measures
After completion of this module,
___________________________________
participants should be able to:
Know the ART Measures
___________________________________
Calculate the ART Measures
Interpret the ART Measures
___________________________________
___________________________________
ART/HMIS Training Materials
Module VIII 1
___________________________________
___________________________________
Overview of the ART Indicators
___________________________________
Basis for selection of Measures
___________________________________
Kenya ART implementation Plan X1 ? X2
International obligations, e.g. WHO, ___________________________________
UNAIDS, PEPFAR, etc.
Efficiency, exclusiveness, feasibility, cost ___________________________________
implications
___________________________________
ART/HMIS Training Materials
Module VIII 2
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 12

14. Overview of the ART Indicators
___________________________________
Measure Categories
___________________________________
Measures of accessibility
Measures of programme success ___________________________________
Measures of adequacy in program support
areas ___________________________________
Early Warning Signal for drug resistance
___________________________________
ART/HMIS Training Materials
Module VIII 3
___________________________________
___________________________________
ART/HMIS Materials - Participant=s Notes 13