Facilitators workbook

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  • 1.Republic of Kenya Ministry of HealthAntiretroviral DrugTherapy in KenyaThe ART/HMISTraining Materials(Facilitators Workbook)National AIDS and STI Control Programme (NASCOP)August 2006

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Table of ContentsModule VI: Data Collection...........................................................................................1Part 1: Completing the Comprehensive Care Clinic Patient Card.............................1Instructions: Exercise 6-1 ..................................................................................1Module VI: Data Collection.........................................................................................10Part 2: Completing the Pre-ART Register ...............................................................10Instructions: Exercise 6-2 ..........................................................................10Module VI: Data Collection.........................................................................................13Part 3: Completing the ART Register......................................................................13Instructions:Exercise 6-3 ...............................................................................13Module VII: Aggregation and Reporting.....................................................................18Part 1: Completing the Comprehensive Care Clinic Monthly Summary Sheet.......18Instructions: Exercise 7-1 ............................................................18Module VII: Aggregation and Reporting.....................................................................26Part 2: Completing the Comprehensive Care Clinic Cohort Summary Sheet .........26Instructions:Exercise 7-2 .........................................................................26Module VIII: ART Programme Measures ...................................................................30Calculating ART Indicators/Measures.....................................................................30Understanding HIV/Care and ART Indicators Exercise 8-1 ..............................30Instructions:..............................................................................................................30Answers to the Pre-Test Questions ..............................................................................37i 3. Module VI: Data CollectionPart 1: Completing the Comprehensive Care Clinic Patient CardInstructions:Exercise 6-11. Read carefully, the two case studies provided below.Case No. 1: Clara Twaha NzomoOn 22/09/2005, a patient by the name of Clara Nzomo, reports toKenyatta National Hospital Comprehensive Care Clinic (CCC). Sheprovided the following particulars to clinic staff: Date of birth:16/09/1970, Address: Plot 142 Market Road, Nairobi, Near theCatholic Church. Her telephone number is +254000000000.She reported that she was a business woman and had no husband. Shewas divorced the previous year. She came coming walking by herselfand was in the company of Mrs. P. Njuguma, her sister who is also hertreatment supporter (they live together). The patient had undergoneVCT at Kenyatta National Hospital VCT Centre, on 14/09/2005 andher HIV test was reactive.The VCT counsellor then referred her to the CCC for further services.At the CCC; she was attended to by Dr. K. Otieno. The followingclinical presentations were recorded: Weight: 58 kg, Temp: 36.9 oC,BP: 130/60. The patient presented a history of Bacterial Pneumoniaand Oral Thrush. She had also experienced fatigue, fever, weakness,weight loss, productive cough, nausea/vomiting, headache, abdominalpain and thrush in the last month.She had never taken ARVs before for either HIV/AIDS or PMTCT,nor was she on any other medication. She was ignorant of having anyallergies.Because she had severe bacterial infections, candidiasis and had lostmore than 10% weight, she was classified under WHO stage 3. On thesame day (22/09/2005) the doctor ordered the following investigations:Hemoglobin, Full Blood Count, RPR, Liver Function Test, Creatinine,Pregnancy Test, RBS, Chest X-ray and CD4 count.The patients CD4 count was 170 and was declared medically eligiblefor ART on 22/09/2005. She was ready to commence ART on23/09/2005 and was put on the 1st line (AZT-3TC-NVP) on the sameday. Her Unique Patient Number was 10100100001 and was put onCTX prophylaxis for two weeks.ART/HMIS Materials - Facilitator=s Workbook 1 4. The following is a summary of the patients subsequent visits:Date Weight (kg)WHO stage23/10/2005 59 3She indicated she was not on any FP method. Her Hb was 10 and shewas given an appointment on the 22nd of November, 2005.Date Weight (kg) WHO stage22/11/2005 613On this date she reported that she had diarhhoea in the last week beforecoming to the clinic. Her Hb had risen to 11 and her CD4 was now198. She was still on the same drug regimen.Case No. 2: Brenda Wekesa KamauBrenda Kamau works as a nurse at one of the health centres in townand is married with 4 children. She was born on 4/05/1964. BesidesBrenda Kamau, her husband, John M. Kamau, has two other wives.Her address is Flat 555.10B, Maseno University Road, Kisumu. On12/09/2005 she reported to the CCC at Kisumu District Hospital.Earlier before coming to the CCC she had been attending a TB clinicwithin the same hospital and it was from here that she was referred tothe CCC. She has the following medical history on her Out-patientfile/referral documents:She was confirmed HIV positive on 10/11/2004 at Kibera Community Health Clinic.Diagnosed with TB in January 2005; Herpes Zoster in 2004,On this visit, she recorded the following parameters: weight: 47kg;Pulse 75/m; BP 130/72 She reported the following problems in theprevious month: fever, fatigue, weakness and weight loss,non-productive cough, nausea, headache, numbness and pain in thelegs and feet,She had never taken ARVs before and was not on any medication. Shealso reported that she was not aware of having any known allergies.Upon assessment, it was discovered that she has severe bacterialinfections, candidiasis, and so her WHO clinical stage is 3. Shecompleted her TB Rx on 12/9/05 and was cured. The clinician (Dr. C.Kiprop) ordered the following tests: Hemoglobin, FBC, RPR, LiverFunction Test, Creatinine, Sputum, Pregnancy Test, Chest X-ray andCD4 count.Her second visit to the CCC was on 19/09/2005, she got her CD4 countresult of 84 and was declared medically eligible for ART, She weighedART/HMIS Materials - Facilitator=s Workbook 2 5. 47kg at this visit. She was started on ART on the same day. Heroriginal 1st line was d4t(40)-3TC-NVP. She was allocated the uniquepatient number as 60200200003. Her treatment supporter was herhusband, who was also in care.On her next visit, Brenda missed her appointment by two days. Shecame to the clinic on 5/10/2005. She reported having developed acough and fever in the last 2 weeks and had night sweats and poorappetite but upon weighing her, the weight had increased to 54 kg andher Hb was 9.4.The client showed good adherence to treatment andhad no signs of TB. She continues on her original 1st line combination.2. Locate the Comprehensive Care Clinic Patient Cards, provided on pages 4-9 of this workbook3. Fill out the information about all the visits made to the clinic so far.4. Is there missing information in the cases that you needed to have to complete the Care Cards? To be able to completely fill out the care card, especially on the patient profile the cases needed to provide detailed information on address and nearest school and health centre and postal address.5. Did you remain with some redundant information from the cases that you could not find a place for on the card? The cases carry a lot of information regarding vital signs, history and lab results which can not be documented on the care card. Note: The Care Card is not a replacement to the traditional patient notes taken by clinicians. Not all details about the patient are recorded on the Care Card. Vital details that do not have a place on the card can still be recorded in the patient notes.Note: For additional details on completing the Care Card, you may refer to section2.2.1 of the ART/HMIS Procedures Manual. ART/HMIS Materials - Facilitator=s Workbook 3 6. Module VI: Data CollectionPart 2: Completing the Pre-ART RegisterInstructions:Exercise 6-21. Locate the two Comprehensive Care Clinic Patient Card(s), completed in Part 1 of this module and Pre-ART Register located on pages 11 and 12 of this Workbook.2. You may read again the two cases in Part 1 to clarify those issues you may not be sure of.3. Transfer all necessary information to the appropriate columns in the Pre-ART Register4. Prepare to discuss the following questions during plenaryNote: For additional details on completing the Pre ART Register, you may refer to section2.2.2 of the ART/HMIS Procedures Manual.Is there missing information on the cards that you needed to have to complete the Pre ART Register The information on the cards is adequate for you to complete the columns on the Pre-ART register except the card will not tell you what period the client is on prophylaxis.Did you remain with some data from the cases that you could not find a place for on the card? The cases contain a lot of information some of which may not go onto the Pre-ART register, e.g. temperature, BP, etc. You will notice that they also have information on lab tests which cannot be documented on the Pre-ART register. Can you spot any other? ART/HMIS Materials - Participant=s Workbook10 7. Module VI: Data CollectionPart 3: Completing the ART RegisterInstructions: Exercise 6-31. Locate the following documents: a. The two Comprehensive Care Clinic Patient Card(s), completed in Part 1 of thismodule b. The Pre-ART Register completed in Part 2 of this module and; c. ART Register on pages 15-17 of this workbook.2. Update the ART register using data from the Care Cards.Tip: Patient records are only transferable to the ART register upon commencement of ART. There after, each patient r