Thailand Experiences with M&E on ART Sanchai Chasombat MD. Panumad Yarnwaidsakul MD. Department of Disease Control,Ministry of Public Health Thailand July 1, 2003

Estimated Cumulative Numbers of HIV/AIDS Cases, 2003  HIV infections (adults and children) 1,054,684  PLWHA(HIV+AIDS) 603,942  PLWA (AIDS) 62,871  New HIV infections in ,260  New AIDS cases in ,415 Source: The Projection for HIV/AIDS in Thailand :

Reported HIV/AIDS cases from 1984 to 2003 As of March 31, 2003 Cumulative AIDS/symptomatic 293,328 AIDS 214,129 symptomatic HIV 79,199 Cumulative deaths 67,288 AIDS 59,002 symptomatic HIV 8,286 PLWA (AIDS) 155,127 People living with symptomatic HIV 70,913 Source: Bureau of Epidemiology, Dep.Disease Control,MoPH, Thailand

Sources of Antiretroviral therapy in Thailand MoPH Access to Care [ ATC ] / National Access to Antiretroviral Programs for PLWHA [ NAPHA ] Co-payment system Patients pay out of their own pockets Patients participating in clinical trials Health Insurance Programs

Universal health Care Scheme HIV/AIDS care packages consist of: - HIV counseling - HIV testing - PMTCT - Common OIs treatment and prophylaxis: provided in all government hospitals - ARV with 3 drugs regimens [ in the process of integration]

Access to Care [ ATC ] /National Access to Antiretroviral Program for PLWHA [ NAPHA ] Initiated in late 2000 From Clinical Research Network extending to ATC Network 119 hospitals growth to 460 hospitals participated,expected more Provided quota up to 3,000 cases in the initial phase to more than 17,000 case so far From naive cases to experienced and complicated cases By the end of 2003, aims at 23,000 cases By the end of 2004, ambitious target is 50,000 cases

Government’s ARV Budget in Million Baht

ATC / NAPHA Training and supervision Protocol management Drug stock management Data management Monitoring and evaluation Laboratory management

Number of Patients Participated in the Programs, As of May 2003 ProgramsAllocated quotaTotal receiversOngoing receivers ATC 1, ATC PATC1, PATC Research Co-payment PMTCT Total

What is M&E? Monitoring is routine, daily assessment of ongoing activities and progress. Evaluation is the episodic assessment of overall achievements. “Things that can change policy and practices” “Systems development to quality improvement” “Research to service” “Small scale to large scale” “Different level different responsibility”

Monitoring of ART Programs “Make it simple and keep it simple” essential markers : weight, CD4, S/E, status of treatment ;continuing on treatment, changing of regimens, terminate, death, loss followed up Protocol development -development of standard tools -Registration and reporting systems -Site visit -Bi-annual/annual workshop on monitoring and programs management Self and external monitoring

Evaluation of ART programs “Do it as much as you can” Balancing between the aims of improving ways of management and research questions Self and external evaluation Evaluation on all major components of projects management, drugs adherence, economic implications.

Challenges M&E is a step by step development Risk of overwhelming of data and overloaded of works Sense of belonging of what has been done No standard of M&E on ART to be used as a model

แบบบันทึก การติดตามการรักษาด้วยยาต้านไวรัสเอดส์ สำหรับผู้ติดเชื้อ เอชไอวีและผู้ป่วยโรคเอดส์ ( ATC data form 1 ) ATC Number __ - __ __ __ __ - __ __ __ __ โรงพยาบาล ______________________ H N ______________________ เลขที่บัตรประชาชน _ - _ _ _ _ - _ _ _ _ _ - _ _ - _ ที่อยู่ เลขที่ _____ หมู่ที่ ___ ถนน ____________ ตำบล _____________ อำเภอ _____________ จังหวัด _____________ รหัส __________ โทรศัพท์ ____________ กรมควบคุมโรค กระทรวงสาธารณสุข

Percent of PLHA and relatives expressing satisfaction with the clinic and amount of information that they received

Thank you Acknowledgement Department of Disease Control, Ministry of Public Health Thailand