Paul De Lay Director, Evaluation UNAIDS UNAIDS Extended MERG Workshop Subnational and Concentrated Epidemics Geneva October 28, 2004 Paul De Lay Director, Evaluation UNAIDS

Summary and Next Steps ART patient and program monitoring ISSUES: Linking patient monitoring and program monitoring-seeking duplication!! Concerns about complexity and density of data. Need more field experience. Too much data vs not enough (drug procurement/good quality clinical care) What are costs of this? Similarities/dissimilarities with TB, and “true” chronic diseases TB invested in vertical staffing Mobile patients Concerns about staffing and training Assigning responsibilities, such as data aggregation and analysis

Summary and Next Steps ART patient and program monitoring ISSUES: Public versus private services-will this work for both? Confidentiality Especially in concentrated epidemics, ? get info on modes of transmission, etc This data set contains early warning signs for ARV resistance (adherence, stockouts, changing regimens, deaths)

Summary and Next Steps ART patient and program monitoring ISSUES: Evaluation of projects (Track One proposal) Harmonizing 3X5, PEPFAR, Track One (Indicators, reports, reporting timelines, etc) Pt clinical monitoring, health facility, subnational, national-what do we need? Standardizing demographic data, especially age cohorts (0-2, 3-4,5-14, 15 and above) ? Value of CD4 and weight gain (other laboratory and clinical) for program monitoring Need long term survival Program management requires #staff per pt, staff trained, coverage, costs

Summary and Next Steps ART patient and program monitoring ISSUES: Need start-up, current, survival, coverage, % on first line and second line Rx (How much of this can be done at subnational levels) Need to cap national level indicators Balance the need to provide guidelines and the need to learn and revise Need to draft an “operations manual” based on the draft operational framework (May need two versions-one to organize technical issues and one for country guidance. Consider including in the “Fundamentals” document)

Summary and Next Steps ART patient and program monitoring ISSUES: A lot of good work has been done to build on... Now the work needs to focus on the country level