ParticiPant training manual for the three interlinked Patient monitoring systems for hiV care/art, mch/ Pmtct, and tB/hiV

(1)

2012 Geneva

ParticiPant training manual for the three interlinked Patient monitoring systems for

hiV care/art, mch/ Pmtct, and tB/hiV

3 interlinked Patient Monitoring system

World Health Organization 20 avenue appia

CH-1211 Geneva 27 Switzerland

HIv Department

e-mail: [email protected]

http://www.who.int/hiv/capacity/

STOP TB Department e-mail [email protected]

Department of Maternal, newborn, Child and adolescents (MCa) e-mail: [email protected]

iMai — integrated Management of adolescent and adult illness iMPaC — integrated Management of Pregnancy and Childbirth iMCi — integrated Management of Childhood illness

(2)

WHO Library Cataloguing-in-Publication Data

Participant training manual for the three interlinked patient monitoring systems for HIV care/ART, MCH/PMTCT and TB/

HIV.

1.Monitoring, Physiologic. 2.HIV infections - drug therapy. 3.Anti-retroviral agents - therapeutic use. 4.Diseases transmission, Vertical - prevention and control. 5.Tuberculosis - drug therapy. 6.AIDS-related opportunistic infections.

7.Pregnancy complications, Infectious - drug therapy. 8.Data collection. 9.Teaching materials. I.World Health Organization.

ISBN 978 92 4 159982 5 (NLM classification: WC 503.2)

© World Health Organization 2012

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail:

[email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail:

[email protected]).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Layout L’IV Com Sàrl, Villars-sous-Yens, Switzerland.

Printed by the WHO Document Production Services, Geneva, Switzerland.

(3)

Patient monitoring is an important part of high quality patient care. Monitoring involves documenting all patient encounters by keeping regular and accurate records of key aspects of the care and treatment offered to patients. This makes it possible to capture the history of a patient or of a group of patients over time and across different clinical sites, and to collect data for reporting on and evaluating patient care at regular intervals.

At your health facilities, you may already be monitoring various health-care activities such as immunization, antenatal visits or the success of tuberculosis (TB) case detection and treatment activities.

This manual focuses on how clinical teams providing patients with HIV care and ART, maternal and child health (MCH) care, including PMTCT, should monitor these patients in groups, and how the team can monitor some of its own activities. It also demonstrates the linkages to the TB/HIV patient monitoring system.

In the context of facility-based care, monitoring offers three major benefits:

• It provides essential information for individual case management.

• It provides key information for managing the health facility (e.g. for ordering drugs and supplies or for making quality improvements).

• It provides information on operating and improving programmes at district, national, and international levels.

If you attended the Integrated Management of Adolescent and Adult Illness (IMAI) clinical course¹, you learned how to provide individual care to HIV patients, and to start clinical monitoring of the care provided to these patients. You learned how to follow each patient’s progress through the clinical stages of HIV infection, and the sequence of key steps that lead from a confirmed HIV test to starting the original first- line regimen. In addition, you also learned something about laboratory monitoring which will help you at facilities with access to laboratory results.

If you have already taken the Integrated Management of Pregnancy and Childbirth (IMPAC)² course, you learned how to provide individual care to HIV-positive pregnant women and their newborns, including clinical monitoring of these patients.

In this course you will see how the patient monitoring systems within these services should be able to ‘talk to each other’. You will also learn how to use the data on the HIV care/ART card, the pre-ART and ART registers, and the ANC, L&D, and HEI registers to produce reports that assist in monitoring the status of whole groups of patients under the care of the clinical team.

The TB patient monitoring tools, including the TB treatment card, and TB suspects and lab registers are covered in a separate curriculum.

In addition, chapters 10-12 of the Participant training manual provide instruction specifically for supervisors/managers and district/regional/national coordinators on how to:

• validate patient monitoring data and use it effectively in supportive supervision;

1.1. Learning objectives

1.2. Purpose of patient monitoring

1. Introduction to patient monitoring systems for

HIV care/ART, MCH/PMTCT and TB/HIV

(6)

It is agreed that HIV-related services should be delivered across a continuum of care. This requires integrated and linked service provision at all levels of the health system. It is recommended that services for HIV should be linked or integrated with other services in the health sector, including TB, sexual and reproductive health, and maternal and newborn health services. Each of these may warrant different but related patient monitoring activities. Therefore, health services and the data collection systems and tools used to monitor patients who receive them (including HIV services) must be integrated as much as possible in order to decrease duplicated collection of data elements common to all care monitoring systems.

The generic three interlinked patient monitoring systems have been developed with the assumption that services are integrated at facility level. Integration means that HIV services are included on the same visit with ANC, labour and delivery, postpartum and newborn and TB services. However, the illustrative tools and minimum data sets are useful in any setting, even when services are only partially integrated or not integrated at all.

For example, there are facilities that refer co-infected TB patients to the HIV clinic immediately after an HIV diagnosis; ANC sites which will do only testing, clinical and immunological staging, and then refer the patient for ART; or ANC sites which will do only testing, then refer the patient for staging and ART to the HIV clinic. At these sites, the interlinked patient monitoring systems help to track patients as they use services from different points of care. For instance, an HIV-positive patient who is enrolled in HIV care may also be receiving TB treatment from the TB clinic, or a woman may be receiving both TB and MCH/PMTCT services.

The extent to which a country uses the three interlinked patient monitoring systems depends on which care scenario(s) is/are currently in place and/or being planned.

It is possible to use the three interlinked patient monitoring systems’ minimum data sets in a modular fashion until a fully integrated model of care is feasible.

Certain adaptations of the generic three interlinked patient monitoring tools may be more relevant in settings without full integration of HIV services. See the Patient monitoring adaptation guide that provides the technical basis for essential and possible adaptations.

The standardized tools of the three interlinked monitoring systems for patients in HIV care, on ART, in MCH/PMTCT programmes or in TB/HIV care fall roughly into three categories:

1. Patient hand-held cards:

Patient-hand held cards help the transfer of critical patient-related information across service delivery points in the same facility or other facilities. For instance, the maternal card facilitates transfer of information from the ANC clinic to the delivery ward, and back to the outpatient postnatal service delivery point. In many settings, there are many more ANC facilities (including outreach sites) than there are delivery facilities. This often results in a pregnant woman delivering in a different facility from where she obtained her ANC services. Given the fast-paced nature of delivery services, the woman’s patient-held card helps assure the continuity of care not possible through other means, e.g. it would take too long to call the ANC facility to trace the woman’s records.

Similarly, patient-held HIV, TB, or child cards (the latter is often known as the ‘road to health’ card or passport), or any other patient-held card (such as a global health passport) that exist in the local context all help to assure continuity of care across service delivery points. They facilitate the transfer of key data elements such as the patient’s ART or TB treatment regimens, history of any complications and other unique identifiers. Their use should be encouraged across all types of services. For example, all staff at service delivery points should encourage patients to bring their patient-held cards to all visits. They should also ask to see the cards each time. This approach should apply to specialized clinics such as TB or HIV services, as well as to all other service delivery points.

1.3. Overview of the

three interlinked patient

monitoring systems

(7)

2. Facility registers/records and appointment books

There is no guarantee that patients will carry their patient-held cards/records with them when they seek care. Therefore, data about patients and their care need to be retained at facilities, as well as being entered into the appropriate patient-held record. This is especially important since it is likely that a patient will seek care at the same facility over time. In chronic care, such as HIV care (including ART), this is achieved by using a facility-held patient card and various registers. The facility-held patient card is the foundation for the entire patient monitoring system. It includes all data elements about the patient’s care. Some elements will be entered at every visit, some will be filled in at the first visit only, and/or updated as needed. Meanwhile, the patient-held card for any particular type of care should be standardized across service delivery points.

Longitudinal registers are registers that filter ‘up’ a portion of information per patient to facilitate tracking key data elements. To provide a better basis for improved chronic care, these registers are designed so that a patient is entered only once and the key variables are filled in as they occur over time. The registers facilitate tracking an individual patient across time, but also make it possible to analyse groups of patients at a glace, as well as to calculate key programmatic indicators. For example, in the case of HIV care, the pre-ART register becomes the facility’s list of all patients ever entered in HIV care there (including transfer-ins). It also includes ‘outcome’

variables that allow you to know how the patient moved on from HIV care (either into ART, died or was lost to follow-up (LTF). In a longitudinal ANC register, each pregnancy and all key data elements associated with that pregnancy are tracked in one row per patient. If staff include HIV care elements (i.e. testing, ART eligibility assessment, the HIV care enrolment date and a unique identifying number) in a longitudinal ANC register, this will help with continuity of care across all services.

3. Report forms

Report forms regularly capture aggregate patient monitoring data. Agreed indicators are summarized and their values are used to take action on a regular basis. Most indicators captured on summary report forms are cross-sectional in nature; they capture a snapshot of a particular programme aspect at one point in time. The indicators included in the quarterly report form are relevant examples.

Because of their timing, some indicators are considered cohort indicators. This includes elements such as if a patient is alive12 months after initiation of ART, and all other outcomes at important, standardized intervals included on the ART cohort analysis form. In TB cases, outcomes are reported quarterly on the cohort of patients registered in the quarter that ended 12 months previously.

The calculation of indicators is often cross sectional, but it is usually most meaningful to track changes in indicator values (those that are both locally and nationally useful) across time. This can be assisted by a data-use template that includes samples tables and/or graphs.

Figures 1.1-1.3 on the following pages show the flow of patients and data from individual medical records to registers and reports.

(8)

Figure 1.1.Overview of data flow from the HIV care/ART patient card to the two registers, to the two reports

Patient-held card

ANC No. _______________ Date enrolled in HIV care ________________ Unique HIV care/ART No. ___________________

Labour and Delivery (transfer from labour record) Infant feeding intention: o EBF o RF o MF Date of delivery___________________________

Place of delivery:

o Home o Hospital o Health Centre o Other _______________

Conducted by: o Nurse/Midwife o Doctor o TBA o Other Condition of

mother___________________________________________

Condition of baby_____________________________________

Mode of delivery (indication if operative delivery) _________________

Postpartum complications: PPH o _________ Other o___________

ARV given during delivery:

ART oTriple ARVs oAZT+3TC oSd NVP oNone o ARV dispensed for mother oAZToTriple ARVsoART Postpartum- mother- outpatient visit Problem with breast feeding ______________________________

Perineum ______________ Lochia_____________________

Breasts ___________________________________________

Infant feeding practice: EBF o RF o MF o Infant

Birth weight _________________ Sex: o Female o Male Baby Immunization: o BCG o OPV 0 Vitamin K: o Yes o No ARV prophylaxis:

o NVP o AZT

Clinical Notes/Additional Postnatal Visits __________________________________________

__________________________________________

Referral site __________________________________

__________________________________________

Reason for referral ______________________________

__________________________________________

Health facility ____________________________ Name__________________________________ Age___________ Address: ____________ District:_____________ Village___________ Marital Status___________________ Gravida___________________ Para_________________________ LMP_____________________ EDD _________________________ Contact person/next of kin ___________________________________

Preferred site of delivery ____________________ Mode of transportation ____________________ Notes _______________________________ ___________________________________ ___________________________________ ___________________________________

MATERNAL HEALTH CARD

Side 1: Summary card Update from encounter card as needed

Side 2: encounter card Updatred with each outpatient visit for patients in HIV care/ART

Patient-held card

ANC No. _______________ Date enrolled in HIV care ________________ Unique HIV care/ART No. ___________________

Labour and Delivery (transfer from labour record) Infant feeding intention: o EBF o RF o MF Date of delivery___________________________

Place of delivery:

o Home o Hospital o Health Centre o Other _______________

Conducted by: o Nurse/Midwife o Doctor o TBA o Other Condition of

mother___________________________________________

Condition of baby_____________________________________

Mode of delivery (indication if operative delivery) _________________

Postpartum complications: PPH o _________ Other o___________

ARV given during delivery:

ART oTriple ARVs oAZT+3TC oSd NVP oNone o ARV dispensed for mother oAZToTriple ARVsoART Postpartum- mother- outpatient visit Problem with breast feeding ______________________________

Perineum ______________ Lochia_____________________

Breasts ___________________________________________

Infant feeding practice: EBF o RF o MF o Infant

Birth weight _________________ Sex: o Female o Male Baby Immunization: o BCG o OPV 0 Vitamin K: o Yes o No ARV prophylaxis:

o NVP o AZT

Clinical Notes/Additional Postnatal Visits __________________________________________

__________________________________________

Referral site __________________________________

__________________________________________

Reason for referral ______________________________

__________________________________________

Health facility ____________________________ Name__________________________________ Age___________ Address: ____________ District:_____________ Village___________ Marital Status___________________ Gravida___________________ Para_________________________ LMP_____________________ EDD _________________________ Contact person/next of kin ___________________________________

Preferred site of delivery ____________________ Mode of transportation ____________________ Notes _______________________________ ___________________________________ ___________________________________ ___________________________________

MATERNAL HEALTH CARD

New patients entered into pre-ART register

Registration Fill when applicable Clinical stage PMTCT ART

Date enrolled In chronic HIV care Unique ID No.

Patient clinic ID No.

Name in full Upper space:

surname Lower space:

given name SexAgeStatus at enrolment

(record TI if transfer in) CTX Start month/year

INH start month/year

TBRX Start month/year

and TB reg No. 1234For each pregnancy, record EDD, ANC No. and HIV -exposed infant No.Date medically eligible for ART Date ART Started (transfer to ART register)

Preg 1 Preg 2 Preg 3 Preg 4

Pre-ART Register page 1

HIV + patient enrols in

chronic HIV

When

ART starts, transfer to ART register

District electronic database for cohort analysis disaggregated

by sex and age

Monthly or quarterly HIV care/ART report

m Number erolled and eligible but not yet started on ART

m New and cumulative number enrolled in ART and HIV care

m Total currency on ART

Follo

w-up education, suppor t and prepara tion for ARV therap

y [to be r

evised]

Date/comments Date/comments Date/comments

Date/comments ation, transmission Basic HIV and TB educ

Prevention: abstinence, saf er sex, condoms Prevention: household precautions, wha t is safe

Post-test counselling: implications of r esults

Positiv

e livingTesting par

tners

Disclosur

e, to whom disclosed (list)

Family/living situa

tion Shared confidentiality

Reproduc

tive choices

, prev

ention of MTC

T Child’s HIV test

Progression of disease

Available tr

eatment/pr

ophylaxis CTX, INH prophylaxisMalaria prevention, IPT

, ITN Follow-up appointments, clinic

al team

ART – Essentials

Why complet

e adherence neededAdherence prepara

tion, indicat

e visits: DATE/r Indicate when READY for ART

esult clinical t

eam discussion

Explain dose, when t

o takean occur, how tWhat c

o manage side effects

What t

o do if one forgets dose What t

o do when travelling Adherence plan (schedule, aids

, explain diar

y)

Treatment supporter pr

eparationy missed Which doses, wh

ARV support group How to contact clinic

Sympt

om management/Pallia

tive c

are a

t home Caregiver bookletHome-based car e – specify

Suppor

t groupsCommunity suppor

t Home-based care, supportART preparation, initiation. support, monitor, RxPro- gression, RxEducate on basics, prevention, disclosure HIV CARE/ART C ARD

Unique No.

ooooooooo

Distric

t _________________________ Health unit __________________ D istrict clinician/t eam ______________

Name ____________________________________________ Patient clinic N

o. __________________________ Sex M o F o Age ____________ DOB _____________________ Marital sta

tus ______________________ ess _________________________________________________________________________________ Addr

Telephone (whose) __________________________________________________________________________Trea

tment supporter/medic

ation pick

-up if ill _______________________________________________________

Addr

ess _________________________________________________________________________________

Telephone (whose) _________________________________________________________________________Home based c

are pr

ovided b

y __________________________________________________________________

Family sta

tus

Exposed infant follo w-up

Name of family members and

partners

Age

HIVP/N

HIV car

eY/N

UniqueNo.

Exposed Infant Name/No.

DOB

Infant feeding practice a

t 3 mos.

CTX star

ted by 2mos

.

HIV test type/result

Final status

(If confirm +) Unique ID

Prior ARVs Y (4) Prior ART

Date_ _/_ _/_ _ T onlyNonePMTC

Where __________________________ ARVs __________________ Earlier ARV not

transfer in _ _/_ _/_ _ Where __________________________ ARVs __________________

HIV car

e Date

Confirmed HIV + t

est

_ _/_ _/_ _ HIV 1 2 Ab/virologic t

est Wher

e __________________________

HIV enrolled _ _/_ _/_ _ o HIV car e transfer in fr om ____________________________

Medically eligible for ART

_ _/_ _/_ _

Clinic

al stage _____________________________________ CD4 ____________________________________________

o Presumptiv e clinical diagnosis of se vere HIV infec tion in infants ART CARE Cohor

t (month/year) __________ / _________ om _______________________ ARVs ________________ ART transfer in fr Date___ / ___ / ___

___ / ___ / ___

Star

t ART 1st -line initital r egimen __________________________________

1st - line

At star

t ART Wt ___________ Cl.stage __________ CD4 __________ Pr eg __________

Substitut

e within 1stt-line___ / ___ / ___

New r

egimen _____________________ Wh y _______________________

___ / ___ / ___

New r

egimen _____________________ Wh y _______________________

2nd -line

Switch to 2 nd-line (or substitution within 2nd-line) ___ / ___ / ___

New r

egimen _____________________ Wh y _______________________

___ / ___ / ___

New r

egimen _____________________ Wh y _______________________

ART treatment interruption — S

top or missed drug pick

-up Stop or LostStop LostStop Lost

Stop Lost

Date ____ / ____ / ____

____ / ____ / ____

Why

____ / ____ / ____

Date if restar

t

____ / ____ / ____

Status

Date ____ / ____ / ____ Dead

Transf

erd out

____ / ____ / ____

Where ________________________________________

Lost to follo w-up (drop) ____ / ____ / ____

Why SUBSTITUTE or SWIT

CH codes

1. To

xicity/side effec

ts 2. Pregnancy3. Risk of pregnancy4. Due to new TB5. New drug available6. Drug out of stock7. Other reason (specify)

Reasons for SWIT

CH to 2nd-line regimen only

:

8. Clinical trea tment failur

e 9. Immunologic failure10. Virologic failure

Drug aller

gies Relevant medic al conditions

Why ST

OP codes

1. To

xicity/side effec

ts 2. Pregnancy3. Treatment failur

e 4. Poor adherence5. Illness, hospitaliza

tion 6. Drugs out of stock

7. Patien

t lacks finances8. Other pa

tient decision

9. Planned Rx interruption 10. Other (specify)11. Excluded HIV infec tion in infant

Manual analysis by facility then district or

Aggregated ART cohort analysis report:

at 6 mo, 12 mon, yearly

m Treatment regimens m Treatment outcome m CD4

Registration Fill when applicable Clinical stage PMTCT ART

Date enrolled In chronic HIV care Unique ID No.

Patient clinic ID No.

Name in full Upper space:

surname Lower space:

given name SexAgeStatus at enrolment

(record TI if transfer in) CTX Start month/year

INH start month/year

TBRX Start month/year

and TB reg No. 1234For each pregnancy, record EDD, ANC No. and HIV -exposed infant No.Date medically eligible for ART Date ART Started (transfer to ART register)

Preg 1 Preg 2 Preg 3 Preg 4

When

ART starts, transfer to ART register

(9)

5. Figure summarizing flow of integrated PMTCT and HIV care/ART patient monitoring systems

26

L&D register Post partum recordPartographLabour record

ART register

ANC register HIV care/ART card 1. HIV care/ART card 5

Status at enrolment: o HIV exposed Infant o TB Rx o Pregnancy o Postpartum o other Unique No. o o o o o o o o oDistrict ________________ Health unit ________________ District clinician/team _________________ Name ___________________________________________ Patient clinic No. _____________________Sex M o F o Age __________ DOB ___________ Marital status _______________Address ___________________________________________________________________________Telephone (whose) __________________________________________________Treatment supporter/medication pick-up if ill _________________________________________________Address ___________________________________________________________________________Telephone (whose) __________________________________________________Home based care provided by ____________________________________________________________ Family statusExposed infant follow-upName of family members and partnersAgeHIVP/N HIV careY/N UniqueNo.

Exposed-infant name/No.DOBInfant feeding practice at 3 mosCTX started by 2 mos HIV test type/result Final status (If confirmed infected) unique ID HIV careDateConfirmed HIV + testHIV 1 2 Ab/virologic test Where _______________HIV enrolledo HIV care transfer in from__________Medically eligible for ARTClinical stage ______ CD4 ________o Presumptive clinical diagnosis of severe HIV infection in infantsDrug allergiesRelevant medical conditions Prior ARVsY(P)Prior ARVDateNoneARV/ART during pregnancy and breastfeeding_ _/_ _/_ _Where _________ARVs _____________

Earlier ARV not transf er in_ _/_ _/_ _Where _________ ARVs _____________ ARTCohort (month/year) _______/______Date_ / _ / _ART transfer in from_____________ ARVs __________ / _ / _Start ART 1st -line initital r

egimen _________________

1st - line At start ARTWt _____ Cl. stage ______ CD4 ______ Preg ______ Substitute within 1

st t-line

_ /_ /_New regimen ________________ Why _____________ /_ /_New regimen ________________ Why ____________

2nd -line

Switch to 2

nd-line (or substitution within 2 nd-line)

_ /_ / _ New regimen ________________ Why _____________ / _ / _New regimen ________________ Why ____________ART treatment interruption – Stop or missed drug pick-upStop or lostStoplostStoplostStoplostStoplostDate WhyDate if restartStatusDate DeadTransferred outWhere _____________Lost to follow-up (drop)

Pre-ART register

RegistrationFill when applicableClinical stagePMTCTARTDate enrolledIn chronic HIV care

Unique ID No.

Patient clinic ID No.

Name in full Upper space: surname Lower space: given nameSexAgeStatus at enrolment(record TI if transfer in) CTX Start month/year INH Start month/year TB RX Start month/year and TB reg No.1234For each pregnancy, record EDD, ANC No. and HIV -exposed infant No.Date medicallyeligible for ART Date ART Started(transfer to ART register)Preg 1Preg 2Preg 3Preg 4

Maternal card

omen vices e are er y )

Quarterly follow - up statusYearYearYearYearYearYearQ1Jan-Mar

Q2Apr-Jun Q3Jul-Sep Q4Oct-Dec Q1Jan-Mar Q2Apr-Jun Q3Jul-Sep Q4Oct-Dec Q1Jan-Mar Q2Apr-Jun Q3Jul-Sep Q4Oct-Dec Q1Jan-Mar Q2Apr-Jun Q3Jul-Sep Q4Oct-Dec Q1Jan-Mar Q2Apr-Jun Q3Jul-Sep Q4Oct-Dec Q1Jan-Mar Q2Apr-Jun Q3Jul-Sep

Q4Oct-Dec Total TB staus YSeen at least once in Y Top row: record follow-up status at end of each quarter CD4 - record last CD4 in quarter ➝ - did not have visit scheduled for that quarter LOST- not seen in the last quarter, but scheduled for a visit TO- transferred out (record to where) DEAD - record date

Bottom row: Record TB status Yes/No - TB status completed at last visit in last quarter

Pre-ART Register page 2 11. Labour and delivery register 40

IdentificationMode of delivery Obstetrics complicationsMaternal outcomeNewbornHIV status at admission(check appropriate)NameAgeANC No.Date of deliverydd/mm/yy 1. SVD 2. Assisted vaginal

3. C/SY/N

1. Stable2. Referred3. DiedSex

Weight in grams

1.<2500 2. ≥2500 1. Term2. Preterm3. StillbirthPNU 11. Labour and delivery register 41

Previous HIV test dateHIV test result (check appropriate) ARV woman took during pregnanc

y

Weeks woman took ARV during pregnanc yARV woman took in labour (check appropriate)Infant received NVP/AZT ARV infant discharged with (check appropriate column or if none, write None) Infant feeding (check appropriate or if mixed feeding, write MF) Intended family planning method chosen Referred to HIV care/ART(dd/mm/yy)PNU

AZTtriple ARVs ART none

(≤4, >4)AZT

Triple ARVs AR TNone(check if received, if none write «none»)AZTNVPEBFRF(Write method)(Refer, already in care)

ParticiPant training manual for the three interlinked Patient monitoring systems for hiV care/art, mch/ Pmtct, and tB/hiV

2012 Geneva