The major reason it is very difficult to measure the outcome and impact of HIV / Aids intervention programme is the movement of patients from one facility to another; one location to another with no means of identifying if the patient is truly a new ART/RVD case or not. This is exactly the same reason statistical report on number or percentage of HIV/Aids cases cannot be said to be correct.
I have worked cumulatively 3 years with facilities that are in partnership with HIV and AIDS intervention programmes in South-south and Southeastern part of Nigeria. I find it exciting working with the ART/RVD unit though.
My key job roles include but not limited to :
Registration of new patients.
Documentation of both old and new patients.
Health education and counseling.
Tracking, statistics and reporting.
Monitoring and Evaluation; baseline and formulation of input, output,outcome and impact indicators.
Data collection through the use of structured questionnaires .
Now, I want to discuss the last item on my job role list – Data collection….
The tool for data collection used was designed only for HIV patients (for emphasis sake, who know their status and are already the facility’s client). And the process of eliciting information was done one-on-one. Given the literacy level of the people in that particular area, I asked and explained each question and tick / write their response accordingly.
Some of the questions formulated are:
Do you know your spouse’s status?
When did you know your present status?
When did you start treatment?
How long have you been on drugs?
Did you miss your drug in the last week or month?
How do you take your drugs?
Mention the drugs you take.
What is viral load?
What is viral load suppression?
When last did you do CD 4 count?
Do you know your result?
What is your viral load unit?
I interacted with the patients in the course of explanation , and what turned into a little question and answer session between I and each of them .
From the questions and other interactions and reports from tracking I found out that:
1. Most HIV/AIDS patients do not transfer to their new facility with referral letters, hence there is no report to show that they have been on drugs , nothing to show the CD 4 count and viral load report.
2. Often they deny knowledge of their status and start all over as a new case.
3. They find it convenient to lie about their treatment progress, they would rather tell you it’s their first time of collecting drugs.
4. Majority don’t even take their drugs, during the course of tracking or sadly death, you will be shocked to find out that they just stack up the drugs they have been collecting, this is a strong indication that they abuse the drugs.
5. Majority abuse their drugs, and return to the facility as a RE-START case.
6. MOST OF THEM DO MULTIPLE REGISTRATION WITH ENTIRELY DIFFERENT IDENTITY(IES).
So, one person might be registered 5 times as HIV case. Thus leading to increase in HIV cases which in actual sense is inflation.
Mr. A would collect drugs meant for himself and Mr. B, C, D thus leading to waste of input (resources)
Summarily, these programmes Kick off with even incorrect baseline and end up with ‘inflated” scope and have little impact to show for it.
Now, how about designing a software and database that will capture and store all cases of HIV that present to the hospital and synchronise and integrate the data ?
One case per one unique ID.
Besides the usual name and unit number (ID) integrating biometrics, particularly finger prints could suffice.
Let unit number 0011 be the only 0011 in the whole country, such that if it is assigned to a patient in Kaduna it can no longer be assigned to any other patient in and outside Kaduna.
If Mr. Okon of Cross River transfers to Imo state , upon presenting himself to the facility his data will be collected , as you key in his details into the system, the database will search the entire system and pop up his already captured details.
For new cases , the next available unit number will be assigned to them.
This would function like ELECTRONIC HEALTH RECORDS (EHR)
Since most of these organisations like Global fund, FHI, CRS provide these facilities with computer system , this won’t be very hard to achieve.
Just one computer or two at the Monitoring and evaluation unit in the medical records department will suffice. And training the manpower concerned…
Facilities just have to maintain patient master index of their patients, while there would be a central database/server maintained by the provider organisation.
If implemented,this will ensure a more solid and correct baseline. It will ensure accurate monitoring of input, outcome measurement /evaluation of outcome against the input, and impact evaluation.
If we must truly control HIV and AIDS we need statistical analysis and reports that are at least 80% correct.