Annex 4: Details of CST6 indicator

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CST6a: Systems and items for management of OIs and for palliative care

Definition

Percentage of health facilities that have the capacity to support advanced clinical management of HIV/AIDS-related OIs and other illnesses and symptoms

Purpose

To assess progress on availability of advanced level HIV/AIDS care for PLWHA

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. Drugs for advanced treatments for OIs and other HIV-related illnesses:

OIs:

i. Cryptococcus fungal infections (e.g., fluconazole or amphotericin B)

ii. Respiratory infections (e.g., acyclovir or ciprofoxacin or ceftriaxone or gentamycin)

iii. Other infections (e.g., procaine penicillin or amoxil)

iv. Herpes infections (e.g., acylovir)

v. Parasitic infections (e.g., cotrim or metronidazole or nalidixic acid)

vi. Herpes ophthalmic infection (e.g., acyclovir ophthalmic)

vii. Psychoneurologic disorders (e.g., dexamethasone, Phenobarbital, fansidar, and cotrimoxazol)

Palliative symptomatic treatment

viii. Relief of pain and neurologic symptoms (e.g., diazepam and prednisolin or dapsone, and oral morphine and codeine)

ix. Fortified protein supplement

Basic HIV/AIDS services

x. All medicines for basic OIs and palliative symptomatic treatment and basic HIV/AIDS services (CST5e)

2. Diagnostic and laboratory capacity for advanced HIV care:

i. Spinal tap kit

ii. Laboratory capacity for:

a. Culturing specimens

b. Liver function tests

c. Haematology (WBC count, Anemia test, platelet count, BUN and creatinine)

d. India Ink Stain

e. Gram Stain

f. ELISA test for HIV

Or

A documented system for referral and receiving results for the above (a-f) including:

a. Record or register where the referral and test result is included, and

b. Indication of provision of test results or follow-up with patient

Numerators:

Number of health facilities that have individual items for the management of OIs and other HIV-related illnesses and symptoms

Number of health facilities that have all individual items for the management of OIs and other HIV-related illnesses and symptoms

Denominators:

Total number of health facilities

Total number of health facilities providing HIV/AIDS-related care services

Note:

If the laboratory or pharmacy is external to the facility, but has a formal agreement and is the designated laboratory or pharmacy for the facility, laboratory capacity and availability of medicines should be assessed in the external referral location.

Remark

WHO indicator

CST6b: Systems and items to support advanced services for HIV-infected clients

Definition

Percentage of health facilities with the capacity to support advanced care for HIV-infected clients

Purpose

To assess progress on availability of systems and items to support advanced services for HIV-infected clients

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

Health facilities where HIV/AIDS clinical and psychological care is being provided are randomly selected and observed and health workers interviewed to assess the following:

1. Number of facilities with the following observed guidelines or protocols:

i. Opportunistic infections

ii. Provision of symptomatic palliative care

iii. Paediatric care for HIV/AIDS

iv. Care protocols for all HIV positive clients

2. Number of facilities where there is an observed record of a system for making individual client appointments

3. At least one provider in the facility has received structured training (either in-service or pre-service) during the prior 3 years where the indicated topic was addressed, and where that training is also related to the provider’s job:

i. Psychological counseling for HIV

ii. Treatment for OIs

iii. Palliative care

iv. Psychoneurologic disorders related to AIDS

v. Pediatric AIDS

4. At least half of the interviewed providers of services for HIV positive clients in the facility were personally supervised during the prior 3 months

Numerators:

Number of health facilities that have individual items for advanced care for HIV-infected clients

Number of health facilities that have all items for advanced care for HIV-infected clients

Denominators:

Total number of health facilities

Total number of health facilities providing HIV/AIDS-related care services

Remark

WHO indicator

CST6c: Systems and items to support ART services

Definition

Percentage of health facilities with the capacity to prescribe and monitor ART

Purpose

To assess progress on availability of capacity to support ART services

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. ARV drugs regularly available with no reported stock outs in last 6 months. Drugs will be country specific. Stock cards should be observed and any stock outs over last six months noted

2. Observed guidelines or protocols for:

i. Treatment and prevention of OIs

ii. Provision of palliative care (symptom and pain control)

iii. Pediatric care for HIV/AIDS

iv. Standard operating procedures for services and interventions for HIV positive clients

3. Observed treatment guidelines for ART:

i. Adolescent and adult ART management

ii. Pediatric ART management

4. Number of facilities with laboratory capacity to conduct or a documented system for referral and receiving results for at least one of the following tests:

CD4 or CD4 alternative or total lymphocte count (TLC) test or viral load

OR

A documented system for referral and receiving laboratory results that includes:

i. Record or register where the test result is included and

ii. Indication of provision of test result to or follow-up with patient

5. A system for appointment and client follow-up that indicates appointment schedules, and whether the client kept the appointment or not

6. Clients receiving ART have individual client cards or records that are maintained at the facility

7. At least one ART service provider in the facility has received structured in-service training related to ART within the last 12 months

8. At least one provider of services for HIV-infected clients has received training on counseling for adherence to drug therapies within the last 12 months

9. At least one provider of service for HIV-infected clients has received training on nutritional rehabilitation for nutritional problems associated with ART within the last 12 months

10. At least half of the interviewed providers of ART services were personally supervised during the previous 3 months

Numerators:

Number of health facilities that have individual items for ART capacity

Number of health facilities that have all items for ART capacity

Denominators:

Total number of health facilities

Total number of health facilities providing ART

Note:

Facilities also include those that refer clients for laboratory tests for ART monitoring through a formal agreement with an external network laboratory or testing unit, if the referring facility is responsible for follow-up on the results of those clients.

Remark

WHO indicator

CST6d: Conditions to provide advanced inpatient care for HIV-infected clients

Definition

Percentage of health facilities that have all relevant items to support inpatient care for HIV-infected clients

Purpose

To assess progress on availability of capacity to support inpatient care for HIV-infected clients

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. Items from indicators CST5a and CST5b (testing and counseling)

2. Items from indicator CST5d (nosocomial infection prevention)

3. Items from indicators CST6a and CST6b specific for resources and personnel available for inpatient services

4. 24-hour regular electricity

5. A functioning client latrine

Numerators:

Number of health facilities that have individual items for provision of inpatient services for HIV-infected clients

Number of health facilities that have all items for provision of inpatient services for HIV-infected clients

Denominators:

Total number of health facilities

Total number of health facilities providing inpatient care for HIV-infected clients

Note:

Regular availability of electricity is defined as a facility where during the prior one week there was no break in electricity for 2 or more hours (and the facility reports they routinely have electricity or there is a back-up generator with fuel).

Remark

WHO indicator

CST6e: Conditions to support homecare services

Definition

Percentage of health facilities that support home care services or have explicit referral systems for homecare services for HIV-infected or terminally ill clients

Purpose

To assess progress on availability of capacity to support homecare services

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Health facilities are randomly selected and then, either

a. The provider indicate that the facility provides homecare services

Or

b. A written document that identifies a location where homecare services can be obtained is observed in the service area

Or

c. A written referral form is observed and the provider can name a location where clients are referred for homecare services

Numerators:

a, b, or c

Denominators:

Total number of health facilities

Total number of health facilities providing HIV-related care services

Remark

WHO indicator

CST6f: System and items for providing post-exposure prophylaxis

Definition

Percentage of health facilities where post-exposure prophylaxis (PEP) is provided and all items to support the service are available

Purpose

To assess progress on availability of capacity to provide post-exposure prophylaxis

Measurement tool

Health facility survey

Frequency

Every 3 years

Responsible body

MoH/HAPCO

Method of measurement

Health facilities are randomly selected and assessed whether they have the following:

1. Facilities offering PEP

i. Observed written protocol for PEP in the service area where PEP is offered

ii. A register or record that indicates PEP services

iii. A system to monitor clients receiving PEP for full compliance with the regime

iv. Country specific PEP ARV available on the day of the survey

v. Number of facilities where the ARV for PEP is kept in a locked storage unit apart from other HIV ART services and maintained solely for PEP

2. Facilities referring for PEP

i. Observed written protocol for PEP in the service area or department

ii. A register or record that indicates referral for and receipt of PEP

iii. A system to monitor personnel receiving PEP

Numerators:

Number of health facilities that have individual items for the provision of PEP

Number of health facilities that have all items for the provision of PEP

Denominators:

Total number of health facilities

Total number of health facilities that report they provide or refer for PEP

Remark

WHO indicator


CST6a: Systems and items for management of OIs and for palliative care
Definition	Percentage of health facilities that have the capacity to support advanced clinical management of HIV/AIDS-related OIs and other illnesses and symptoms
Purpose	To assess progress on availability of advanced level HIV/AIDS care for PLWHA
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. Drugs for advanced treatments for OIs and other HIV-related illnesses: OIs: i. Cryptococcus fungal infections (e.g., fluconazole or amphotericin B) ii. Respiratory infections (e.g., acyclovir or ciprofoxacin or ceftriaxone or gentamycin) iii. Other infections (e.g., procaine penicillin or amoxil) iv. Herpes infections (e.g., acylovir) v. Parasitic infections (e.g., cotrim or metronidazole or nalidixic acid) vi. Herpes ophthalmic infection (e.g., acyclovir ophthalmic) vii. Psychoneurologic disorders (e.g., dexamethasone, Phenobarbital, fansidar, and cotrimoxazol) Palliative symptomatic treatment viii. Relief of pain and neurologic symptoms (e.g., diazepam and prednisolin or dapsone, and oral morphine and codeine) ix. Fortified protein supplement Basic HIV/AIDS services x. All medicines for basic OIs and palliative symptomatic treatment and basic HIV/AIDS services (CST5e) 2. Diagnostic and laboratory capacity for advanced HIV care: i. Spinal tap kit ii. Laboratory capacity for: a. Culturing specimens b. Liver function tests c. Haematology (WBC count, Anemia test, platelet count, BUN and creatinine) d. India Ink Stain e. Gram Stain f. ELISA test for HIV Or A documented system for referral and receiving results for the above (a-f) including: a. Record or register where the referral and test result is included, and b. Indication of provision of test results or follow-up with patient Numerators: Number of health facilities that have individual items for the management of OIs and other HIV-related illnesses and symptoms Number of health facilities that have all individual items for the management of OIs and other HIV-related illnesses and symptoms Denominators: Total number of health facilities Total number of health facilities providing HIV/AIDS-related care services Note: If the laboratory or pharmacy is external to the facility, but has a formal agreement and is the designated laboratory or pharmacy for the facility, laboratory capacity and availability of medicines should be assessed in the external referral location.
Remark	WHO indicator


CST6b: Systems and items to support advanced services for HIV-infected clients
Definition	Percentage of health facilities with the capacity to support advanced care for HIV-infected clients
Purpose	To assess progress on availability of systems and items to support advanced services for HIV-infected clients
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement Method of measurement	Health facilities where HIV/AIDS clinical and psychological care is being provided are randomly selected and observed and health workers interviewed to assess the following: 1. Number of facilities with the following observed guidelines or protocols: i. Opportunistic infections ii. Provision of symptomatic palliative care iii. Paediatric care for HIV/AIDS iv. Care protocols for all HIV positive clients 2. Number of facilities where there is an observed record of a system for making individual client appointments 3. At least one provider in the facility has received structured training (either in-service or pre-service) during the prior 3 years where the indicated topic was addressed, and where that training is also related to the provider’s job: i. Psychological counseling for HIV ii. Treatment for OIs iii. Palliative care iv. Psychoneurologic disorders related to AIDS v. Pediatric AIDS 4. At least half of the interviewed providers of services for HIV positive clients in the facility were personally supervised during the prior 3 months Numerators: Number of health facilities that have individual items for advanced care for HIV-infected clients Number of health facilities that have all items for advanced care for HIV-infected clients Denominators: Total number of health facilities Total number of health facilities providing HIV/AIDS-related care services
Remark	WHO indicator


CST6e: Conditions to support homecare services
Definition	Percentage of health facilities that support home care services or have explicit referral systems for homecare services for HIV-infected or terminally ill clients
Purpose	To assess progress on availability of capacity to support homecare services
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement	Health facilities are randomly selected and then, either a. The provider indicate that the facility provides homecare services Or b. A written document that identifies a location where homecare services can be obtained is observed in the service area Or c. A written referral form is observed and the provider can name a location where clients are referred for homecare services Numerators: a, b, or c Denominators: Total number of health facilities Total number of health facilities providing HIV-related care services
Remark	WHO indicator


CST6f: System and items for providing post-exposure prophylaxis
Definition	Percentage of health facilities where post-exposure prophylaxis (PEP) is provided and all items to support the service are available
Purpose	To assess progress on availability of capacity to provide post-exposure prophylaxis
Measurement tool	Health facility survey
Frequency	Every 3 years
Responsible body	MoH/HAPCO
Method of measurement	Health facilities are randomly selected and assessed whether they have the following: 1. Facilities offering PEP i. Observed written protocol for PEP in the service area where PEP is offered ii. A register or record that indicates PEP services iii. A system to monitor clients receiving PEP for full compliance with the regime iv. Country specific PEP ARV available on the day of the survey v. Number of facilities where the ARV for PEP is kept in a locked storage unit apart from other HIV ART services and maintained solely for PEP 2. Facilities referring for PEP i. Observed written protocol for PEP in the service area or department ii. A register or record that indicates referral for and receipt of PEP iii. A system to monitor personnel receiving PEP Numerators: Number of health facilities that have individual items for the provision of PEP Number of health facilities that have all items for the provision of PEP Denominators: Total number of health facilities Total number of health facilities that report they provide or refer for PEP
Remark	WHO indicator