MONITORING OF ART

The purpose of monitoring patients on ART is to assess:

  • Response to ART and early detection of treatment failure
  • Side effects and toxicity
  • Adherence

The schedule of monitoring visits follow a pre-set calendar for the 1st one year after initiation of ART, i.e:

  • At 1, 2 and 3 months from start of ART
  • At 6, 9, 12 months

After 12 months from initiation of ART, the Differentiated Model of Care Delivery is followed, in which schedule and modalities of periodic checks are based on individual needs and characteristics of the patient.

The aim of this model is:

  • A client centered approach, so that stable patients have spaced checks and fast tracks drug pick ups
  • More efficient use of resources by avoiding overcrowding and long waiting times
  • More focus on unstable/complex patients

(Refer to MOH HIV/ART guidelines for more details).

TYPE OF
MONITORING
COMPONENTS
Clinical
Monitoring
  • Screen for and manage opportunistic
    infections (OI) and STI
  • Assess for pregnancy, and/or use or
    need of FP
  • Screen and manage co-morbidities
    including depression
  • Weight and nutritional assessement
  • Disclosure

For children and adolescents:

  • Growth and development, school
    attendance, behavioural issues, sexual
    awareness
Laboratory
Monitoring
Viral load

  • Is preferred method to monitor
    response to ART and treatment
    failure:
  • First VL: done at 6 months from
    initiation
  • In adults: annually thereafter if
    patient is suppressed (< 1000 copies/
    ml)
  • In children and adolescents < 19
    years: every 6 months if patient is
    suppressed
  • In pregnant women: at first ANC visit
    regardless of previous checks
  • If patients not suppressed: see
    algorithm below
CD4 monitoring

  • Recommended at baseline to screen
    for risk of opportunistic infections
  • In patients who are suppressed but are
    in clinical stage 3-4
  • In patients on prophylaxis for
    cryptococcus to inform decison on
    when to stop fluconazole
Other tests

  • According to clinical findings