5
d4T+3TC+ABC | |||||||||||||||
6 | AZT+3TC+ABC | ||||||||||||||
7 | 3TC+ABC+EFV | ||||||||||||||
8 | 3TC+ABC+NVP | ||||||||||||||
Treatment regimens other than the above regimens (clearly state the drug name of the treatment regimen and write 1 line for each patient) | |||||||||||||||
1 | |||||||||||||||
2 | |||||||||||||||
3 | |||||||||||||||
4 | |||||||||||||||
5 | |||||||||||||||
6 | |||||||||||||||
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Appendix 3 - Follow-up table of patient cohort maintaining ARV treatment after 12 months
For groups of patients who started ARV treatment from January to December of the year 2 years before the data collection year.
TT | For patients starting ARV treatment from January to December every year | Patient groups by month, from January to December yearly | |
Initial | At 12 months after starting treatment | ||
1 | Number of patients STARTING ARV treatment at the facility (Number of patients ORIGINAL) | ||
2 | Number of PATIENTS TRANSFERRED during the follow-up period | ||
3 | Number of patients TRANSFERRED during the follow-up period | ||
4 | ACTUAL number of patients to be monitored (Original + CT - CD) | ||
4.1 | Number of patients starting ART with first-line regimen | ||
4.2 | Number of patients starting ART with second-line regimen | ||
Data source: ARV TREATMENT BOOK Facility name:
5
Number of patients who are ALIVE AND STILL UNDER TREATMENT treatment, in which: | |||
5.1 | Number of patients who started on level 1 and continued on the same level 1 regimen as at baseline | ||
5.2 | Number of patients starting step 1 and having to change drugs in the step 1 regimen | ||
5.3 | Number of patients who started on line 1 and had to switch to line 2 | ||
5.4 | Number of patients who started level 2 and continued treatment | ||
6 | Number of patients who had to stop/discontinue treatment or not be examined | ||
7 | Number of deaths | ||
8 | Number of patients who dropped out of treatment (lost to follow-up) **** |
Note:
1. Details of patients who dropped out of treatment should be further clarified in Table 1.
3
2. How to cross-check data: (a) The result of Row 5 = Row 5.1+5.2+5.3+5.4; (b) The result of Row 5 + Row 6 + Row 7 + Row 8 must be equal
Line 4
145
Appendix 4 - Patients who have dropped out of treatment (patients who have not returned for a follow-up visit for 3 months)
or more)
(For patients who initiated ARV treatment during January to December of the year prior to the 2-year data collection year and dropped out within 12 months of treatment)
Data source: ARV TREATMENT BOOK + MEDICAL RECORD
OUTPATIENT
Facility Name: Date:
Collector Name:
TT
BN Code (only write the last 4 digits) | Start treatment ARV (Day/Month/ Year) | Last visit date | Last follow-up appointment date (according to doctor's appointment schedule) Doctor) | Reasons why patients abandon treatment | Date of return to ARV treatment (if any)(Date) /Month/Y (ah) | Note (Clearly state the medical record code if the patient returns) | |
1 | |||||||
2 | |||||||
3 | |||||||
4 | |||||||
5 | |||||||
6 |
Appendix 5: Re-examination on schedule (Choose a date in October every year as the original examination date and record the patient's examination dates and re-examination appointment dates for the next 2 follow-up visits after the original examination date)
Data source: OUTPATIENT RECORDS
If the doctor does not write the examination date and follow-up appointment date on the patient's medical record, write KR (Unknown) in the box.
respectively.
Facility Name: Date: Data Entry Person: Page No.:
TT | BN Code (only write the last 4 digits) | Original examination date in October of the year | First re-examination | Second check-up | ||
Examination date | Follow-up appointment date | Examination date | Follow-up appointment date | Examination date | ||
1 | ||||||
2 | ||||||
3 | ||||||
4 | ||||||
TT | BN Code (only write 4) last number) | Original examination date in October of the year | First re-examination | Second check-up | ||
Examination date | Follow-up appointment date | Examination date | Follow-up appointment date | Examination date | ||
26 | ||||||
27 | ||||||
28 | ||||||
29 | ||||||
Appendix 6 - Monitoring the continued availability of ARV treatment drugs
Data source: WAREHOUSE CARD + MEDICINE IMPORT/EXPORT NOTE
Facility Name: Date: Collector Name
decade:
ARV drugs are stored
in:
ARV drug name
Record the drug with inventory number = 0 in each month of the year (if any). | ||||||||||||
January | February | March | April | May | June | July | August | September | October | November | December | |
Note:
1. If the drug storage facility is in an even warehouseand retail warehouse , must collect information from both warehouses and suggest using 2 different pages.
2. In case at some point in the month the quantity of medicine is zero (0), clearly state the day when the quantity of medicine = 0 and the date of entering the number.
new medicine that month.
3. If there is no month in which the amount of medicine is zero (0) at the retail warehouse, there is no need to collect more at the
even stock
Appendix 7: Results of early warning of HIV drug resistance at 42 PKNT in 2010
TT
Base | Practice of prescribing drugs | Patient abandoned treatment | Maintain outline ARV level 1 | Re-examination on time | Continuous drug supply | |
1 | HIV Center Bac Giang | 100.0% | 6.9% | 76.5% | 86.3% | 12 |
2 | Ninh Binh HIV Center | 100.0% | 2.4% | 92.8% | 100.0% | 12 |
3 | Pho Yen Thai Nguyen | 100.0% | 0.0% | 84.2% | 100.0% | 12 |
4 | National Institute of Civil Engineering | 100.0% | 8.8% | 85.7% | 88.6% | 12 |
5 | National Children's Hospital | 100.0% | 4.7% | 87.1% | 95.7% | 12 |
6 | Dong Anh Medical Center | 100.0% | 0.0% | 98.9% | 99.1% | 12 |
7 | Tu Liem Medical Center | 100.0% | 2.8% | 90.1% | 95.3% | 12 |
8 | Dong Da Hospital | 100.0% | 5.7% | 79.2% | 95.6% | 12 |
9 | Hai Duong HIV Center | 100.0% | 15.0% | 71.7% | 89.0% | 12 |
10 | Viet Tiep Hospital Hai Phong | 98.9% | 4.9% | 79.5% | 91.6% | 12 |
11 | Le Chan Medical Center | 100.0% | 0.0% | 91.7% | 96.0% | 12 |
12 | Hai Phong Children's Hospital | 100.0% | 0.0% | 92.3% | 80.3% | 12 |
13 | Quang Ninh Provincial General Hospital | 100.0% | 9.4% | 81.7% | 99.3% | 12 |
14 | Uong Bi General Hospital | 100.0% | 1.0% | 90.6% | 100.0% | 12 |
15 | Thanh Hoa Provincial Hospital | 100.0% | 8.6% | 79.3% | 95.4% | 12 |
16 | HIV Center Hung Yen | 100.0% | 0.0% | 67.5% | 16.7% | 12 |
17 | Vinh Phuc HIV Center | 100.0% | 3.5% | 80.2% | 94.4% | 12 |
18 | Mai Son Hospital, Son La | 100.0% | 0.0% | 56.5% | 86.3% | 12 |
19 | Khanh Hoa HIV Center | 100.0% | 8.5% | 61.7% | 60.6% | 12 |
20 | Quang Nam Provincial Hospital | 100.0% | 0.0% | 78.1% | 84.4% | 12 |
21 | Dak Lak Provincial Hospital | 100.0% | 28.3% | 63.3% | 52.9% | 12 |
22 | Buon Ma Thuot | 100.0% | 0.0% | 100.0% | 51.9% | 12 |
23 | Hospital for Tropical Diseases | 100.0% | 5.62% | 87.9% | 98.0% | 12 |
24 | District 1 Medical Center | 100.0% | 7.36% | 83.7% | 89.6% | 12 |
25 | District 2 Medical Center | 100.0% | 2.91% | 82.9% | 89.9% | 12 |
26 | District 4 Medical Center | 100.0% | 8.06% | 74.4% | 84.6% | 12 |
27 | District 10 Medical Center | 100.0% | 3.29% | 85.4% | 84.1% | 12 |
28 | Binh Tan Medical Center | 100.0% | 8.33% | 84.2% | 97.2% | 12 |
29 | Binh Thanh Medical Center | 100.0% | 3.42% | 83.7% | 87.4% | 12 |
30 | Children's Hospital 1 | 97.4% | 6.77% | 76.7% | 100.0% | 12 |
31 | Children's Hospital 2 | 98.3% | 6.02% | 72.3% | 97.6% | 12 |
32 | Can Tho Provincial Hospital | 100.0% | 0.93% | 84.3% | 81.0% | 12 |
33 | An Giang General Hospital | 100.0% | 3.14% | 76.4% | 100.0% | 12 |
34 | Chau Phu, An Giang | 100.0% | 0.00% | 81.8% | 98.8% | 12 |
35 | Tan Chau, An Giang | 100.0% | 0.96% | 84.6% | 85.9% | 12 |
36 | Dong Thap Provincial Hospital | 100.0% | 8.33% | 76.0% | 82.2% | 12 |
37 | Rach Gia, Kien Giang | 100.0% | 13.19% | 65.9% | 73.0% | 12 |
38 | Kien Giang General Hospital | 100.0% | 19.44% | 69.4% | 75.3% | 12 |
39 | Tay Ninh Provincial Hospital | 100.0% | 7.32% | 68.3% | 67.9% | 12 |
40 | Dong Nai Provincial Hospital | 100.0% | 1.27% | 82.3% | 89.9% | 12 |
41 | Tien Giang Provincial Hospital | 100.0% | 0.00% | 76.9% | 100.0% | 12 |
42 | Ben Tre Provincial Hospital | 100.0% | 1.89% | 84.9% | 97.0% | 12 |
Shared | 99.9% | 5.4% | 82.5% | 90.2% | 12 |
Appendix 8: Results of early warning of HIV drug resistance at 42 PKNT in 2011
TT
Base | EWI 1: Practice single standard | EWI 2: Ratio disease rate multiply | EWI 3: First-line regimen retention rate | EWI 4: Ratio recurrence examination on time | EWI 5: Supply medicine | |
1 | HIV Center Bac Giang | 100.0% | 20.0% | 68.6% | 92.7% | 12 |
2 | Ninh Binh HIV Center | 100.0% | 0.0% | 79.5% | 96.3% | 12 |
3 | Pho Yen Thai Nguyen | 100.0% | 4.0% | 77.2% | 42.3% | 12 |
4 | National Institute of Civil Engineering | 100.0% | 0.9% | 89.5% | 75.8% | 12 |
5 | National Children's Hospital | 100.0% | 4.5% | 61.4% | 92.7% | 12 |
6 | Dong Anh Medical Center | 100.0% | 0.7% | 97.1% | 93.5% | 12 |
7 | Tu Liem Medical Center | 100.0% | 0.0% | 93.6% | 93.6% | 12 |
8 | Dong Da Hospital | 100.0% | 2.5% | 85.4% | 85.5% | 12 |
9 | Hai Duong HIV Center | 100.0% | 10.4% | 81.1% | 69.6% | 12 |
10 | Viet Tiep Hospital Hai Phong | 100.0% | 4.2% | 79.7% | 89.5% | 12 |
11 | Le Chan Medical Center | 100.0% | 0.0% | 97.4% | 96.3% | 12 |
12 | Hai Phong Children's Hospital | 100.0% | 0.0% | 93.1% | 74.0% | 12 |
13 | Quang Ninh Provincial General Hospital | 100.0% | 2.2% | 82.8% | 97.7% | 12 |
14 | Uong Bi General Hospital | 100.0% | 0.0% | 90.9% | 100.0% | 12 |
15 | Thanh Hoa Provincial Hospital | 100.0% | 0.0% | 86.4% | 80.8% | 12 |
16 | HIV Center Hung Yen | 100.0% | 2.8% | 75.0% | 96.8% | 12 |
17 | Vinh Phuc HIV Center | 100.0% | 1.4% | 76.4% | 100.0% | 12 |
18 | Mai Son Hospital, Son La | 100.0% | 4.9% | 83.3% | 76.1% | 12 |
19 | Khanh Hoa HIV Center | 100.0% | 14.3% | 55.1% | 62.6% | 12 |
20 | Quang Nam Provincial Hospital | 100.0% | 20.4% | 65.3% | 96.0% | 12 |
21 | Dak Lak Provincial Hospital | 100.0% | 3.2% | 77.4% | 47.0% | 12 |
22 | Buon Ma Thuot | 100.0% | 22.0% | 65.9% | 80.0% | 12 |
23 | Hospital for Tropical Diseases | 100.0% | 9.3% | 85.9% | 99.0% | 12 |
24 | District 1 Medical Center | 100.0% | 4.5% | 80.4% | 98.6% | 12 |
25 | District 2 Medical Center | 100.0% | 0.0% | 88.5% | 89.2% | 12 |
26 | District 4 Medical Center | 100.0% | 8.0% | 82.4% | 84.6% | 12 |
27 | District 10 Medical Center | 100.0% | 6.4% | 79.8% | 94.3% | 12 |
28 | Binh Tan Medical Center | 100.0% | 6.8% | 79.5% | 88.3% | 12 |
29 | Binh Thanh Medical Center | 100.0% | 6.8% | 82.6% | 76.0% | 12 |
30 | Children's Hospital 1 | 100.0% | 4.9% | 81.7% | 86.3% | 12 |
31 | Children's Hospital 2 | 100.0% | 7.1% | 78.6% | 97.1% | 12 |
32 | Can Tho Provincial Hospital | 100.0% | 1.7% | 78.6% | 90.0% | 12 |
33 | An Giang General Hospital | 100.0% | 5.7% | 77.1% | 99.2% | 12 |
34 | Chau Phu, An Giang | 100.0% | 2.4% | 83.5% | 81.3% | 12 |
35 | Tan Chau, An Giang | 100.0% | 3.4% | 72.4% | 97.3% | 12 |
36 | Dong Thap Provincial Hospital | 100.0% | 2.0% | 76.0% | 89.1% | 12 |
37 | Rach Gia, Kien Giang | 100.0% | 15.8% | 73.7% | 73.0% | 12 |
38 | Kien Giang General Hospital | 100.0% | 24.5% | 71.7% | 87.0% | 12 |
39 | Tay Ninh Provincial Hospital | 100.0% | 6.0% | 85.1% | 73.8% | 12 |
40 | Dong Nai Provincial Hospital | 100.0% | 5.1% | 78.6% | 90.0% | 12 |
41 | Tien Giang Provincial Hospital | 100.0% | 2.7% | 89.2% | 87.5% | 12 |
42 | Ben Tre Provincial Hospital | 100.0% | 1.4% | 84.1% | 94.0% | 12 |
Overall results | 100.0% | 5.8% | 82.1% | 86.8% | 12 |