AMPATH pMTCT

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Last updated: Aug 18, 2010Version comment

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This is an attempt to describe/organize the pMTCT project for implementation into OpenMRS. Please feel free to edit and add comments to this!

Project Goals

The purpose of using the AMRS to track the process of pMTCT is to better manage and follow our HIV+ pregnant women. This will be used in a clinical capacity to effectively treat our patients and to better monitor and evaluate our program, though it also allows for some amazing research opportunities.

Primarily, we want to know:

  • Of all the pregnant women who came into our ANC clinic, how many:
    • were tested and counseled
    • were positive
  • Of those who were positive how many were enrolled in AMPATH
  • Of those enrolled in AMPATH, how many delivered in our hospital
  • Of those mothers who delivered or returned after delivery at home how many women used formula and following formula or breastfeeding what is the serostatus of the child.

Getting these women into the system and being able to track their treatment effects entire families as PMTCT becomes the entry point to care for mothers, children and their partners. This is a really exciting process for us!

Workflows for entry points into system

Antenatal / pMTCT Clinics

  • Pregnant woman’s first visit:
  1. Initially presents to antenatal clinic (ANC):
    • Weight, blood pressure
    • Palpation
    • If found to be pregnant, patient referred to PMTCT clinic
  2. Presents to PMTCT clinic
    • Counseled
    • Tested
    • Post-test counseled
    • Outreach worker fills tracer card (locator)
    • If HIV-, goes to doctor
    • If HIV+, escorted to AMPATH Module 1
    • During counseling the mother is encouraged to have her spouse tested, many times the spouse or partner will come in over the weekend with the mother when he is free to be tested and they look in the log book by PMTCT# and record ‘spouse tested’ and ‘results’.
  • HIV+ pregnant woman’s second ANC visit:
  1. Presents to ANC for normal palpation
  2. If AMPATH clinic day is the same day she goes to AMPATH. Otherwise she returns home.
  3. Unless a mother complains to the doctor of potential complications like STIs, she may return to the side lab located here in PMTCT. Otherwise the entire maintenance of the HIV+ mother is handled in AMPATH and ANC.

Maternity Ward

  • Women presenting to the maternity ward are a mixture of patients: some women have presented to ANC, but have not been tested, some women have presented to PMTCT (tested and counseled) and were enrolled in AMPATH and then others are presenting for the very first time only to deliver.
  1. Woman is identified as AMPATH or ANC client
    • Serostatus recorded in register
  2. If status is unknown and there is time, the woman is counseled and tested
    • If status is positive, woman and baby are given NVP
    • Some clinics offer universal NVP (if status is unknown, administer NVP)
  3. Following delivery, if the woman still has not been tested, she will be counseled and tested
  4. For those women who have elected to formula feed their infants, preparation is demonstrated and formula given.
  5. For those women testing positive in maternity, they will be escorted by the ‘locator person’ to the AMPATH clinic. In smaller clinic settings, the maternity nurse will ensure the mother passes through AMPATH.

Data Collection

Definitions

  1. ANC #: antenatal clinic number: corresponds to ?
  2. BIO #: (the bun-in-oven number (smile)): corresponds to the specific pregnancy for the mother. Each mother can have one or more BIO#s, corresponding to each pregnancy
  3. AMPATH ID: if mother has been seen in the AMPATH system

    pMTCT Log Book

  • Our PMTCT log book (essentially a PMTCT counseling log book) is capturing only information related to a pregnant woman’s first visit.
  • The ANC #, the BIO# (TBD) and AMPATH # are captured creating our first data ‘link’.
  • For questions addressing partner’s testing status and serology, we are thinking of providing a free testing card to the mother that the male can return with. The card will have the mother’s ANC number on it and partner status can be recorded in a separate book identifying the mother’s ANC# and assignment of the partner’s AMPATH# if positive creating another data ‘link’. (Note: this would probably not be part of the medical records system – just thinking this through…).

    Maternal Log Book

  1. Our maternity log book captures ANC#, AMPATH#, testing status, serology, meds given, baby’s birth date and sex, referral to AMPATH and the mother’s next clinic appointment date.
  2. Our formula book captures mother’s AMPATH# and child’s AMPATH# (data link) along with child’s DOB to monitor length of time on formula and amount of formula given.
  3. Any other information related to an HIV+ mother or her infant is captured in the adult or peds encounter forms tied to an AMPATH number. Therefore, hopefully we can truly follow a mother and child through her treatment and through our system by use of the AMPATH numbers.

Outcomes

ANC / pMTCT Clinics

  • # pg women counseled
  • # pg women tested
  • # of tracer cards filled
  • # of HIV + women
  • # of pg women enrolled in AMPATH
  • # partners tested

    Maternity Ward

  • # booked (already enrolled) women counseled and tested
  • # unbooked (never enrolled) women counseled and tested
  • # women given NVP
  • # infants given NVP
  • # women given triple therapy
  • # of live births
  • # of still births
  • # of unbooked patients referred to AMPATH.
  • # mothers/infants using formula
  • length of time infant has been using formula
  • dates a mother came to pick up formula
  • mother/child pairs.

Implementation

  • What we established in the conference call was that for those women who test negative in the ANC, or for those women who test positive but do not immediately receive an AMPATH #, the data will be stored in a flat table.
  • Once an AMPATH# is assigned to a patient in the table the data will be 'pushed' to the AMRS.
  • To ensure the linkage of a pregnant mother from the ANC clinic to the PMTCT clinic to the AMPATH clinic we will give the mother a card with a BIO # (name TBD).
  • Changes to make to forms:
  1. Add BIO# column to PMTCT log
  2. Add BIO# column and update drugs on Labor and Delivery log
  3. Add ANC#, BIO#, mother's name and DOB to Formula log
  4. Add ANC# and change WHO staging criteria to adult encounter form

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