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Registers and CentralisedReporting
SAHIVCS Conference 2018
Ruth Lancaster – NDoH
Herbert Musariri - CHAI
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Registers and CentralisedReporting
SAHIVCS Conference 2018
Ruth Lancaster – NDoH
Herbert Musariri - CHAI
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PROBLEM
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BACKGROUND
• 3rd line ART • Started 2013• Defined mandate• Centralised (-WC)• Algorithm-based decision making
• DRV; DTG; ETR• Captured on an Excel spreadsheet (“3rd line
database”)
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BACKGROUND
• DTG: HP13 Supplementary Contract (2017)
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DATABASES
• 3RD line database• 1 row = 1 application
0
100
200
300
400
500
600
2013 2014 2015 2016 2017
DRV DTG
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RSA Pharma database
PROCUREMENT
0
200
400
600
800
1000
1200
1400
1600
Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18
Dolutegravir 50mg tablets 30 tablets
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Drug consumptionPatient level data
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DATABASES
• 3RD line database• 1 row = 1 application• Non-3rd line mandate DTG use• Patient referrals
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DATABASES
Baseline – Jan-Feb 2016Intervention 1 – Mar-Dec 2016Intervention 2 – Jan-Apr 2017
Steegan. Active engagement between laboratory and
clinicians improves linkage to third-line antiretroviral
treatment
• 3RD line database• 1 row = 1 application• Non-3rd line mandate DTG use• Patient referrals
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DATABASES
Sheik. A third-line ART referral process in the
Western Cape Province , South Africa: Estimating
qualification and predictors of referral
Referral criteria (adults):• > 15 y• PI > 2 y• VL not suppressed x 3
Met criteria for referral
N=947
Actually referred
N=167
Met criteria and not referredN=905
Met criteria and referred
N=42
• 3RD line database• 1 row = 1 application• Non-3rd line mandate DTG use• Patient referrals
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DATABASES
• RSA Pharma database• Contract items• Procurement level data• Data inputted by suppliers• Monthly trends (orders/deliveries)
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METHODOLOGY
ATC/DDD
Data smoothing
Growth estimation
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METHODOLOGY
• Manually Fit Linear Growth Models (proForecaster)
ATC/DDD
Data smoothing
Growth estimation
0
200
400
600
800
1,000
1,200
1,400
1,600
Dolutegravir 50mg tablets 30 tablets
Observations Adjusted consumption
RSA Pharma database
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METHODOLOGY
• Defined Daily Dose:
ATC/DDD
Data smoothing
Growth estimation
Assumed average maintenance dose per day
for a medicine used for its main indication in
Adults
Uses:
• Technical measurement that allows
measurement and comparison of volume of
medicine use
• Rough estimate of consumption, not an
exact picture of actual use
ATC StrengthStrength
UnitPackSize
Pack SizeUnit
DDDDDDUnit
Prescriptiondays/month
Dolutegravir 50mg tablets 30 tablets
J05AX12 50 mg 30 tablet 50 mg 30
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METHODOLOGY
ATC/DDD
Data smoothing
Growth estimation
0
200
400
600
800
1,000
1,200
1,400
1,600
Observations Adjusted consumption Patient numbers per month based on DDD
• Estimated patient numbers(linear growth)
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RESULTS
0
200
400
600
800
1,000
1,200
1,400
Patient numbers
Dolutegravir-Consumption Data (-WC) Dolutegravir 3L Database (-WC)
Dolutegravir-Consumption Data (+WC)
Patient growth estimation
HP13 Supplementary
Contract
RSA Pharma database launched
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RALTEGRAVIR?
0
200
400
600
800
1000
1200
1400
Patient numbers
Dolutegravir (Consumption Data) Dolutegravir (3L Database)
Raltegravir (Consumption Data) Raltegravir (3L Database)
RSA Pharma database launched
HP13 Supplementary
Contract
Patient growth estimation
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RESULTS (RAL DTG)
0
200
400
600
800
1000
1200
RAL --> DTG Switch Rate 10%
Dolutegravir (3L Database) Raltegravir (3L Database)
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CONCLUSION
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Herbert Musariri (Clinton Health Access Initiative)
CO-AUTHOR