ART REGISTERExercise 1 Kunjungan bulanan: ● 1st row, write patient outcome: on

treatment (OT) if patient picked up ART drugs; stopped (ST) if

ART was stopped by the doctor; missing (MIS) if the patient
missed the scheduled visit; lost to follow-up (LFU) if the patient
Status fungsional Obat substitusi lini 1 is missing for ≥3 months; restart (RS) if ART was restarted after
TGL mulai CD4 Paduan ART an interruption; transferred out (TR); dead (D); (NA) if the
1-kerja; (juml absolut utk dewasa patient was not scheduled to visit this month ● 2nd row: write
ART 2-Ambulatori;
dan % utk anak)
saat mulai Tgl Mg
adherence Bln
for 1the patients on Bln ( A=>95%,
treatment Bln Bln Bln
B=80-95%,
3-Baring Alasan Rejimen baru ke2
Bln Bln 2
substitusi C=<80%) 3 4 5 6 7
1 2-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

B A 170 190 T T T T T T T
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
2 7-Dec-05 At start of Rx At 6 months At start of Rx At 6 months
d4T+3TC+EFV
C B 150 210 5-Jan-05 T T T T T T T
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
3 9-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

C B 80 180 T T T ST RS/T T T
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
4 14-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

B A 120 190 T T T T T T T
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
5 15-Dec-05 At start of Rx At 6 months At start of Rx

B B 100 T T T A A GFU GFU

At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
6 19-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

C B 170 220 T T T T T T T
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
7 20-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

B A 190 310 T T T T T T T
At 12 months At 24 months At 12 months At 24 months

ZDV+3TC+NVP
8 20-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

B A 150 190 T T T T T T T
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
9 22-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

B A 30 T T M M M M M
At 12 months At 24 months At 12 months At 24 months

d4T+3TC+NVP
1 27-Dec-05 At start of Rx At 6 months At start of Rx At 6 months

0 A A 160 220 T T T T T T T
27-Dec-05

At 12 months At 24 months At 12 months At 24 months

d4T+3TC+EFV
 Nama RS: ………………………………….

Untuk kohort yang memulai ART menurut

bulan/tahun: pada awal terapi kemudian hasilnya
setelah 6 bulan dengan ART, 12 bulan dengan ART, Cohort bl 6- bl 12- bl 24- Cohort bl 6-
24 bulan dengan ART Oct 04 Apr 05 Oct 05 Oct 06 Nov 04 May 05

M Mulai ART di klinik ini - kohort orisinal

RM Rujuk Masuk

RK Rujuk Keluar
S Jumlah kohort sekarang

H Dengan rejimen lini pertama orisinal

I Dengan rejimen lini pertama lain (Substitusi)

J Dengan rejimen lini ke-2 (Swtich)

Stop

Meninggal dunia

Gagal Follow-up
Proporsi kohort yang hidup dan dengan ART

[ (H + I + J) / N * 100 ]

Proporsi CD4 > 200

Status fungsional

A Proporsi Kerja

B Proporsi Ambulatori

C Proporsi Berbaring

Jumlah orang yang mengambil ARV setiap

bulan selama 6 bulan x x x x
Jumlah orang yang mengambil ARV setiap
bulan selama 12 bulan x x x x x
Jumlah orang yang mengambil ARV setiap
X
bulan selama 24 bulan
 LAPORAN KOHORT
mengenai dampak pengobatan ARV
kohort ditetapkan menurut bulan tahun ketika
mereka memulai ART
kohort ditetapkan menurut bulan tahun ketika dilanjutkan untuk masing2 kohort bulanan
mereka memulai ART
dilanjutkan untuk masing2 kohort bulanan

bl 12- bl 24- Cohort bl 6- bl 12- bl 24-

Nov 05 Nov-06 Dec 04 Jun 05 Dec 05 Dec 06

10 10
x 0
x 0
10 10
7
1
0
0
1
1

8/10
0/10 4/8

1/10 4/8

6/10 4/8

3/10 0/8

x x x 8 x x
x x x x
X X X X X
X X X X