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Objectives

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  1. Orientation to data collection processes and inaugural quarterly discussion of latest data on ICAP programs MER April 25 2007 ICAP quarterly data meeting

  2. Review and discuss the process of data collection, cleaning, analysis and dissemination in NY and in-country Share latest data on ICAP supported programs across 14 countries Discuss how data are or can be used for program improvement Discuss format of future ICAP quarterly data meetings Objectives

  3. Unified Reporting System (URS) Site Census Program and Facility Characteristics Tracking System (P-FaCTS) Care and treatment data PMTCT(+) data TB/HIV data Patient-level data Open discussion Outline

  4. ICAP/CU-supported countries

  5. Need to capture standard donor and ICAP indicators on the scale and quality of ICAP-supported programs on a quarterly basis. Care & treatment: 166 indicators (203 of 222 sites reporting as of 4/07) PMTCT+: 37 indicators (105/115 sites reporting as of 04/07) TB/HIV: 22 indicators (not yet started, expected from 141 sites) Testing & counseling, infant diagnosis, adherence support in the works Programs are expanding, diversity of programming is expanding Need for more indicators?! ICAP supports an estimated 694 programmatic activities at 260 facilities in 14 countries (2.7 activities per site)

  6. What: Central reporting system that utilizes a web-based application for capturing and disseminating data on multiple ICAP-supported activities and programs Purpose: To streamline, standardize, and increase the efficiency and utilization of routinely collected data by any ICAP staff member Unified Reporting System (URS)

  7. Data collection URS structure Data processing Data entry QA Outputs Web components Datasets Data checks & cleaning Donor/MOH reports Canned/ ad hoc reports Maps Detailed analyses

  8. What: Real-time inventory of all planned, current, and closed ICAP sites. Supported activities, funding source(s) and their targets are also captured Purpose: To have one up to date master list of sites, activities and targets that all ICAP staff can refer to for planning and evaluation Site Census module

  9. Number of ICAPsupported sites by activity, March 2007 Source: ICAP Site Census, March 2007

  10. Number ofICAP-supported sites by country, March 2007 (n=274) Source: ICAP Site Census, March 2007

  11. What: Collects program and facility information on ICAP-supported care and treatment programs semi-annually Purpose: To describe the scope, diversity, and comprehensiveness of ICAP-supported care and treatment programs, and evaluate multi-level factors that influence program performance and patient-level outcomes Program and Facility Characteristics Tracking System (P-FaCTS) module

  12. P-FaCTS nomenclature and examples of information collected

  13. Location and type of ICAP-supported care and treatment facilities (n=162) Source: P-FaCTS January 2007

  14. Availability and comprehensiveness of on-site services at ICAP-supported care and treatment facilities (n=162) Source: P-FaCTS January 2007

  15. Availability and comprehensiveness of patient support services at ICAP-supported care and treatment facilities (n=162) Source: P-FaCTS January 2007

  16. Availability and comprehensiveness of on-site laboratory services at ICAP-supported care and treatment facilities (n=162) Source: P-FaCTS January 2007

  17. Number of providers per 1000 patients on ART at ICAP-supported care and treatment facilities (n=162)) Source: P-FaCTS January 2007

  18. Care and treatment programs vary in comprehensiveness of services offered Activities and components of ICAP-supported care and treatment programs are dynamic, therefore necessary to conduct routine surveys PFaCTS data can be used in conjunction with program data for program planning and evaluation P-FaCTS summary

  19. Care and treatment

  20. Number of ICAP-supported care and treatment sites by country, March 2007 (n=222) Source: ICAP Site Census, March 2007

  21. Pre-ART and ART care enrollment by age, sex and pregnancy status CD4 count for ART patients (baseline, 6 and 12 months) ART regimens by age ART discontinuation and reasons Number of trainings on ART and palliative care Care and treatment aggregate indicators received onquarterly basis by facility (currently 209/222 in 10 countries)

  22. Care and treatment indicator collection and submission CDC-Atlanta MER C&T Lead MER Liaison MER Liaison Program Review Data queries Data queries Manual data checks MER Data Analyst On-line reporting module (URS) Automated data checks Automated data checks USG M&E Officer USG M&E Officer Site A Site B Site A Site B M&E & Clinical staff M&E & Clinical staff

  23. In-country USG reporting Track 1.0 reporting (Atlanta) Dissemination of data for program evaluation and planning Summary tables and graphs By country and time period Slide set for presentations Important trends In-depth analyses Abstracts from Implementer and IAS meeting Uses of care and treatment data

  24. Example of quarterly summary data table – country over time

  25. Example of facility line list for each country

  26. Number of ICAP-supported care and treatment sites reporting by country, July 2004 – December 2006 (Total number of sites reporting = 165)

  27. Cumulative enrollment in HIV care (pre-ART and ART) & ART care at ICAP-supported sites, July 2004 - December 2006 HIV care (pre-ART and ART) Nigeria, Swaziland, Zambia added ART Care Ethiopia added Lesotho added Kenya Rwanda So. Africa Tanzania Mozambique added

  28. Cumulative pediatric enrollment in HIV care (pre-ART and ART) & ART care at ICAP-supported sites, July 2004 - December 2006 HIV care (pre-ART and ART) Nigeria, Swaziland, Zambia added ART Care Ethiopia added Lesotho added Kenya Rwanda So. Africa Tanzania Mozambique added

  29. Cumulative enrollment in ICAP-supported sites by ART status and country, July 2004 - December 2006 Total in care (n=185,903) ART care (n=87,746)

  30. Cumulative enrollment in pre-ART vs. ART care in ICAP-supported care and treatment sites by country as of December 2006* (Total in care = 185,903) N=23,908 N=13,056 N=21,616 N=4,417 N=26,532 N=22,746 N=3,118 N=59,079 N=11,431 *Swaziland data not available

  31. Cumulative enrollment in HIV care (pre-ART and ART) by age, sex and country at ICAP-supported sites as of December 2006 (Total in care = 185,903) *Swaziland data not available

  32. Cumulative enrollment on ART by age, sex and country at ICAP-supported sites as of December 2006 (Total on ART = 87,746)

  33. Mean number of patients enrolled in ICAP-supported care and treatment facilities

  34. Mean number of patients enrolled in ICAP-supported care and treatment facilities (and country variability)

  35. ART eligibility and initiation for patients receiving care at ICAP-supported care and treatment sites, October to December 2006 (Total received care during quarter = 127,943)

  36. ART regimens in adults and children at ICAP-supported sites October-December 2006 Adults 15+ (%) Children <15 (%) *In South Africa, d4T-3TC-LPV/r is also prescribed as a first-line regimen

  37. Average median CD4 count (cells/µL) at baseline and 6 and 12 months after ART initiation by country at ICAP-supported sites as of December 2006* *CD4 data not available for all ART patients. Data not available for Nigeria, Swaziland, and Zambia.

  38. Reasons for ART discontinuation at ICAP-supported sites as of December 2006

  39. Reasons for ART discontinuation by country at ICAP-supported sites as of December 2006* N=4 N=634 N=1241 N=1989 N=2,701 N=1,103 N=319 N=3,119 * Transfers not considered discontinuers

  40. Comparing results and targets

  41. ART patients in more comprehensive programs may have better follow-up care Median=74% Support activities include peer-educator program, outreach program nutritional support, adherence support Median=44% 1 or 2 activities 3 or 4 activities Source: Quarterly report data and PFaCTS, January 2007

  42. PMTCT/PMTCT-plus

  43. Number of ICAP/CU-supported pMTCT(+) sites, March 2007 (n=115) Source: ICAP Site Census, March 2007

  44. Developed list of 39 indicators (counseling and testing in ANC, prophylaxis to mother and infant, maternity, follow-up of exposed infant) 95 of 115 sites in 5 countries reported 4 key indicators (Oct-Dec 2006) Next round will include all 39 indicators Expect close collaboration and communication btwn M&E and PMTCT program staff PMTCT(+)Currently: 115 facilities in 5 countries

  45. Family focused care PMTCT is the entry point for HIV-infected women to access care and ART if eligible ANC testing is the first step of the process But need to go beyond that to ensure that: women are accessing care and treatment and; HIV-exposed infants receive follow-up ICAP model

  46. Women tested in ANC and received results95 ICAP-supported PMTCT sites, October-December, 2006

  47. Women receiving SD-NVP* in ANC 95 ICAP-supported PMTCT sites, October-December, 2006

  48. Provision of services to pregnant women in ICAP-supported PMTCT programs in Mozambique, Nigeria, Rwanda, Tanzania(February, 2005-September, 2006)

  49. Enrollment and outcomes from 20 UTAP supported PMTCT sites in Mozambique, 2006