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

Orientation to data collection processes and inaugural quarterly discussion of latest data on ICAP programs

MERApril 25 2007ICAP quarterly data meeting

Objectives

• 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

Outline

• 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

ICAP/CU-supported countries

ICAP supports an estimated 694 programmatic activities at 260 facilities in 14 countries (2.7 activities per site)

• 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?!

Unified Reporting System (URS)

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

URS structure

GIS

Patient level data

Other indicators, as appropriate Testing &

counseling

indicators

Care &

treatment

indicators

TB/HIV

indicators

pMTCT

indicators

P-FACTS

Site Census

CIEISIN

Donor/MOH

reports

Maps

Web components

Data

processingOutputs

Datasets

Data checks &

cleaning

QA

Canned/ ad

hoc reports

Data entry

Data collection

Detailed

analyses

Site Census module

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

222

115141

103 108

274

0

50

100

150

200

250

300

Care &treatment

pMTCT TB/HIV Testing &counseling

Lab support Total

Type of activity

Nu

mb

er o

f si

tes

Source: ICAP Site Census, March 2007

Number of ICAPsupported sites by activity, March 2007


Number of ICAP-supported sites by country, March 2007 (n=274)

Program and Facility Characteristics Tracking System (P-FaCTS) module

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

Context:

(e.g., Washington Heights, NYC)

Urban/rural, adult and antenatal HIV prevalence, TB incidence

Site:

(i.e., CU Presbyterian Hosp)

Services: e.g., pMTCT, labor and delivery, TB, VCT

Characteristics: Type, catchment population, number of beds

Facility:

(i.e., an HIV clinic within the site)

Physical plant: e.g., # exam rooms, area of facility

Programmatic: e.g., patient support groups, nutritional support, adherence support

Staffing: # of physicians, nurses, counselors, pharmacists

Laboratory: CD4, HIV RNA, infant diagnosis, liver function test

P-FaCTS nomenclature and examples of information collected

0%

20%

40%

60%

80%

100%

Urban Rural

Primary Secondary Tertiary

Location and type of ICAP-supported care and treatment facilities (n=162)

Source: P-FaCTS January 2007

9489

8386

0

20

40

60

80

100

pMTCT VCT TB ART pharmacy

%

2 services, 6%

3 services, 26%

4 services, 65%

1 service, 3%

Availability and comprehensiveness of on-site services at ICAP-supported care and

treatment facilities (n=162)


1 service, 5%

2 services, 38%

3 services, 36%

4 services, 21%

Availability and comprehensiveness of patient support services at ICAP-supported care and

treatment facilities (n=162)

99 93

30

50

0

20

40

60

80

100

Adherencesupport

Nutritionalsupport

Peer-educator

Outreach

%


40 35

10 12

60 60

0

20

40

60

80

100

%

Availability and comprehensiveness ofon-site laboratory services at ICAP-supported care

and treatment facilities (n=162)


4

0 1 2

5

1 0

65

13

2426

8

2

7 6

12

8

51

17

0

10

20

30

40

50

60

Ethiopia Kenya Lesotho Mozambique Nigeria South Africa Tanzania

pe

r/1

00

0 p

atie

nts

on

AR

T

Physicians Nurses Other staff

Number of providers per 1000 patients on ART at ICAP-supported care and treatment facilities (n=162))


P-FaCTS summary• 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

Care and treatment

4137

35

2925

21

13

85

2 2 1 2 10

5

10

15

20

25

30

35

40

45

South

Afri

ca

Rwanda

Ethio

pia

Kenya

Moza

mbiq

ue

Tanza

nia

Swazila

nd

Niger

ia

Lesot

ho

Uganda

Zambia

Thaila

nd

Cote

d'Ivoire

Camer

oon

Number of ICAP-supported care and treatment sites by country, March 2007 (n=222)


Care and treatment aggregate indicators received onquarterly basis by facility (currently 209/222 in 10 countries)

• 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 indicator collection and submission

M&E Officer M&E Officer

On-line reporting module (URS)

MER Data Analyst

Automated

data checks

Site B Site ASite A Site B

Automated

data checks

Manual data checks

MER Liaison MER LiaisonMER C&T Lead

CDC-AtlantaCDC-Atlanta

Data queries

Data queries

M&E & Clinical staff

Program Review

M&E & Clinical staff

USGUSG USGUSG

Uses of care and treatment data

• 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

Mozambique

Number of sites reporting

Cumulative enrollment in HIV care

Mean number of patients enrolled in HIV care per site

MinimumMaximum

Cumulative enrollment in HIV careWomen 15+ 3051 51% 6537 54% 8431 54% 14946 55% 18531 55% 23189 55% 27234Men 15+ 1648 28% 3874 32% 4865 31% 9278 34% 11562 34% 14315 34% 16684Children <15 1251 21% 1801 15% 2450 16% 3165 12% 3907 11% 4825 11% 5699

ART 1033 17% 1262 10% 2310 15% 5745 21% 7993 24% 10347 24% 13152Non-ART care 4917 83% 10950 90% 13436 85% 21644 79% 26007 76% 31982 76% 36465

Table 2: Characteristics of patients on ART at ICAP-Supported Sites in Mozambique by QuarterMozambique

Cumulative enrollment on ART

Mean number of patients enrolled in ART care per site

MinimumMaximum

Cumulative enrollment on ART Women 15+ 466 45% 539 43% 1068 46% 2875 50% 4091 51% 5320 51% 6817Men 15+ 343 33% 415 33% 783 34% 2246 39% 3087 39% 3951 38% 4956Children <15 224 22% 308 24% 459 20% 624 11% 815 10% 1076 10% 1379

On ART as of Dec 31, 2006Women 15+ 456 45% 481 41% 1014 46% 2789 50% 3911 52% 4965 52% 5901Men 15+ 335 33% 405 34% 745 34% 2156 39% 2894 38% 3598 38% 4142Children <15 214 21% 293 25% 440 20% 618 11% 784 10% 956 10% 1256

2531 2880 3262449 299 505 2092

571 739 598106 82 6 8 4 44 15207 210 231 479

J AN-MAR 06 APR-JUN 06 JUL-SEP 06

1033 1262 2310 5745 7993 10347 13152

J AN-MAR 05 APR-JUN 05 JUL-SEP 05 OCT-DEC 05

114 22 453453 4428 5470 6677 7829 8917 9485148 650 56 189

34000 42329 49617

992 2035 1431 2282 2429 2822 2255

5950 12212 15746 27389

JAN-MAR 06 APR-JUN 06 JUL-SEP 06

6 6 11 12 14 15 22

JAN-MAR 05 APR-JUN 05 JUL-SEP 05 OCT-DEC 05

Example of quarterly summary data table – country over time

Example of facility line list for each country

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

Ethiopia

Kenya

Mozambique

Nigeria

Rwanda

Tanzania

ZambiaLesotho

South Africa

Swaziland

0

5

10

15

20

25

30

35

Jul-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun2006

Jul-Sep2006

Oct-Dec2006

Nu

mb

er

of

Sit

es

Re

po

rtin

g

9259 1008917221

26331

45986

58406

72357

87746

5517

22018

36496

52168

74551

97144

124253

146470

185903

2494

4071

73440

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

Jul-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun2006

Jul-Sep2006

Oct-Dec2006

Quarter

Nu

mb

er o

f p

atie

nts

Kenya Rwanda

So. Africa Tanzania

HIV care (pre-ART and ART)

ART Care

Mozambique added

Ethiopia added

Nigeria, Swaziland, Zambia added

Cumulative enrollment in HIV care (pre-ART and ART) & ART care at ICAP-supported sites, July 2004 - December 2006

Lesotho added

Cumulative pediatric enrollment in HIV care (pre-ART and ART) & ART care at ICAP-supported sites, July 2004 - December 2006

2958

4153

5566

6875

9509

13322

16398

19955

353753 1060

15522041

4382

5553

6730

8000

567 10542000

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Jul-Sep 2004 Oct-Dec 2004 Jan-Mar 2005 Apr-Jun 2005 Jul-Sep 2005 Oct-Dec 2005 Jan-Mar 2006 Apr-Jun 2006 Jul-Sep 2006 Oct-Dec 2006

Nu

mb

er

of

pa

tie

nts

Kenya Rwanda

So. Africa Tanzania

HIV care (pre-ART and ART)

ART Care

Mozambique added

Ethiopia added

Lesotho added

Nigeria, Swaziland, Zambia added

Total in care (n=185,903) ART care (n=87,746)

Cumulative enrollment in ICAP-supported sites by ART status and country, July 2004 - December 2006

Ethiopia

Kenya

Lesotho

Mozambique

Nigeria

Rwanda

South Africa

Tanzania

Zambia

0

20000

40000

60000

80000

100000

120000

140000

160000

180000

Jul-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun

2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun

2006

Jul-Sep2006

Oct-Dec2006

Nu

mb

er o

f p

atie

nts

Ethiopia

Kenya

Lesotho

Mozambique

Nigeria

Rwanda

South Africa

Swaziland

Tanzania

Zambia

0

10000

20000

30000

40000

50000

60000

70000

80000

90000

100000

Jul-Sep2004

Oct-Dec2004

Jan-Mar2005

Apr-Jun

2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar2006

Apr-Jun

2006

Jul-Sep2006

Oct-Dec2006

Nu

mb

er o

f p

atie

nts

56%49% 49% 48% 46% 44% 41%

28% 26%

44%51% 51% 52% 54% 56% 59%

72% 74%

0%

20%

40%

60%

80%

100%

Pre-ART

ART

N=23,908 N=13,056 N=21,616 N=4,417 N=26,532 N=22,746 N=59,079

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=3,118 N=11,431

*Swaziland data not available

0

10000

20000

30000

40000

50000

60000

Mozambique Kenya South Africa Rwanda Ethiopia Tanzania Lesotho Nigeria Zambia

Nu

mb

er

of

pa

tie

nts

Children <15

Men 15+

Women 15+

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

Cumulative enrollment on ART by age, sex and country at ICAP-supported sites as of December 2006

(Total on ART = 87,746)

0

2000

4000

6000

8000

10000

12000

14000

16000

Mozambique Kenya Swaziland Ethiopia Rwanda South Africa Tanzania Lesotho Nigeria Zambia

Nu

mb

er

of

pa

tie

nts

Children <15

Men 15+

Women 15+

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

683

1895

2462

631769 758 768

1105

386

865700

306 375 335 376 461

0

500

1000

1500

2000

2500

3000

Mea

n N

umbe

r of

Pat

ient

s P

er S

ite

HIV Care ART

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

683 1895 2462 631 769 758 768 1105386 865 700 306 375 335 376 4610

2000

4000

6000

8000

10000

12000

Ethio

pia

Kenya

Moza

mbiq

ue

Niger

ia

Rwanda

South A

frica

Tanza

nia

Overa

ll

Me

an

Nu

mb

er

of

Pa

tie

nts

Pe

r S

ite

HIV Care ART

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)

18%

10% 9% 4%2%

0%

0%0%

20%

40%

60%

80%

100%

Nigeria South Africa Kenya Tanzania Mozambique Ethiopia Lesotho Rwanda

Eligible, started ART Eligible, Not receiving ART Not Eligible

ART regimens in adults and children at ICAP-supported sites October-December 2006

Ethiopia Kenya Mozambique Nigeria Rwanda South Africa Tanzania Overall

N=9,643 N=5,405 N=11,146 N=769 N=7,493 N=7,617 N=4,766 N=46,839

d4T-3TC-NVP 53 78 77 46 46 9 80 56

d4T-3TC-EFV 20 8 10 1 9 86 4 24

ZDV-3TC-NVP 19 3 3 49 29 1 10 11

ZDV-3TC-EFV 8 1 4 4 13 2 6 6

2nd line regimen

0 3 6 0 2 1 0 2

Unknown 0 5 0 0 2 0 0 1

Ethiopia Kenya Mozambique Nigeria Rwanda South Africa Tanzania Overall

N=514 N=460 N=616 N=10 N=754 N=981 N=319 N=3,644

d4T-3TC-NVP 19 58 50 100 48 26 5 29

d4T-3TC-EFV 6 17 4 0 9 62 3 22

ZDV-3TC-NVP 69 12 43 0 26 2 72 30

ZDV-3TC-EFV 4 2 1 0 16 15 8 9

Other* 0 0 0 0 0 14 0 4

2nd line regimen

1 2 3 0 1 18 12 7

Unknown 0 10 0 0 1 0 0 2

Adults 15+ (%)

Children <15 (%)

*In South Africa, d4T-3TC-LPV/r is also prescribed as a first-line regimen

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*

108119

104

178191

117136 136

264277

305

335

294278

300 308 300

246256

268

290304

223

260

0

50

100

150

200

250

300

350

400

Ethiopia Kenya Lesotho Mozambique Rwanda South Africa Tanzania Overall

CD

4 ce

ll co

un

t

Baseline CD4 6-month CD4 12-month CD4

*CD4 data not available for all ART patients. Data not available for Nigeria, Swaziland, and Zambia.

Stopped ART, 4%

Died, 33%

Unknown/LTF, 64%

Reason for Discontinuation

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

Continued ART, 76,529,

87%

Discontinued, 11,217, 13%

100%

72%

47%38%

32% 30%

13%

5%

6%

0% 8%

14%

49%55%

68% 63%

22% 18%

1%

0

0%

77%

0

82%

0%

20%

40%

60%

80%

100%

Zambia Rw anda South Africa Mozambique Ethiopia Tanzania Lesotho Kenya

Death Stopped ART (continuing in care) Unknown/LTF

Reasons for ART discontinuation by country at ICAP-supported sites as of December 2006*

N=1241 N=1989 N=2,701 N=1,103 N=3,119

* Transfers not considered discontinuers

N=634N=4 N=319

Comparing results and targetsPatients ever enrolled into care and ever initiated ART in Military Hospital,

Mozambique: Results v.s. MISAU targets (2005-2007)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Ma

i

Jun

Jul

Ag

o

Se

t

Ou

t

No

v

De

z

Jan

Fe

v

Ma

r

Ab

r

Ma

i

Jun

Jul

Ag

o

Se

t

Ou

t

No

v

De

z

Jan

Fe

v

Ma

r

Ab

r

Ma

i

Jun

Jul

Ag

o

Se

t

Ou

t

No

v

2005 2006 2007

Cumulative enrolment Cumulative on ART Targets for cumulative on ART

ART patients in more comprehensive programs may have better follow-up care

Presence of CD4 Count and Support Activities

0

0.2

0.4

0.6

0.8

1

% o

f c

oh

ort

wit

h C

D4

co

un

t 6

mo

nth

s

po

st-

AR

T i

nit

iati

on

1 or 2 activities 3 or 4 activities

Median=44%

Median=74%

Support activities include peer-educator program, outreach program nutritional support, adherence support

Source: Quarterly report data and PFaCTS, January 2007

PMTCT/PMTCT-plus

Number of ICAP/CU-supported pMTCT(+) sites, March 2007 (n=115)

39

34

20

11 10

1 0 0 0 0 0 0 0 00

5

10

15

20

25

30

35

40

45

Niger

ia

Ethio

pia

Moza

mbiq

ue

Kenya

Rwanda

South

Afri

ca

Lesot

ho

Camer

oon

Cote

d'Ivoire

Swazila

nd

Tanza

nia

Thaila

nd

Uganda

Zambia


PMTCT(+)Currently: 115 facilities in 5 countries

• 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

ICAP model

• 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

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

9146

6046

29663706

2504

0100020003000400050006000700080009000

10000

Ethio

pia

Moz

ambiq

ue

Rwan

da

Niger

ia

Tanza

nia

# te

sted

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

360 358

185

72 98

050

100150200250300350400450

Ethio

pia

Moza

mbiq

ue

Rwan

da

Niger

ia

Tanza

nia

# re

ceiv

ing

SD

-NV

P

Provision of services to pregnant women in ICAP-supported PMTCT programs in Mozambique, Nigeria, Rwanda, Tanzania

(February, 2005-September, 2006)

21841 21119

1689 1662 1188

0

5000

10000

15000

20000

25000

1st A

NC vis

it

Teste

d

Positi

ve

spac

e

Moth

er re

ceiv

ed A

RT

Infa

nt rec

eive

d ART

#

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

12463

10121

1303 694 335 788 4320

2000

4000

6000

8000

10000

12000

#w omenreceiving 1st

antenatal carevisit

# tested #positive #received ARTprophylaxis in

ANC

x #received ARTprophylaxis in

maternity

#infantsreceived ARTprophylaxis

#infantsinitiating

cotrimoxazole

#

Provision of services to pregnant women in ICAP-supported PMTCT programs in 4 countries (Mozambique, Nigeria, Rwanda, Tanzania)

(February, 2005-September, 2006)

Early Infant Diagnosis4 sites in Tanzania, Oct 1, 2006-March 21, 2007

385

320

49

248

329

050

100150200250300350400450

Identified Tested PCR+ PCR- StartedCTX

Limitations of aggregate data

• Cannot evaluate whether pregnant women are enrolled in care and treatment when eligible

• Difficult to measure efficacy of PMTCT program without linking mother’s PMTCT and infant prophylaxis and infant outcome

MTCT-Plus: pMTCT and pregnancy/infant monitoringExample: Following the “index” pregnancy

196 HIV-inf womenenrolled ≤ Dec 05, all eventually initiated

ART for tx

24: not recently pregnant

172: enrolled AP/ recently PP

153: live births

6: pregnancy ended prior to term

13: unk pregnancy outcome (for investigation)

129: mom rec’d pMTCT/ or

initated ART tx

10: mom’s pMTCT unk

14: children not enrolled in M+ (for

investigation)

139: children enrolled in M+

Adult women

Infants

Monitoring for new/subsequent

pregnancies at HIV clinical care visits

Infant HIV testing & diagnosis

Breastfeeding monitoring

Clinical monitoringCTX prophylaxis

linked by mom’s ID

Data source: 2 MTCT-Plus sites (1 in Kenya, 1 in South Africa)

Targeted Evaluations

• Addresses “Why”

• Helps identify barriers and facilitating factors

• Provides details

Reasons for not taking SD-NVPamong women who received it

30 30

20 20

0

10

20

30

40

50

Forgetfulness Fearful of drug Labor progressedtoo quickly

Husbandpresent/had notdisclosed HIV

status

%

Newborn brought to health facility for SD-NVP among women who delivered at home

28

3

31

38

30

0

10

20

30

40

50

Newbornbrought to

health facility

Day of delivery 1 day afterdelivery

2 days afterdelivery

>=3 days afterdelivery

%

If newborn brought to facility, timing of visit

Conclusions

• Excellent uptake of counseling and testing in ANC – MZ: 81%– TZ: 86%– RW: 99%

• Within countries, seroprevalence in ANC consistent over time

• TZ: 83% of exposed children receiving PCR; 85% started CTX

• Linking maternal and infant outcomes• Linking mother to Care and Treatment

TB/HIV

Number of ICAP/CU-supported TB/HIV sites (n=141), March 2007

39

34

27

20

13

8

0 0 0 0 0 0 0 00

5

10

15

20

25

30

35

40

45

South

Afri

ca

Ethio

pia

Rwanda

Tanza

nia

Moza

mbiq

ue

Niger

ia

Camer

oon

Cote

d'Ivoire

Kenya

Lesot

ho

Swazila

nd

Thaila

nd

Uganda

Zambia


TB/HIV

• Developed list of 20 indicators (TB screening, diagnosis, and treatment; HIV counseling and testing at TB clinics and enrolment into HIV care and treatment)

• Integrated 4 SOC indicators

• 114 sites in 6 countries expected to report Jan-March 07 data by end of May 07

• Expect close collaboration and communication between M&E and TB/HIV program staff

TB Screening among HIV-positive patients receiving care & treatment in ICAP-supported TB Model Centers in Mozambique & Rwanda

705

417

225

15 150

200

400

600

800

Enrolled into care Screened for TBScreened positive Diagnosed positiveEnrolled into TB treatment

(59%)

(54%)

(100%)

Mozambique (August-November, 2006)

2673

2115

28138 38

0

500

1000

1500

2000

2500

3000

Enrolled into care Screened for TBScreened positive Diagnosed positiveEnrolled into TB treatment

(79%)

(13%)(100%)

Rwanda (January-December, 2006)

HIV testing among TB patients in ICAP-supported sites in Rwanda and South Africa

13491222

546

290

0

500

1000

1500

Newly registered TB patientsTested for HIVHIV+Enrolled into care and treatment

(91%) (45%)

(53%)

South Africa (September-December, 2006)

691

207107

181

0

200

400

600

800

Newly registered TB patientsTested for HIVHIV+Enrolled into care and treatment

(30%)(52%)

Rwanda (January-December, 2006)

Conclusions

• Good implementation of TB screening in Rwanda and Mozambique (SOC target is over 90%)

• HIV counseling and testing at TB clinics is efficient way to identify patients

• Hard to capture linkages data TB clinic HIV clinic; HIV clinic TB clinic

Patient-level data on care and treatment

What is meant by patient-level data?

• Information collected for each patient at every clinic visit:

* Clinical data

* Laboratory results

* Medication

* Patient disposition/status

Purpose of collecting patient-level data with electronic databases

• Consistent with MOH priorities• Improve quality of care (e.g. tracked

missed visits, identify patients who have missed visits)

• Automate routine reporting (e.g. reduce burden of MOH and other routine reporting)

• Compare patient outcomes across sites to evaluate models of care

MozambiqueN=11,557n (%)5 facilities

EthiopiaN=7197N (%)6 facilities

RwandaN=7672n (%)7 facilities

6 additional countriesN=5844(adults only)n (%)6 facilities

TotalN=32,270n (%)24 facilites

MTCT-plus supported sitesPEPFAR supported

389 (3)11,168 (97)

0 (0)7197 (100)

321 (4)7351 (96)

5844 (100)0 (0)

6554 (20)25,716 (80)

FemaleMaleMissing

6782 (59)4677 (40)98 (<1)

4111 957)3084 (43)2 (<1)

4985 (65)2460 (32)227 (3)

4874 (83)963 (16)7 (<1)

19,048 (59)10,735 (33)2487 (8)

ART careNon-ART care

3876 (34)7681 (66)

1185 (16)6012 (84)

3177 (41)4495 (59)

2163 (37)3681 (63)

10,401 (32)21,869 (68)

Age at enrolment: 0-14 y yrs 15-25 yrs 26-35 yrs 36-45 yrs >45 yrs Missing

141 (1)2069 (18)4621 (40)2976 (26)1750 (15)0 (0)

716 (10)1281 (18)3041 (42)1589 (22)570 (8)0 (0)

585 (8)1016 (13)2747 (36)2156 (28)1092 (14)76 (<1)

n/a1860 (32)3190 (55)704 (12)77 (1)13 (<1)

1446 (4)6226 (19)13,599 (42)7425 (23)3489 (11)85 (<1)

Patient-level data

MozambiqueN=11,557n (%)5 facilities

EthiopiaN=7197N (%)6 facilities

RwandaN=7672n (%)7 facilities

6 additional countriesN=5844(adults only)n (%)6 facilities

TotalN=32,270n (%)24 facilities

WHO stage at enrolment Stage 1 Stage 2 Stage 3 Stage 4 Missing

1140 (10)1105 (10)2465 (21)451 (4)6396 (55)

164 (2)314 (4)697 (10)174 (2)5848 (81)

2042 (27)1852 (24)2008 (26)197 (3)1573 (20)

3560 (61)1207 (21)931 (16)140 (2)6 (<1)

6906 (21)4478 (14)6101 (19)962 (3)13823 (43)

CD4 count at enrolment in care:Median (range)

199 (1,1812)n=5282

Missing328 (0,1996)n=6501

345 (1,1845)n=5120

297 (0,1996)N=16,903

Point of entry into care: pMTCT VCT In-patient Out-patient Other Missing

445 (4)5286 (46)530 (5)2910 (25)1559 (13)827 (7)

33 (<1)3399 (47)1 (<1)4 (<1)756 (11)3004 (42)

1585 (21)4710 (61)400 (5)158 (2)396 (5)423 (6)

5844 (100)0 (0)0 (0)0 (0)0 (0)0 (0)

13,395 (42)931 (3)7907 (24)2711 (8)3072 (10)4254 (13)

Patient-level data

MTCT-Plus patient-level data: Example 1

Plot of CD4 cell count measurements by time on ART for a cohort of 1321 adult patients from 13 sites initiating ART

6m 12m 18m

Data as of August 2005


Plot of CD4 cell count measurements, stratified by baseline CD4 count group, by time on ART for a cohort of 1836 pediatric patients from 13 sites initiating ART



Program losses* in a cohort of >2000 adult patients from 13 sites who initiated ART, over time since ART initiation

K-M by Gender

K-M OverallK-M by Gender

Log-rank test (p=0.22)

*voluntary program withdrawals, deaths, LTF


Future patient-level data analyses

• Measure outcomes (e.g. survival, change in CD4 count) of patients in more ICAP-supported care and treatment programs

• Identify facility and program-level characteristics that independently influence patient outcomes

Current assessment of indicator reporting for ICAP-supported activities by country

Country SiteCare & Treatment PMTCT TBHIV

CounselingTesting Lab

Cameroon 1

Cote dIvoire 2

Ethiopia 35

Kenya 29

Lesotho 5

Mozambique 40

Nigeria 42

Rwanda 37

South Africa 41

Swaziland 13

Tanzania 24

Thailand 1

Uganda 2

Zambia 2

14 274 222 115 141 103 108

Key messages and recommendations

Discussion

• Implications for country work plans • Ideas for future format for quarterly data meeting• How better we can feedback data to country offices?

– Currently indicator tables, graphs, line listings– Dataset of indicators for local analysis– PFaCTS summary tables, linelistings, and datasets

• Future:– Online canned and ad hoc reports from URS– Combine info from all URS modules– Online mapping capabilities from URS– Country profiles (annual, semiannual)?– In-country quarterly data reviews?– Other formats/fora?

Where to find MER outputs

• P/MER Public

• Eventually on web

Documents

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