Metrics

Metrics for Monitoring the Cascade of HIV Services

Dr Yu DongbaoWHO Regional Office for the Western Pacific

21 Nov. 2013

FHI360/WHO Session: Improving the HIV Cascade of Services: Advances in Reducing Loss to Follow Up between HIV Testing, Pre-ARV Care and Sustained Adherence to ARV. 21 Nov. 2013 Hall G

2 |World Health Organization

Western Pacific Region

What are the Metrics

How to use the metrics

Issues/challenges and plan

OutlineOutline

Let’s fix it…Let’s fix it…

Source: FHI360



What are the Metrics?What are the Metrics?

% of pre‐ART patients

retained in care

Diagnosis Enrollment in Care

Antiretroviral Treatment

Outcome(Viral suppression or MTCT)

Linkage to care Retention Retention

CASCAD

ES

% of PLHIV enrolled in

care

PROGRA

MME

CONCEPTUAL FRAMEWORK

% of ART patients

retained in care

Ratio (or %) of # PLHIV newly

enrolled in care to # newly

diagnosed

CONTINUUM

OF CA

REPM

TCT

% of TB patientstested for HIVTB

‐HIV

HIV % of PLHIV

who know their status

% of pregnant women tested for HIV

% of eligible PLHIV

receiving ART

% of incident TB‐HIV cases treated for TB & HIV

% of HIV‐exposed infants tested within 2 months of birth

% of HIV‐positive pregnant women whose partner has been tested

CD4 count at time of enrollment

% of key populations (SW, MSM, PWID) tested for HIV

% of PLHIV enrolled in care whose partner has been tested

% of months in reporting period with no ARV stock outs

% of on time drug pick up

% of PLHIV initiating ART within 30 days of eligibility

% of pregnant women with HIV who receive ARV drugs during pregnancy

% of HIV‐exposed infants who receive ARV prophylaxis

% of PLHIV on ART with

undetectableVL

% of tested HIV‐exposed infants who are HIV‐positive

Objectives and target audiences

• Objectives: To identify the bottlenecks and gaps along the cascade of HIV services; andTo assist national programmes in prioritizing key indicators to monitor the cascade of HIV services

• Target audience: program managers, staff and M&E officers at national and subnational levels



Uses routine monitoring data at local level, plus estimation data at national levelUse visualized graphics or dashboard Triangulate with other data sources when

possibleElectronic data collection system with

unique identifiers improves tracking of cascade of services

How to use the Metrics?



Field test in Cambodia and Viet Nam, with data collected from China, Indonesia and Myanmar in Oct. 2013

Purpose: To validate the data availability and usefulness

Results: The metrics provide useful framework for programme

assessment and data interpretationAll indicators can be calculated using aggregated data, but

unique identifier code (UIC) would improve the monitoringAdapt the indicators and analysis to country situation as

necessary Capacity building required at subnational level

The field test …The field test …



Example of cascade analysis (1): Too many people are not aware of their HIV status

Example of cascade analysis (1): Too many people are not aware of their HIV status

100%

49.5% 42.3%

21.9% 15.5% 13.2%

0100000200000300000400000500000600000700000800000900000

Est. No. of PLHIVin 2012 *

No. PLHIVdiagnosed &Reported

PLHIV in care(pre‐ART+ART)

PLHIV still on ART No. receiving VL VL suppressed

Source: * UNAIDS 2013, NCAIDS China, WHO-UNAIDS National AIDS Programme Managers Meeting, Feb 2013

Cascade of HIV diagnosis to care, China, 2012



Example of cascade analysis (2): Too many people are lost after diagnosis

Example of cascade analysis (2): Too many people are lost after diagnosis

Many loss after diagnosisMany loss after diagnosis

256,845

201,703

82,241 72,711

n.a n.a -

50,000

100,000

150,000

200,000

250,000

300,000

Estimated ofPLHIV *

PLHIVdiagnosed

and reported

PLHIV in care(pre-

ART+ART)

PLHIVcurrently

receiving ART

No. receivingVL

VLsuppressed

Many lost after diagnosis

Cascade of HIV diagnosis to care, Vietnam, 2012

Source: * UNAIDS 2013, VAAC Vietnam, WHO-UNAIDS National AIDS Programme Managers Meeting, Feb 2013

Issues and challenges

• Local vs. national use: local capacity • Programme data vs. estimation data• Definition of and monitoring retention of “care”• Cohort vs. cross sectional analysis• Use of data and programmatic actions



The Guide and timeline…The Guide and timeline…

The Asia Pacific Metrics for Monitoring Cascade of HIV Services contains: A framework Core indicators: cascade and programme indicators Guide on data presentation, analysis and interpretation Guide on use of the Metrics for programme improvement

Timeline: finalization by Dec. 2013; and publish in early 2014

In summary…

• A useful tool for improve the linkages and retention across the full cascade of services and reduce loss to follow up

• There are issues/challenges: capacity, data quality, and UIC, etc…

• Suggestions and inputs welcome

Acknowledgement

• Government partners from Cambodia, Viet Nam, China, Indonesia and Myanmar for their leadership and support

• Celine Daly and Tobi Saidel• Ying‐ru Lo, Masami Fujita, Masaya Kato, Nicole Seguy, Zhang Lan, Razia Pendse, Oscar Barreneche and colleagues from WHO, UNAIDS, CDC, FHI360,

• Members of the Technical Advisory Group



Thank you!Thank you!

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