Caitlin Madevu-Matson ([email protected]) Charon Gwynn ([email protected]) SI-NY
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Transcript of Caitlin Madevu-Matson ([email protected]) Charon Gwynn ([email protected]) SI-NY
INSIGHTS INTO HIV CARE SERVICE
COMPREHENSIVENESS AND
LABORATORY CAPACITY AT ICAP-SUPPORTED FACILITIES:
FINDINGS FROM PFACTS 2013Caitlin Madevu-Matson ([email protected])
Charon Gwynn ([email protected])SI-NY
PFACTS• Structured repeated assessment of facilities to
describe the scope, diversity, capacity and comprehensiveness of ICAP-supported programs
• Captures information not available from routine indicators :– Context: Location, type– Facility characteristics: Related services, e.g.
ANC, MC– Clinic and lab components: Staffing configuration
and training, patient support services, laboratory quality essentials
• Data used for program planning, monitoring and evaluation– Reports and webinars– URS– Analyses with other data sources
PFACTS IMPLEMENTATION
• Assessment tools– Core questions maintained from previous
round, tool revised with clinical and programs units
• Data collection– Assessments completed with health facility
personnel– Questionnaires reviewed by in-country ICAP
clinical and M&E units• Data validated through checks and results
uploaded to URS
Care and Treatment PFaCTS
• 7 rounds, 2007 - 2013
• 80 questions
Laboratory PFaCTS• 2 rounds, 2011 -
2013• 162 questions
CARE & TREATMENT PFACTS
Objectives• Present results
from Care and treatment PFaCTS Round 7
• Describe the comprehensiveness of ICAP-supported programs
OUTLINE
• PFaCTS implementation
• Current characteristics– Context
– Facility
– Clinic
• Comprehensiveness of HIV Care Service
• Summary
• Implications
DEFINITIONS
Facility
Clinic
COMPLETENESS OF PFACTS REPORTING OVER TIME
Round 1 (2007)
Round 2 (2007)
Round 3 (2008)
Round 4 (2009)
Round 5 (2010)
Round 6 (2011)
Round 7 (2013)
-
200
400
600
800
1,000
1,200
211 227
356
541
687
1,003 1,062
158 202
345
490
665
977 1,017
Facilities supported Facilities assessed
Num
ber o
f fac
ilitie
s
COMPLETENESS OF PFACTS REPORTING OVER TIME
Round 1 (2007)
Round 2 (2007)
Round 3 (2008)
Round 4 (2009)
Round 5 (2010)
Round 6 (2011)
Round 7 (2013)
-
200
400
600
800
1,000
1,200
211 227
356
541
687
1,003 1,062
158 202
345
490
665
977 1,017
Facilities supported Facilities assessed
Num
ber o
f fac
ilitie
s
75%
96%
OUTLINE
• PFaCTS implementation
• Current characteristics– Context : country, location and type
– Facility : services provided outside the CT clinic
– Clinic : services provided in the CT clinic
• Comprehensiveness of HIV Care Service
• Summary
• Implications
COUNTRIES CONTRIBUTING TO PFACTS ROUND 7
• 96% (1017/1062) of facilities with ICAP-supported care and treatment services completed PFaCTS Round 7
• In country completeness ranged from 79% to 100%
Cote d'Ivoire n=27 DR Congo
n=50
Ethiopia n=312
Kenya n=260
Mozambique
n=77
Swaziland
n=83
Tanzania
n=208
FACILITY LOCATION AND TYPE
Geographic location Type of facility0
20
40
60
80
100
Urban; 16.71583088
Semi-urban; 32.74336283
Rural; 50.54080629
Public primary; 64
Public secondary / ter-tiary; 15
Private/other; 21
Perc
ent o
f fac
ilitie
s, %
AVAILABILITY OF HIV RELATED SERVICES (n=1017)
PITC in any clinic/ward PMTCT in ANC TB treatment0
20
40
60
80
100100 97
88
Perc
ent o
f fac
ilitie
s, %
PMTCT SERVICE VARIATION (N=991)
ART in ANC WHO Option0
20
40
60
80
100
ART in ANC; 64.48
Refer to HIV clinic; 32.8
Refer to other facility, 2.72
Option A; 66
Option B; 3
Option B+; 30
Perc
ent o
f fac
ilitie
s, %
TB SERVICE VARIATION (N=1,017)
IPT Triage of TB suspects TB treatment0
20
40
60
80
100
58.672
TB clinic only; 60.18
HIV care clinic only; 20.94
HIV care and TB clinic; 6.59
Perc
ent o
f fac
ilitie
s, %
AVAILABILITY OF KEY PATIENT SUPPORT SERVICES (n=1017)
ART adherenc
e coun
seling
Male condo
m provision
Outreach
Nutritiona
l treatm
ent (children
)
Nutritio
nal tr
eatment
(adults)
0
20
40
60
80
100 99
8881 79
74
Perc
ent o
f fac
ilitie
s, %
TYPE OF ART ADHERENCE SUPPORT AVAILABLE
Clinic a
ppoin
tmen
t remind
er ca
rds
Hando
uts
Pill box
es or
bliste
r pac
ks
Calend
ars or
chec
klist to
track
ART
Clinic s
creen
s edu
catio
nal vi
deos
0
20
40
60
80
100
82
28 24
5 3
Perc
ent o
f fac
ilitie
s, %
OUTREACH ACTIVITIES BY TYPE OF PERSONNEL
Peer educator Clinicians Outreach worker Social worker Other0
20
40
60
80
100
61
42
16
59
Perc
ent o
f fac
ilitie
s, %
SECONDARY PREVENTION SERVICE AVAILABILITY
0
20
40
60
80
100 99
7870
45
Perc
ent o
f fac
ilitie
s, %
OUTLINE
• PFaCTS implementation
• Current characteristics– Context
– Facility
– Clinic
• Comprehensiveness of HIV Care Service
• Summary
• Implications
HIV CARECOMPREHENSIVENE
SSCOMPONENTSQuestions
• Does ICAP support comprehensive HIV care programs?
• Has comprehensiveness of HIV care programs changed over time?
• Is there variability in the changes?
WHO Priority Interventions1. Enabling people to know their HIV status
VCT / PITC
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmissionInterventions for IDU
PMTCT
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Treatment and care for HIV
Lab services for HIV monitoring
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
WHO Priority Interventions
Comprehensive components from PFaCTS
1. Enabling people to know their HIV status
VCT / PITC PITC on-site
2. Maximizing the health sector’s response to HIV preventionPreventing sexual transmission
Education on behavior change, STI screening, condoms
Interventions for IDU Screening and education on substance use
PMTCT PMTCT on-site
3. Scaling up HIV/AIDS treatment and care
Preventing and treating illness
Cotrimoxazole and TBNutritional counseling
Treatment and care for HIV
Adherence support Outreach services
Lab services for HIV monitoring CD4 on- or off-site
COMPREHENSIVE SERVICES OVER TIME
2007 n= 245
2008 n= 345
2009 n= 490
2009 n= 666
2011 n= 977
2013 n= 1017
0
20
40
60
80
100
1624
5569 73 73
5344
29
23 18 2230 26
148 9 41 5 2 1
High (7) Medium (6) Low (3-5) Very low (<3)
Perc
ent o
f fac
ilitie
s, %
COMPREHENSIVE SERVICES OVER TIME, SUBSET
2007 2008 2009 2010 2011 20130
20
40
60
80
100
16
24
55
6973 73
1518
57
94 92 90
All participating facilities (increasing n) Subset of facilities participating in every round (n=93)
Perc
ent o
f fac
ilitie
s, %
COMPREHENSIVE SERVICES OVER TIME, BY FACILITY TYPE
Public Primary Public Secondary/Tertiary Private/Other0
20
40
60
80
100
2007 2008 2009 2010 2011 2013
Perc
ent o
f fac
ilitie
s, %
OUTLINE
• PFaCTS implementation
• Current characteristics– Context
– Facility
– Clinic
• Comprehensiveness of HIV Care Service
• Summary
• Implications
CT SUMMARY (1)
• Overall, ICAP facilities maintained high survey completeness
• High on-site availability of essential HIV care services• Counseling and testing• PMTCT• TB treatment• ART adherence counseling• Outreach • Nutritional counseling• Secondary prevention
CT SUMMARY (2)
• The comprehensiveness of essential HIV care services at all ICAP-supported facilities increased rapidly in 2009 and seems to have stabilized
• Higher proportion of facilities have comprehensive services in • Facilities supported by ICAP for longer time• Public primary and secondary/tertiary
compared to private/other
• ICAP-supported facilities provide comprehensive services even though most facilities are rural and public primary facilities
• Scale up and expansion of ICAP support to new areas may mean not all facilities will be equipped to offer comprehensive services
• Combine PFaCTS results with routinely collected program and clinical data
– Confirm if availability of comprehensive services is beneficial for program and patient outcomes
– Advocate for wider implementation of comprehensive service delivery models
IMPLICATIONS FOR HIV CARE AND TREATMENT
Laboratory PFaCTS
Outline• Rationale & Objectives• General findings• Capacity score• Summary& Implications
Laboratory PFaCTS• Captures information on the scope, diversity,
and capacity of ICAP-supported laboratories• Provides information on laboratory quality
essentials (QEs)– Infrastructure and equipment– Human resources– Quality assurance activities– Facility safety– Supply chain management
• Two rounds of PFaCTS conducted to date (2011 & 2013)
RATIONALE FOR LABORATORY PFACTS
• At the facility level:– Measure capacity and progress toward
accreditation– Gap analysis and development of laboratory
specific improvement plan
• At the program level:– Identify gaps in implementing QEs across
supported labs– Prioritization and strategy development
ICAP’S LABORATORY CAPACITY BUILDING FRAMEWORK
Objective Components
1. Improve Integrated Laboratory Infrastructure
physical infrastructure, equipment and accessories
2. Strengthen laboratory personnel capacity
personnel capacity to provide high-quality diagnostic services
3. Improve Laboratory Quality Management System
quality management systems & lab accreditation
4. Strengthen the laboratory network system
laboratory referral system & EQA schemes
OBJECTIVES• To summarize findings from Lab
PFaCTS 2013
• To compare laboratory capacity between years and by key characteristics
OUTLINE• Rationale & Objectives• General findings• Capacity score• Summary& Implications
PEPFAR DEFINITION OF CLINICAL LABORATORY
Laboratory that has the capacity to: Perform testing for the diagnosis of HIV infection with either rapid test, EIA or molecular methods; and
Has dedicated laboratory personnel
Perform clinical laboratory tests in any of the following areas:Hematology - Clinical chemistry - Serology Microbiology - CD4 testing - HIV viral loads
TB diagnostic - Malaria diagnosis - OI diagnosis
LABORATORIES COMPLETING PFACTS 2013
# Supported # Reported % Reported
Ethiopia 295 289 98
Kenya 184 182 99
Tanzania 175 119 68
Mozambique 58 53 91
Cote d'lvoire 10 4 40
DR Congo 8 7 88
All Countries 730 654 90
ICAP SUPPORTED LABORATORIES BY FACILITY TYPE AND COUNTRY
All countries (n=654)
Kenya (n=182)
Tanzania (n=119)
Ethiopia (n=289)
Mozambique (n=53)
Cote d'Ivoire (n=4)
DR Congo (n=7)
0
20
40
60
80
100
7887
6680 77
14
1913
26
18 21
10086
3 1 8 2 2
Primary Secondary Tertiary/reference lab
Perc
ent o
f lab
orat
orie
s, %
TYPE OF SUPPORT PROVIDED BY ICAP
AccreditationConstruction/revnovation
RefurbishmentSafety supplies
Processing suppliesEquipment maintenance
Human resourcesTest kit/regent supply
EQASample transportation
EquipmentSupervision
Documents developmentTraining & mentoring
0 20 40 60 80 100
9
15
18
22
25
33
36
41
53
62
69
69
80
91
Percent of laboratories, %
TYPE OF HIV-RELATED TESTS PERFORMED ONSITE
HIV rapid test AFB Syphilis Hematology CD4 count Clinic chem-istry
CD4 percent0
20
40
60
80
10097
9283
48
27 26
9
Perc
ent o
f lab
orat
orie
s, %
Light/F
luoresce
nce m
icrosc
ope
Refrigerator
Back up g
enerator
Hemotolog
y analy
zer
Clinical ch
emistry a
nalyze
r
CD4 mac
hine 0
20
40
60
80
100
88
69
42
28 25 22
ESSENTIAL EQUIPMENT FOR HIV CARE
Perc
ent o
f lab
orat
orie
s, %
TYPE OF BIOSAFETY EQUIPMENT
Lab coat Detergents Sharps container
Hand wash sta-
tion
Fire ex-tinguisher
Autoclave Protective glasses
Eye wash station
Biosafety cabinet
0
20
40
60
80
100 9488 86
76
18 15 14 11 11
Perc
ent o
f lab
orat
orie
s, %
STAFF TRAINED IN KEY TESTS AND LABORATORY MANGEMENT SKILLS
Quality control
Inventory
Biosafety
AFB
HIV rapid test
Malaria
Hematology
Syphilis
Clinic chemistry
CD4 test
Man
agem
ent s
kills
HIV-
rela
ted
test
ing
0 10 20 30 40 50 60 70 80 90
54
43
35
84
79
77
67
67
65
60
Percent of staff, %
QUALITY ASSURANCE/QUALITY CONTROL FOR HIV RELATED TESTS
HIV rapid test (n=635)
CD4 test (n=175)
Hematology (n=314)
Clinical chemistry test (n=171)
0
20
40
60
80
100100
66
48
70
37
24
14 13
3947
1723
Internal controlInternal proficiencyExternal proficiency
Perc
ent o
f lab
orat
orie
s, %
OUTLINE• Rationale & Objectives• General findings• Capacity score• Summary& Implications
ICAP’S LABORATORY CAPACITY BUILDING FRAMEWORK
Objective Components
1. Improve Integrated Laboratory Infrastructure
physical infrastructure, equipment and accessories
2. Strengthen laboratory personnel capacity
personnel capacity to provide high-quality diagnostic services
3. Improve Laboratory Quality Management System
quality management systems & lab accreditation
4. Strengthen the laboratory network system
laboratory referral system & EQA schemes
LABORATORY CAPACITY SCOREScore Domain Lab PFaCTS Variables
1. Improve Integrated Laboratory Infrastructure
• HIV related tests• laboratory equipment• biosafety equipment/materials• supply chain management system • supply shortages• data collection & specimen
transportation
2. Strengthen laboratory personnel capacity
• % staff received training on each test
3. Improve Laboratory Quality Management System
• SOP, Internal controls, internal and external proficiency testing
Total Points = 100
CAPACITY SCORES BY FACILITY TYPE AND LOCATION
All (n=654)
Primary (n=511)
Secondary (n=126)
Tertiary (n=17)
Urban (n=111)
Semi-urban (n=250)
Rural (n=240)
Unknown (n=53)
0
20
40
60
80
100
48 45
61 5953
4945 44
Aver
age
capa
city
scor
e
CAPACITY SCORES BY COUNTRY AND YEAR
All countries (n=331)
Cote d'Ivoire (n=3)
DR Congo (n=6)
Ethiopia (n=74)
Kenya (n=125)
Mozambique (n=26)
Tanzania (n=97)
0
20
40
60
80
100
46
63
3643 45
37
525156 55 56
5043
5120112013
Aver
age
capa
city
sco
re
*Restricted to laboratories completing both 2011 and 2013 Pfacts rounds.
CAPACITY SCORES BY FACILITY AND LOCATION
*Restricted to laboratories completing both 2011 and 2013 PFaCTs rounds.
Primary (n=212)
Secondary (n=106)
Tertiary lab (n=13)
Urban (n=57)
Semi-urban
(n=113)
Rural (n=132)
Unknown (n=29)
0
20
40
60
80
100
41
5560
4552
4339
45
62 6156 56
47 44 20112013
Aver
age
capa
city
sco
re
OUTLINE• Rationale & Objectives• General findings• Capacity score• Summary& Implications
SUMMARY • ICAP supports a wide range of capacity
building activities in the countries where we work
• Technical support areas identified include QA/QC, human resources and infrastructure
• Capacity at ICAP laboratories– highest at secondary and tertiary and urban
facilities – increased between 2011 and 2013
IMPLICATIONS• Laboratory PFaCTS can be used to
identify and address technical support area needs
• Use of capacity scoring allows for a comprehensive approach to monitoring capacity from routinely collected PFaCTS data
PFACTS DATA USE• Analysis of key PFaCTS variables can
identify areas for targeted technical assistance as well as achievement of program successes
• Innovative approaches in the use of PFaCTS data help us better understand the programs we support
Where’s the Data?
URS
Wiki
Wiki
Acknowledgements
• Country M&E, Laboratory and Clinical Teams
• Bereket Alemayehu, Yingfeng Wu, Suzue Saito, SI Specialists
Thank You
FOR MORE INFORMATION
PFaCTS resources• To view the questionnaires and reports for all
rounds, visit the ICAP Data Dissemination page and select PFaCTS.• http://icapdatadissemination.wikischolars.columbia.edu/
Welcome
• To access more PFaCTS results, log into the URS • https://urs2.icap.columbia.edu/