ICAP MASTER SLIDE DECKData reported through June 2009

Notes:•Swaziland has not reported for the April-June 2009 quarter, so the results from January-March 2009 were carried over•PFACTS Slides are based off of PFACTS Round 3 data

Number of ICAP-supported sites by activity, June 2009 (n=935)

Nu

mb

er

of s

ites

Nu

mb

er

of s

ites

Number of ICAP-supported sites by country, June 2009 (n=935)

Care and treatment indicators

Program and Facility Characteristics Tracking System (PFaCTS)

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

Location and type of ICAP-supported HIV care and treatment sites (n=341, June 2008)

n=192 n=149

% s

ites

% s

ites

with

ser

vice

sProportion of ICAP-supported HIV care and

treatment sites offering HIV-related services on site (n=341, June 2008)

Proportion of sites offering HIV-related services on-site, by number of services (n=341, June 2008)

Proportion of ICAP-supported sites offering ≥4 HIV-related services on site (n=338, June 2008)

Average =76%

% s

ites

with

≥4

serv

ice

s

Proportion of ICAP-supported sites offering on-site patient support services, by type of service

(n=323, June 2008)

% s

ites

with

ser

vice

Proportion of HIV care and treatment sites offering on-site patient support services, by number of

services offered (n=323, June 2008)

Proportion of ICAP-supported HIV care and treatment sites with ≥4 on-site patient support

services (n=241)

% o

f site

s w

ith ≥

4 s

ervi

ces

Average =45%

High proportion of ICAP-supported sites have access to key HIV-related laboratory assays

% s

ites

Proportion of ICAP-supported HIV care and treatment sites with access to laboratory assays

by number of assays (n=336, June 2008)1 assay; 2%

2 assays; 1%

3 assays; 3%

4 assays; 13%

5 assays; 52%

6 assays; 29%

Proportion of ICAP-supported sites with access to key HIV-related lab assays (n=342, June 2008)

% s

ites Average

=98%

Key laboratory assays include: CD4, CD4 percent, HIV-RNA, LFT, and blood chemistry. PCR laboratory tests are excluded.

100% 100% 100% 100%

92% 91% 90% 88%

79% 77%

0%

50%

100%

Proportion of ICAP-supported sites with access to PCR laboratory assays (n=325, June 2008)

% s

ites

Average =92%

Mean number of full-time health care providers at HIV care and treatment sites (n=348, June 2008)

Mea

n nu

mbe

r of

pro

vide

rs

Mean number of outreach workers at ICAP-supported HIV care and treatment sites with

outreach programs (n=183, June 2008)

Mea

n nu

mbe

r of

out

reac

h w

orke

rs

Trend in proportion of ICAP-supported sites offering on-site patient support services (n=175,

June 2008)

% o

f si

tes

Prevention services are offered at most ICAP-supported sites (n=71, June 2008)

92%95%

92%

78%

63%

19%

94% 96%

84%78%

67%

31%

0%

50%

100%

Counseling regarding disclosure

Education on behavior and

safe sex

Provision of condoms

Referral for on-site screening

for STIs

Education on high-risk

substance abuse

Screening for drug and

alcohol abuse

Jul-07 Jul-08

% s

ites

Care and treatment quarterly indicators

HIV care and treatment services, as of June 2009

HIV patients ever enrolled in ICAP supported sites (including closed sites)

HIV patients ever initiating ART in ICAP supported sites (including closed sites)

741,104 362,126

New enrollment in care and treatment programs#

of n

ew

pat

ien

ts

Lesotho, Rwanda,S. Africa, Tanzania

Mozambique

Nigeria,

Zambia

Cote

d’Ivoire

482 sites

671,749 ever enrolled

in care

Nu

mb

er o

f p

atie

nts

Nu

mb

er of facilities

Swaziland

Cumulative enrollment in ICAP-supported HIV care and treatment programs (currently reporting)

327,092 ever initiated

ART

482 sites

Nu

mb

er o

f p

atie

nts

Nu

mb

er of facilities

Lesotho, Rwanda,S. Africa, Tanzania

Mozambique

Nigeria,

Zambia

Cote

d’Ivoire

Swaziland

Cumulative pediatric enrollment in ICAP-supported HIV care and treatment programs (currently reporting)

69,575 ever enrolled

in care

30,859 ever initiated

ART

Cumulative enrollment in HIV care in ICAP-supported HIV care and treatment programs by country

(n= 671,749)

Mozambique

South Africa

Ethiopia

Kenya

Tanzania

Rwanda

Lesotho

NigeriaZambia

Cote d’Ivoire

Nu

mb

er o

f p

atie

nts

Swaziland

Mozambique

South Africa

Ethiopia

Kenya

Tanzania

Rwanda

Lesotho

Nigeria Zambia

Swaziland

Nu

mb

er o

f p

atie

nts

Cumulative enrollment on ART at ICAP-supported HIV care and treatment programs by country

(n=327,092)

Cote d’Ivoire

Cumulative person-years on ART at ICAP-supported care and treatment programs, as of June 2009

Cum

ulat

ive

pers

on-y

ears

on

AR

T

Reported dead

Lost to follow up

Cumulative initiating ART

ART patients retained in care

Cumulative and current enrollment in ART care at ICAP-supported HIV care and treatment programs

as of June 2009 (n= 327,092)

Nu

mb

er

of p

atie

nts

Total care enrollment (n=671,749) Total ART enrollment (n=327,092)

Cumulative enrollment in ICAP-supported HIV care and treatment programs by ART status, age, and sex,

as of June 2009

Men 15+

Women 15+

Children <15 Children <15

Men 15+

Women 15+

Proportion of all enrolled patients who initiated ART in ICAP-supported treatment programs as of June 2009

% p

atie

nts

initi

atin

g A

RT

n=41

,237

n= 4

4,55

7

n=67

1,74

9

n=34

,517

n=58

,766

n=79

,256

n=46

,058

n=86

,116

n=77

,362

n=3,

589

n=10

,526

n=18

8,76

5

n=344,657 n=327,092 n=671,749

Cumulative enrollment in HIV care and treatment programs by age and sex, as of June 2009

% p

atie

nts

Children represent 10% of those in care (cumulative as of June 2009)%

pa

tient

s in

HIV

car

e

n=41

,237

n= 4

4,55

7

n=67

1,74

9

n=3,

589

n=86

,116

n=46

,058

n=58

,766

n=77

,362

n=79

,256

n=10

,526

n=18

8,76

5

n=35

,517

% p

atie

nts

on A

RT

Children represent 9% of patients initiating ART (cumulative as of June 2009)

n=21

,192

n= 2

4,40

5

n=32

7,09

2

n=2,

066

n=22

,679

n=26

,999

n=37

,054

n=43

,823

n=46

,309

n=4,

205

n=35

,174

n=63

,186

% p

edi

atr

ic p

atie

nts

in H

IV c

are

Cumulative pediatric HIV care enrollment, as of June 2009

n=152n=3,786n=16,355 n=9,654n=1,478n=5,830n=10,411 n=6,790 n=4,688n=69,575 n=7,027 n=3,404

Cumulative pediatric ART enrollment, as of June 2009

% p

edi

atr

ic p

atie

nts

on

AR

T

n=3,217n=3,604n=5,600 n=4,161n=85n=874n=4,047 n=1,590 n=2,570n=30,859 n=1,651 n=3,460

ART initiation among patients eligible for ART in ICAP-supported programs, April-June 2009

% p

atie

nts

elig

ible

for

AR

T

n=1,433n=1,156n=5,644 n=2,002 n=425n=2,768n=3,846 n=2,705 n=160n=26,352 n=2,542 n=3,671

Eligible, but not started: Number in HIV care during the quarter and eligible for ART but NOT started ART by the end of the quarter.”Eligible, started: All those who were eligible and started on ART during the reporting quarter.

ART regimens distributed in ICAP-supported HIV care and treatment programs,

April-June 2009 Overall (Adults)

N = 179,715 Overall (Children)

N = 21,000

1st line regimen 151,867 (85%) 14,169 (67%)

d4T-3TC-NVP 81,796 (46%) 5,283 (25%)

d4T-3TC-EFV 36,242 (20%) 3,081 (15%)

ZDV-3TC-NVP 21,644 (12 %) 3,816 (18%)

ZDV-3TC-EFV 8,527 (4.7%) 1,011 (4.8%)

Other 3,658 (2.0%) 978 (4.7%)

2nd line regimen 658 (.37%) 255 (1.2%)

Unknown regimen 27,190 (15%) 6,576 (31%)

ART regimens distributed to adults in ICAP-supported HIV care and treatment programs,

April-June 2009

Cote d'Ivoire Ethiopia Kenya Lesotho Mozam-

bique Nigeria Rwanda South

Africa

Swaziland Tanzania Zambia

n=1,761 n=24,794 n=20,848 n=11,472 n=39,370 n=21,611 n=14,982 n=30,319 n= 28,355 n=14,458 n=100

1st line regimen

1,731 24,234 16,336 11,466 35,805 3,556 14,810 29,730 0 14,080 0

(98%) (98%) (78%) (99%) (91%) (16%) (99%) (98%) .00%) (97%) (.00%)

2nd line regimen

4 44 82 6 29 118 87 255 0 33 0

(.23%) (.18%) (.39%) (.05%) (.07%) (.55%) (.58%) (.84%) (.00%) (.23%) (.00%)

Unknown 26 516 4,430 0 3,536 17,937 85 334 28,355 345 100

(1.5%) (2.1%) (21%) (0%) (9.0%) (83%) (.57%) (1.1%) (100%) (2.4%) (100%)

* In South Africa, D4T-3TC-LPV/r , ZDV-ddl-LPV/r , and ABC-ddl-LPV/r are prescribed as a first-line regimen for pediatric patients.

ART regimens distributed to children in ICAP supported HIV care and treatment programs,

April-June 2009

Cote d'Ivoire Ethiopia Kenya Lesotho Mozam-

bique Nigeria Rwanda South

Africa Swaziland Tanzania Zambia

n=72 n=2,315 n=2,873 n=587 n=3,999 n=1,408 n=1,996 n=3,158 n=2,913 n=1,179 n=3,413

1st line regimen

72 2,196 2,311 466 2,055 248 1,968 3,044 0 1,179 630

(100%) (95%) (80%) (79%) (51%) (18%) (99%) (96%) (.00%) (100%) (18%)

2nd line regimen

0 9 127 2 5 5 18 89 0 0 0

(.00%) (.39%) (4.4%) (.34%) (.13%) (.36%) (.90%) (2.8%) (.00%) (.00%) (.00%)

Unknown 0 110 435 119 1,939 1,155 10 25 2,913 0 2,783

(.00%) (4.8%) (15%) (20%) (48%) (82%) (.50%) (.79%) (100%) (.00%) (82%)

Proportion of patients with CD4 count at baseline, 6, and 12 months after ART initiation

% p

atie

nts

wit

h C

D4

cou

nt

n=9,921n=7,420n=13,420 n=25,854n=10,683 n=9,557 n=8,497n=114,694 n=29,342

Robust and sustained increases in median CD4 count among cohorts of patients initiating ART

CD

4 C

ell

Co

unt (

cells

/ul)

n=9,921 n=7,420 13,420n=25,854n=10,683 n=9,557n=8,497n=114,694 n=29,342

Change in Median CD4 count at 6 and12 months of ART, as of June 2009

Ch

ang

e in

med

ian

CD

4 co

un

t (c

ells

/µL

)

10.3% per year on ART

Status of ART patients at ICAP-supported HIV care and treatment programs as of June 2009

(n= 327,092)

*Includes patients who transferred out while on ART.

.59% per year on

ART

5.3% per year on

ART

Lost to Follow-up

Reported Dead

Stopped ART

Reasons for ART discontinuation in ICAP-supported HIV facilities as of June 2009

n=167n=3,200n=6,520 n=3,511n=9,277n=13,541 n=9,124n=8.078 n=5,909 n=573 n=1,941

% o

f D

isco

nti

nu

ing

Pat

ien

ts

PMTCT indicators

Pregnant women counseled and tested inICAP-supported PMTCT programs, cumulative

as of June 2009

# o

f Wo

men

Pregnant women counseled and tested inICAP-supported PMTCT programs, cumulative

as of June 2009

% W

om

en

Pregnant women counseled and tested and prophylaxed in PMTCT programs over time

# o

f W

om

en

Pregnant women counseled and tested inICAP-supported PMTCT programs over time

% W

om

en

First ANC n=60,520 n=67,421 n=83,315 n=83,431 n=91,663

Pregnant women counseled and tested in PMTCT programs, by country as of June 2009

% W

om

en

First ANC n=51,374 n=216,885 n=9,349 n=86,254n=168,728 n=44,511n=14,420

Type of ART prophylaxis for HIV-positive women at ICAP-supported PMTCT programs, April-June 2009

n=2,260 n=145 n=1,121 n=101 n=361n=4,624 n=493 n=143

% W

om

en

n=2,247 n=2,536 n=2,931 n=3,964 n=3,587n=1,216 n=1,932 n=3,717

Time-shift towards more complex PMTCT regimens at PMTCT programs

% o

f W

om

en

n=4,624

Indicators for TB Screening in HIV Care Settings

TB Screening in HIV Care Settings

Country Sites supported Sites reporting

Cote d’Ivoire 35 34

Ethiopia 53 46

Kenya 81 79

Lesotho 1 0

Mozambique 39 39

Nigeria 33 30

Rwanda 46 46

South Africa 28 27

Swaziland 31 0

Tanzania 89 86

TOTAL 436 387 (89%)

Proportion of new HIV patients screened for TB at enrollment, April-June 2009

% p

atie

nts

n=33,079 n=2,411 n=3,942 n=4,723 n=11,469n=7,011 n=2,539New HIV patients

n=984

90% target

n=17,700 n=18,713New HIV patients

n=23,094 n=24,661 n=32,959 n=29,281 n=33,173

Proportion of new HIV patients screened for TB at enrollment in HIV programs over time

% o

f p

atie

nts

n=33,079

Proportion of new HIV patients screened for TB at enrollment in ICAP-supported care and treatment

programs over time, by country

% p

atie

nts

Proportion of new HIV patients screened for TB at enrollment in ICAP-supported care and treatment

programs over time, by country

% p

atie

nts

Proportion of new HIV patients screened for TB at enrollment in ICAP-supported care and treatment

programs over time, by country

% p

atie

nts

Proportion of all HIV patients screened for TB who screened positive, April-June 2009

n=22,409 n=1,316 n=6,037 n=704 n=3,769n=4,493 n=2,331Patients screened

n=3,759

% p

atie

nts

n=4,293 n=663 n=452 n=650 n=2,082 n=178Patients screened positive

n=268

Proportion of all new HIV patients with a positive TB screen who initiated TB treatment at an ICAP-

supported program, April-June 2009

% p

atie

nts

Proportion of all new HIV patients who initiated TB treatment at ICAP-supported care and treatment

programs, April-June 2009

New HIV patients

n=37,535 n=2,539 n=3,942 n=4,456 n=11,469 n=7,011n=4,723 n=2,411 n=984

Indicators for HIV Testing in TB Patients

HIV testing in TB clinics as of June 2009

Country Sites supported Sites reporting

Cote d’Ivoire 11 11

Ethiopia 53 51

Kenya 80 73

Mozambique 37 32

Nigeria 61 50

Rwanda 28 27

South Africa 2 2

TOTAL 273 256 (94%)

Proportion of new patients with an unknown HIV status at ICAP-supported TB clinics who were HIV tested, April-June 2009

% p

atie

nts

Tested at any clinicTested at TB clinic

New TB patients w/ unknown HIV status

n=10,847 n=6,261 n=706 n=341 n=297 n=1,854 n=1,207 n=181

Proportion of new TB patients with unknown HIV status at ICAP-supported TB clinics tested for HIV over time

% p

atie

nts

n=7,164 n=6,771 n=7,466 n=7,273 n=9,986 n=8,754 n=11,307 n=11,281 n=11,102 n=10,847TB patients with unknown

HIV status

Proportion of HIV tested TB patients at ICAP-supported TB treatment programs who tested positive,

April - June 2009Tested at any clinicTested at TB clinic

% p

atie

nts

n=10,133 n=195 n=662 n=6,097 n=1,035 n=286 n=1,709 n=149

New TB patients

tested for HIV

Proportion of HIV(+) TB patients enrolling in HIV care at ICAP TB treatment programs, April-June 2009

% p

atie

nts

Tested at any clinicTested at TB clinic

n=1,802 n=83 n=273 n=108 n=109 n=426 n=598 n=29New TB

patients testing positive for HIV