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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
Source: ICAP Site Census, 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)
Source: P-FaCTS January 2007
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
%
Source: P-FaCTS January 2007
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)
Source: P-FaCTS January 2007
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))
Source: P-FaCTS January 2007
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)
Source: ICAP Site Census, March 2007
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
Source: ICAP Site Census, March 2007
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
Source: ICAP Site Census, March 2007
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
MTCT-Plus patient-level data: Example 2
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
Data as of August 2005
MTCT-Plus patient-level data: Example 3
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
Data as of August 2005
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