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Program and Facility Characteristics Tracking System ( PFaCTS ) May 8, 2007 ICAP New York Data dissemination meeting. Outline. Provisional data from first quarter of 2008 Proposed procedures for the development and implementation of new multi-country M&E indicators and data collection modules

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  1. Program and Facility Characteristics Tracking System(PFaCTS)May 8, 2007ICAP New YorkData dissemination meeting

  2. Outline • Provisional data from first quarter of 2008 • Proposed procedures for the development and implementation of new multi-country M&E indicators and data collection modules • Content area presentation • ICAP Program and Facility Characteristics Tracking System

  3. I. Summary of ICAP-supported activities through March 2008 • Care and treatment (cumulative) • 256 of 284 sites reporting • 458,848 patients have been cumulatively enrolled in care since 2004, 213,549 of whom initiated ART. • TB screening in HIV patients (last quarter) • 188 of 235 sites reporting • Of 30,050 newly enrolled patients, 68% were screened for TB at enrollment (compared with 65%, 61%, and 54% in the previous 3 quarters, respectively). • PMTCT (last quarter) • 322 of 342 sites reporting • 51,503 women attending ANC (first visit) were screened for HIV, 7,029 screened positive, and 2,579 received prophylaxis • 8,070 PMTCT client partners were tested.  • Counseling and testing (last quarter) • 198 sites (in 7 countries) providing services • 131,540 individuals received counseling and testing for HIV and received their test results

  4. Proposed procedures for the development and implementation of new multi-country M&E indicators and data collection modules

  5. What constitutes a M&E data collection module (DCM)? • Any systematically collected indicator information that is collected across all ICAP country programs and facilities and is expected to be reported to ICAP-NY for the purposes of program monitoring and evaluation, program planning or analysis • Examples: • Quarterly care and treatment indicators • PFaCTS

  6. Upcoming new indicators and DCMs • New indicators indicators • New suites of indicators as part of PEPFAR II • New data collection modules • Testing and counseling • Laboratory service indicators • Laboratory PFaCTS

  7. Procedures for Developing new DCMs • A brief proposal for new DCMs must be submitted to the Director of the M&E unit • Proposal format and workspace page is under development • Proposals should include: • rationale for collecting the data • description of the type of data to be collected • summary of the existing infrastructure within ICAP programs to collect the data • proposed timeline • The ICAP Leadership will approve or reject the proposal for a new DCM • If approved, an MER-NY technical lead will be assigned to work with an ICAP-NY content expert and in-country M&E teams to develop an SOP for the DCM • The SOP will include: • A rationale for the DCM • Indicators/variables, definitions and data sources to be used • Procedures and roles/responsibilities for capturing data • Relevant existing sources of information (e.g., indicators, SOCs, etc) will be reviewed in the DCM SOP development process • Draft SOP will be piloted in at least one country; lessons learned will be incorporated in the SOP

  8. Review & Implementation of Approved DCMs • The final draft of the DCM SOP will be shared for review and comment with ICAP-NY, Country Directors and relevant staff to discuss the rationale, importance and appropriateness of the DCM • Comments and issues on the proposed DCM will be taken, reviewed and resolved in the 2 weeks following the presentation of the DSM • Approximately 1 month after the comment period a finalized SOP will be distributed to the countries for implementation • The finalized SOP will be distributed to the countries • Country M&E teams and other relevant staff will be expected to begin implementing the SOP in the next reporting cycle (depending on the type of DCM) • Countries without the necessary infrastructure to implement the DCM will have more time, but will be expected to develop an implementation plan (with help from the M&E Liaison)

  9. Presentation Outline • Summary of recently submitted ICAP data • PFaCTS background • Program planning and implementation with PFaCTS data IV. Description and evaluation with PFaCTS data V. Operational research with PFaCTS VI. PFaCTS on URS

  10. II. PFaCTS • Semi-annual facility assessment designed to capture information on: • Site characteristics • e.g., level of service, location • Facility characteristics • e.g., number of exam rooms • Program characteristics • e.g., program components, lab services, patient support • Contextual information • E.g., background HIV prevalence, urban/rural • Staffing information • E.g., staff configuration, staff turnover • First PFaCTS: January-June 2007

  11. Strengths and limitations of PFaCTS • Strengths • A helpful implementation tool • Gets at a wide array of program implementation (e.g., laboratory, patient-support services, context) • Measures aspects of implementation (e.g., comprehensiveness) that are not captured by conventional program indicators • Describes characteristics of facilities and programs, the contexts in which they operate, and their evolution • Structured approach and standard definitions • A helpful tool for operations research • Limitations • Limited depth with regard to information gathered on implementation of complex programmatic activities • Accuracy and validity needs assessment and attention • May improve with increased use • Hard to get standard application of definitions across so many settings

  12. Program and Facility Characteristics Tracking System • Uses of PFaCTS: • Program planning and implementation: identifying gaps in care and tracking implementation of care and treatment programs • Description and evaluation: describe programs and scope of programs, assessing how programs are evolving • Evaluation and Operations Research: Examine associations between program, facility, and contextual information and patient outcomes, with both aggregate and patient-level data

  13. January-June 2007 July-December 2007 Number of care and treatment facilities supported 255 274 Number of facilities reporting care and treatment data 249 262 Number of facilities completing PFaCTS Round 1: 176 Round 2: 240 Current status Number of facilities completing both PFaCTS 175 Trends

  14. III. Program planning and implementation

  15. Support services available at sites

  16. Laboratory assays available at sites

  17. Staff configuration at sites

  18. Trends in support services available at sites

  19. Trends in laboratory assays available at sites

  20. Trends in staff configuration at sites

  21. IV. Description and Evaluation

  22. Location and type of ICAP-supported HIV care and treatment sites n=154 n=85 % sites

  23. On-site services by location of HIV care and treatment facility

  24. Support services

  25. Support services (continued)

  26. Support services (continued)

  27. Proportion of ICAP-supported HIV care and treatment sites offering on-site patient support services by number of patients on ART (n=240)

  28. Family-focused care model

  29. Proportion of ICAP-supported HIV care and treatment sites offering family-focused care service components (n=240) % of sites offering family-focused care service

  30. Prevention related services

  31. Proportion of ICAP-supported HIV care and treatment sites withprevention services (n=240) % of patients accessing prevention services

  32. Laboratory services available to the care and treatment program

  33. Laboratory services (continued)

  34. Proportion of ICAP-supported HIV care and treatment sites with access to key HIV-related laboratory assays (n=240) ICAP Average=95% % sites * Key HIV-related laboratory assays include CD4, CD4 percent, HIV-RNA, LFT and blood chemistry.

  35. Staffing Characteristics

  36. Number of full time equivalent providers at ICAP-supported HIV care and treatment sites by country and overall (n=240) Number of full time equivalent providers

  37. Mean number of ART patients per facility by country and overall, December 2007

  38. Mean number of health care providers per 1000 patients on ART at ICAP-supported HIV care and treatment sites (n=240) Number of providers per 1000 patients on ART

  39. Assessing program evolution

  40. Trend in proportion of ICAP-supported HIV care and treatment sites offering on-site services(n=175)

  41. Trend in proportion of ICAP-supported HIV care and treatment sites offering on-site patient support services (n=175)

  42. Proportion of ICAP-supported HIV care and treatment sites with access to laboratory assays (n=175) % sites

  43. V. Operational research

  44. Are loss to follow-up rates associated with program and facility characteristics? • “Identifying Optimal Models of HIV Care Approaches in Sub-Saharan Africa” protocols funded by Doris Duke Charitable Foundation, CDC public health evaluations in Mozambique and South Africa

  45. Availability of support services and lost to follow-up rates * LTF rate = # patients lost to follow-up per 1000 person-years on ART

  46. Lost to follow-up and person-years on ART at ICAP-supported care and treatment sites † Per 1000 person-years; weighted by cumulative ART enrolment and adjusted for country

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