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ICAP: Success as a Track 1.0 implementing partner

ICAP: Success as a Track 1.0 implementing partner. November 16, 2011. About ICAP.

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ICAP: Success as a Track 1.0 implementing partner

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  1. ICAP: Success as a Track 1.0 implementing partner November 16, 2011

  2. About ICAP ICAP was founded in 2004 at Columbia University’s Mailman School of Public Health. Now a global leader in HIV/AIDS services, ICAP has supported work at more than 2,000 sites across 21 countries around the world. More than one million people have received HIV services through ICAP-supported programs. ICAP’s support extends beyond direct provision of HIV services to help improve strategic planning, infrastructure, management, training, clinical mentorship, supportive supervision, quality improvement, laboratories, medical records, pharmacy systems, and monitoring and evaluation.

  3. Organizational Structure ICAP-NY Headquarters • Situated at the Mailman School of Public Health at Columbia University • Expertise in program development, implementation, research and student training • Responsibility for administrative, financial, strategic planning and development functions Country Programs • Large country teams under leadership of country directors • Provide national, regional, facility and community level support • Expertise in capacity building: program implementation, logistics, clinical issues, laboratory services, administration, financial management, monitoring and evaluation

  4. Where ICAP Works Rwanda South Africa Swaziland Tajikistan Tanzania Thailand* United States Uganda* Zambia • Cameroon* • Côte d’Ivoire • Democratic Republic of the Congo • Ethiopia • Dominican Republic* • Kazakhstan • Kenya • Kyrgyzstan • Lesotho • Malawi • Mali • Mozambique • Nigeria Notes:Boldindicates countries with ICAP offices.* Country ICAP has supported in the past

  5. Where ICAP Works *Denoted by countries in light blue TUNISIA MOROCCO ALGERIA WESTERN LIBYA EGYPT SAHARA MAURITANIA MALI NIGER ERITREA SENEGAL CHAD SUDAN THE DJIBOUTI GAMBIA BURKINA GUINEA GUINEA BISSAU BENIN NIGERIA TOGO ETHIOPIA COTE CENTRAL SIERRA D’IVOIRE GHANA AFRICAN LEONE REPUBLIC LIBERIA CAMEROON UGANDA SOMALIA DEMOCRATIC KENYA EQUATORIAL REP. OF REPUBLIC GUINEA THE OF THE CONGO GABON CONGO RWANDA BURUNDI TANZANIA ANGOLA MALAWI ANGOLA ZAMBIA MOZAMBIQUE MADAGASCAR MADAGASCAR ZIMBABWE NAMIBIA BOTSWANA SWAZILAND LESOTHO SOUTH AFRICA

  6. Overview of ICAP program accomplishments

  7. ICAP supported services at the facility level

  8. ICAP supported facilities in Kenya, by type of services

  9. ICAP SUPPORTED HIV COUNSELING AND TESTING IN MOZAMBIQUE ICAP SUPPORTED LABORATORIES IN ETHIOPIA

  10. activities at Track 1.0 supported facilities, June 30, 2011 Number of facilities Source: ICAP Site Census, June 2011 Note: Some facilities offer more than one activity.

  11. activities atall ICAP supported facilities, June 30, 2011 Number of facilities Source: ICAP Site Census, June 2011 Note: Some facilities offer more than one activity.

  12. icap accomplishments: hiv care and treatment • More than 1.3 million patients enrolled into HIV care in ~900 facilities • 650,000 (50%) patients initiated ART • 56,000 (9%) ART patients were <15 years of age • 380,000 (71%) of 534,000 patients enrolled in facilities reporting TB screening data were screened for TB at enrollment

  13. Cumulative enrollment in hiv care and treatment at facilities ever supported in track 1.0 584 clinics Côte d’Ivoire 941,819in care Nigeria Kenya*, Mozambique Rwanda, S. Africa, Tanzania Number of patients Number of clinics 484,617 on ART Ethiopia Source: ICAP URS June 2011. Notes: Data are only from clinics supported and reporting. The country arrows depict when the country began contributing data. *Data for Kenya includes Central Province only.

  14. Cumulative enrollment in hiv care and treatment at facilities ever supported by icap* 898 clinics Côte d’Ivoire 1,292,079 in care Nigeria, Zambia Swaziland 649,880 on ART Kenya, Lesotho, Mozambique Rwanda, S. Africa, Tanzania Number of patients Number of clinics Ethiopia Source: ICAP URS June 2011. Notes:The country arrows depict when the country began contributing data. *Does not include facilities funded through the MTCT Plus mechanism.

  15. sustained cohort retention (6 and 12 months) after art initiation at supported facilities Trend : P=0.7299 Trend: P=0.0844 Percent retained 6 months Percent retained 12 months Number of clinics reporting cohort data Source: ICAP URS June 2011 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  16. icap accomplishments: pmtct • 1.8 million pregnant women HIV tested at ANC in ~ 1,700 facilities • 113,000 (6%) women tested positive + 20,000 (1%) known positive • 96,000 (72% of all positive) women received ARV prophylaxis, including 12,000 who received triple therapy

  17. Number of pregnant women attending anc and receiving hiv testing, by quarter Kenya S. Africa Côte d’Ivoire Mozambique, Rwanda, Ethiopia, Nigeria, Tanzania Number of clinics Number of women 1,668 clinics 122,011 HIV tests 215,120 ANC visits Source: ICAP URS June 2011. The country arrows depict when the country started contributing data.

  18. icap accomplishments: hiv testing and counseling, tb/hiv, and laboratory services • 3.7 million people tested for HIV in ~1000 facilities • 304,154 HIV-infected patients screened for TB-related symptoms upon enrollment into HIV care and treatment. • 41,577diagnosed with TB and initiated TB treatment at these facilities • ~1 million HIV simple rapid tests and ~650,000 CD4 count tests processed in ~500 laboratories

  19. Knowledge Management Approaches

  20. Knowledge management tools (1) Unified reporting system (URS): • Web-based data system that captures and disseminates routine monitoring data from multiple ICAP-supported activities and programs at ICAP-supported sites • Automated reports allow for real-time use of data for program monitoring and evaluation • Technical assistance provided to country programs and MoH to develop similar databases for aggregate data collection, reporting and use

  21. Knowledge management tools (2) Patient-level data warehouse • Warehouse captures a minimum set of HIV care and treatment and TB screening data elements from diverse country-level patient databases • Automated reports generated to feedback information to sites on patient characteristics and clinical outcomes • Technical assistance provided to country programs and MoH to develop and enhance patient level data collection systems for reporting and clinical care

  22. ICAP patient-level data warehouse elements Visit Table: Visit date, WHO stage, CD4 count & percent, height,weight, Hb, ALT, next scheduled visit date • Enrollment Table • Basic demographic information • Age • Sex • enrollment date • Prior ARV use • Point of entry • Transfer Medication and pregnancy Table: ART regimen, regimen start & end date, regimen switch and reason, TB screening date and result, TB, cotrimoxazole, and fluconazole medication dates, Pregnancy status, weeks gestation, due date, actual pregnancy end date Status Table: Patient disposition status (dead, transferred, withdrew, LTF, stopped ART, etc) and status date Follow-up data: 1 row per measure per patient Baseline: 1 row per patient Currently: 183 facilities, 440,000 patients enrolled in care, and 234,000 initiating ART across 5 countries.

  23. Automated feedback reports

  24. Strategies to enhance data dissemination and use for Program improvement Webinars: Quarterly web-based interactive meetings to expand knowledge base and ensure best practices among ICAP staff, as well as other interested stakeholders • Clinical: • Improving effectiveness of adherence in HIV treatment settings • Rapid initiation of ART/ARV during pregnancy • ART for prevention: Evidence from recent studies • M&E methodology and data dissemination: • Using aggregate data for program M&E • Basic epidemiologic measures of disease occurrence • Using routinely-collected data to estimate patient retention DataBytes: Periodic bulletin highlighting results from routine data • Characteristics and outcomes among youth enrolled in ICAP care and treatment facilities

  25. Health Systems Strengthening through icap support

  26. Cumulative number of health workers trained in art and non art palliative care

  27. Availability of laboratory assays at facilities where icap supports care and treatment (n=594) Percent of facilities Source: ICAP PFaCTS Round 5, June 2011. Note: Laboratory services offered:Within the facility:  specimen collection and testing done within this facility. At another facility: specimen collection done within this facility and testing conducted at another facility or both specimen collection and testing are conducted at another facility.

  28. Increasing availability of patient support services at icap supported care and treatment clinics (n=248*) Percent with service Source: ICAP PFaCTS June 2011. Notes: *Only clinics that submitted all three rounds of data collection are included. ART adherence counseling: Verbal patient education provided by trained personnel at least every 3 months. Outreach: patients who miss clinic follow-up or medication pick up visits are identified and contacted by facility personnel. Nutritional treatment for children and infants: treatment and weaning for severely malnourished children / infants. Nutritional treatment for adults: treatment for severely malnourished adults.  Food rations for adults or children: provision of snacks, food packets, or other food rations to promote ART adherence or household food security.

  29. Increased use of multi drug arv regimens in icap supported pmtct programs Percent of women n= 3,684n= 5,133n = 5,778n= 7,931n= 7,990n= 9,070 Source: ICAP URS June 2011 Notes: Multi-drug regimens prior to April 2011 include AZT/sd-NVP, AZT/3TC tail postpartum, and HAART at 34 weeks. *Central data collection of indicator "HIV+ women already on ART" began in April 2011

  30. Growing Proportion of new hivcare patients screened for tb Number of clinics Percent of patients New HIV care patients n=22,289 n=26,984 n=30,440 n=33,311 n=34,834 n=38,432 n=43,525 Source: ICAP URS June 2011 Note: Côte d’Ivoire began reporting in April-June 2008 quarter and South Africa began in July-September 2008 quarter. Data are only from clinics currently supported and reporting. As of March 2010, new HIV care patients excludes patients who knew their TB status at enrollment.

  31. Proportion of new tb patients with unknown hiv status at icap supported tb clinics tested for hiv over time Percent of patients TB patients with unknown HIV status n=6,590 n=7,662 n=10,471 n=10,037 n=12,289 n=6,955 n=10,974 n=15,162 Source: ICAP URS June 2011.

  32. hiv testing and counseling services At icap supported facilities Number of patients Source: ICAP URS June 2011

  33. increasing number of care and treatment clinics submitting data to icap-ny patient-level data warehouse Source: ICAP Patient-level Data Warehouse June 2011

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