Caitlin Madevu-Matson (cm3315@columbia.edu) Charon Gwynn (crg2128@columbia.edu) SI-NY

1. Insights into HIV Care Service Comprehensiveness and Laboratory Capacity at ICAP-supported Facilities: Findings from PFaCTS 2013 Caitlin Madevu-Matson (cm3315@columbia.edu)Charon Gwynn (crg2128@columbia.edu)SI-NY

2. 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

3. PFaCTS Implementation • Care and Treatment PFaCTS • 7 rounds, 2007 - 2013 • 80 questions • Laboratory PFaCTS • 2 rounds, 2011 - 2013 • 162 questions • 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

4. CARE & TREATMENT PFaCTS Objectives • Present results from Care and treatment PFaCTS Round 7 • Describe the comprehensiveness of ICAP-supported programs

5. PFaCTS implementation Current characteristics Context Facility Clinic Comprehensiveness of HIV Care Service Summary Implications Outline

6. Definitions Facility Clinic

7. Completeness of PFaCTS reportingover time

8. Completeness of PFaCTS reportingover time 96% 75%

9. 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 Outline

10. 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%

11. Facility location and Type

12. Availability of HIV related services (n=1017)

13. PMTCT Service Variation (n=991)

14. TB service Variation (n=1,017)

15. Availability of key patient support services (n=1017)

16. Type of ART adherence support available

17. Outreach activities by type of personnel

18. Secondary prevention service availability

19. PFaCTS implementation Current characteristics Context Facility Clinic Comprehensiveness of HIV Care Service Summary Implications Outline

20. HIV Care Comprehensiveness Components Questions • Does ICAP support comprehensive HIV care programs? • Has comprehensiveness of HIV care programs changed over time? • Is there variability in the changes?

33. Comprehensive Services over time

34. Comprehensive Services over time, subset

35. Comprehensive Services over time, by facility type

36. PFaCTS implementation Current characteristics Context Facility Clinic Comprehensiveness of HIV Care Service Summary Implications Outline

37. 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

38. 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

39. Implications for HIV care and treatment • 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

40. Laboratory PFaCTS

41. Outline • Rationale & Objectives • General findings • Capacity score • Summary& Implications

42. 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)

43. 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

44. ICAP’s Laboratory Capacity Building Framework

45. Objectives • To summarize findings from Lab PFaCTS 2013 • To compare laboratory capacity between years and by key characteristics

46. Outline • Rationale & Objectives • General findings • Capacity score • Summary& Implications

47. PEPFAR Definition of Clinical Laboratory

48. Laboratories completing PFaCTS 2013

49. ICAP SUPPORTED LABORATORIES BY FACILITY TYPE AND COUNTRY

50. TYPE OF SUPPORT PROVIDED BY ICAP