ICAP Data Dissemination: Master Slide Deck

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Presentation transcript:

ICAP Data Dissemination: Master Slide Deck Data through September 30, 2012

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Number of selected activities at supported facilities, Site Census Number of selected activities at supported facilities, as of September 30, 2012 Number of facilities Updated 11.28.11 Definitions Care and treatment: HIV care is defined as comprehensive palliative care to pre-ART and ART patients, which includes routine follow up visits, CD4 testing, and cotrimoxazole prophylaxis for opportunistic infections. HIV treatment is defined as provision of antiretroviral treatment. Facilities only providing pediatric care and treatment should be included in this category. Programs that provide only ART prophylaxis to pregnant women or that provide care and treatment services within TB clinics should NOT be included here. PMTCT: PMTCT activities include, at a minimum, HIV testing in an antenatal care setting and, for HIV-infected women, provision of ARV prophylaxis. The ARV prophylaxis should be available and provided in the antenatal care setting. Early infant diagnosis: Early infant diagnosis is defined as obtaining dried blood spots (DBS) or venous blood samples from HIV-exposed infants for DNA PCR testing. DBS can be provided in a variety of settings including antenatal care, maternal and child health (MCH) clinics, or HIV care and treatment, but to be counted as a site that provides early infant diagnosis, the sample collection must be done on-site. The processing of the sample, however, need not be done on site. Do not include this activity if HIV-exposed infants are referred off-site for DBS or venous blood collection. TB screening among HIV patients (TB/HIV): This category refers to screening for and diagnosis of active TB among HIV-infected patients enrolled in an ICAP-supported HIV care and treatment facility. Training of clinicians on methods of active TB screening and diagnosis and support to improve the recording of information related to this screening and diagnosis should be among the support provided. HIV testing among TB patients (HIV/TB): This category refers to support for HIV testing at TB treatment facilities in sites where ICAP supports the care and treatment facility. TB Model Centers directly supported by ICAP should also be included here. Testing and counseling: Testing and counseling includes HIV counseling and testing services offered at out-patient or in-patient departments (adult or pediatric) by clinical staff or lay staff, often referred to as PICT (Provider-initiated Counseling and Testing) or PIHCT (Provider Initiated HIV Counseling and Testing), as well as counseling and testing services offered as part of VCT. Do NOT include counseling and testing services offered in PMTCT or TB facilities. Laboratory support: Laboratory support is defined as the development and strengthening of laboratory facilities to support HIV/AIDS and TB-related activities. At a minimum this includes staff training and technical assistance, such as setting up infant diagnosis systems, advising on quality assurance for HIV rapid testing or for CD4 testing, and site supervision. In addition to these elements, laboratory support may include renovations, selection and procurement of equipment and commodities for chemistry analysis that are appropriate in resource limited setting. The laboratories may or may not be co-located at a site where ICAP provides other support (i.e. for care and treatment, PMTCT). Free-standing laboratories should also be included here (i.e. National Reference Laboratory in Rwanda or National Health Laboratory Services in South Africa) and added as new sites. Source: ICAP Site Census, December 2012 Note: Some facilities offer more than one activity.

Number of facilities by country, as of September 30, 2012 Number of facilities Source: ICAP Site Census, December 2012

Care and treatment indicators

Care and treatment clinics ever supported

Cumulative enrollment in HIV care and treatment, by quarter As of September 2012: 1,612,642 enrolled in care 833,712 initiated ART 1,244 clinics Number of patients Number of clinics Source: ICAP URS December 2012. Note: Includes adults and children. Data are from all clinics ever supported.

Cumulative pediatric enrollment in HIV care and treatment, by quarter As of September 2012: 148,248 enrolled in care 75,140 initiated ART 1,244 clinics Number of patients Number of clinics Up S22 730 92405 46757 Source: ICAP URS December 2012. Note: Data are from clinics ever supported.

Care and treatment clinics currently supported

Care and treatment clinics reporting, as of September 30, 2012 up Source: ICAP URS December 2012.

Cumulative enrollment in HIV care and treatment, by quarter As of September 2012: 751,407 enrolled in care 431,242 initiated ART 806 clinics Number of patients Number of clinics Up S21 730 1083253 534,124 Source: ICAP URS December 2012. Notes: Includes adults and children. Data are only from clinics currently supported and reporting.

Cumulative pediatric enrollment in HIV care and treatment, by quarter As of September 2012: 65,361 enrolled in care 39,033 initiated ART 806 clinics Number of patients Number of clinics S22 Source: ICAP URS December 2012. Note: Data are only from clinics currently supported and reporting.

New enrollment in HIV care and treatment, by quarter From July-September 2012: 37,187 enrolling in care 21,807 initiating ART 802 clinics Number of patients Number of clinics Up S19 730 55214 33337 SA Oct 04, Moz, Rwanda Jan 2005, TZ Jul 2005 , Eth Oct 2005, Nig Jan 06, Ken Apr 06, CI Jan 08, Swa Jan 09 Source: ICAP URS December 2012. Note: New enrollment includes adults and children. New on treatment include patients who transfer in already on ART. Data are only from clinics currently supported and reporting.

Age and sex distribution of patients enrolled in care, by country, as of September 30, 2012 Percent of patients S29a up Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting.

Age and sex distribution of patients initiating ART, by country, as of September 30, 2012 Percent of patients S31 up Take home message: The patient population varies across ICAP-supported countries, reflecting differences in the epidemic as well as differences in entry points. Overall, 9% of our patient population are children under 15. Note that a smaller proportion of children (10% v.s. 11.0%) are on ART, likely reflecting difficulties making diagnosis of HIV infection in children. Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting.

Percent of pediatric patients Age distribution of pediatric patients enrolled in care, by country, as of September 30, 2012 Percent of pediatric patients S32 Take home message: Most pediatric patients receiving HIV care were under 5 years of age (41%). In Nigeria, Swaziland and Zambia, the majority of pediatric patients were under 1. Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting.

Percent pediatric patients on ART Age distribution of pediatric patients initiating ART, by country, as of September 30, 2012 Percent pediatric patients on ART s33 Take home message: There is large variability for proportion of <1 year enrolled in ART across countries. This is likely a reflection of the variation in the availability of early infant diagnosis. Note that the proportion of patients <1 year in ART care is about half of that in HIV care (22% v.s. 41% from previous slide). Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting.

Percent patients on ART Proportion of ART patients on second-line regimens, by country, July-September, 2012 Percent patients on ART s33 Take home message: There is large variability for proportion of <1 year enrolled in ART across countries. This is likely a reflection of the variation in the availability of early infant diagnosis. Note that the proportion of patients <1 year in ART care is about half of that in HIV care (22% v.s. 41% from previous slide). Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting.

Proportion of patients with CD4 count at baseline, 6 and 12 months after ART initiation, by country, as of September 30, 2012 Percent of patients s38 Source: ICAP URS December 2012 Notes: This reflects cumulative cohort data for patients followed 12 months. Data are only from clinics currently supported and reporting.

CD4 Cell Count (cells/ul) Median CD4 count at baseline, 6 and 12 months after ART initiation, by country, as of September 30, 2012 CD4 Cell Count (cells/ul) s39 Source: ICAP URS December 2012 Notes: This reflects cumulative cohort data for patients followed 12 months. Baseline CD4 count is an average of 6 and 12 month cohort baseline data. Data are only from clinics currently supported and reporting.

Status of ART patients, by country, as of September 30, 2012 Percent of ART patients Reported dead S41 0.14 3.5 7.0 Rates are calculated as the percent of people lost to follow up, dead, or stopped ART, per person year on ART. Source: ICAP URS December 2012 Notes: Includes adults and children, and patients who transferred out while on ART. Data are only from clinics currently supported and reporting.

Number of care and treatment providers trained, by country, as of September 30, 2012 Number or providers S42 Take home message: As explained in the previous slide, the majority of those who discontinued ART were lost to follow up. In Kenya and Lesotho, the proportion of lost to follow up among all those have discontinued treatment were very high at 76 and 74% Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting.

Care and treatment clinic characteristics Country Clinics supported Clinics reporting Côte d’Ivoire 64 63 DR Congo 17 Ethiopia 85 75 Kenya 237 221 Mozambique 66 Nigeria 43 42 Rwanda 48 South Africa 102 80 Swaziland 59 Tanzania 127 TOTAL 848 796 (94%) Source: ICAP Care and treatment PFaCTS Round 6, December 2012.

Geographic location and type of facility (n=796) Percent of clinics S4 Source: ICAP Care and treatment PFaCTS Round 6, December 2012. Note: Urban = officially designated cities with city administration and political bodies; Semi-urban = large and small towns, peri-urban areas, growth points and mining communities; Rural = subsistence and commercial farming areas.

Geographic location of care and treatment clinics, by country Percent of clinics country Source: ICAP Care and treatment PFaCTS Round 6, December 2012. Note: Urban = officially designated cities with city administration and political bodies; Semi-urban = large and small towns, peri-urban areas, growth points and mining communities; Rural = subsistence and commercial farming areas.

Proportion of HIV care and treatment clinics offering patient support services (n=789) Percent of clinics s8 Source: ICAP Care and treatment PFaCTS Round 6, December 2012. Notes: 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 or support for children/infants: provision of nutritional supplements or weaning foods. Nutritional treatment for adults: provision of nutritional supplements or therapeutic foods, e.g. Plumpy’Nut. Food rations: provision of rations, e.g. snacks or food packets to promote ART adherence or household food security.

Proportion of facilities offering laboratory assays (n=796) Percent of facilities s11 Source: ICAP Care and treatment PFaCTS Round 6, December 2012. Notes: 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. Clinical chemistry includes creatinine and liver enzyme tests.

Mean number of providers Mean number of full-time health care providers at HIV care and treatment clinics, by country (n=787) Mean number of providers S15 Take home message: There is wide variability in number of providers in ICAP supported countries. Overall, an average of 4 health care providers provided services to patients at ICAP-supported facilities. Health care providers include three categories of staff: physicians, health officer/medical assistants, and nurses. Nurses represent the majority of health care providers in all countries. Source: ICAP Care and treatment PFaCTS Round 6, December 2012.

Proportion of HIV care and treatment clinics where nurses prescribe ARVs, by country (n=790) Percent of clinics s11a Source: ICAP Care and treatment PFaCTS Round 6, December 2012.

PMTCT Indicators

PMTCT clinics ever supported

Number of pregnant women attending ANC and receiving HIV testing, April 2007 – September 2012 As of September 2012: 2,976,011 attending ANC 2,469,039 HIV tested 2,687 clinics Number of women Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data from clinics ever supported.

PMTCT clinics currently supported

PMTCT clinics reporting as of September 30, 2012 Country Clinics supported Clinics reporting Côte d’Ivoire 28 DRC 154 110 Ethiopia 281 275 Kenya 702 649 Mozambique 202 Nigeria 51 Rwanda South Africa Swaziland 62 Tanzania 616 584 TOTAL 2129 1697 (80%) Source: ICAP URS December 2012

Number of pregnant women attending ANC and receiving HIV testing, April 2007 – September 2012 As of September 2012: 3,431,003 attending ANC 2,862,948 HIV tested 2,809 clinics Number of women Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012.. Notes: Data are only from clinics currently supported and reporting.

Type of ART regimen for PMTCT, by country, July-September 2012 Percent of women pm4format Source: ICAP URS December 2012. Notes: Multi-drug regimens include AZT/sd-NVP, AZT/3TC tail postpartum, HAART at 34 weeks. Data are only from clinics currently supported and reporting.

Type of ART regimen for PMTCT, by quarter, as of September 30, 2012 Percent of women Source: ICAP URS December 2012 Notes: Multi-drug regimens include AZT/sd-NVP, AZT/3TC tail postpartum, HAART at 34 weeks. Data are only from clinics currently supported and reporting.

Proportion of HIV+ pregnant women assessed for ART eligibility, as of September 30, 2012 Percent of women Source: ICAP URS December 2012 Notes: Multi-drug regimens include AZT/sd-NVP, AZT/3TC tail postpartum, HAART at 34 weeks. Data are only from clinics currently supported and reporting.

ART eligibility and initiation of ART among HIV+ pregnant women, by country, as of September 30, 2012 Number of women Pm6- Swaz?! Source: ICAP URS December 2012 Notes: Data is not available for all indicators in all countries. ART eligibility assessed through clinical staging or CD4. Newly initiating ART includes women in ANC or care and treatment clinics. Data are only from clinics currently supported and reporting.

HIV-exposed infants, by country, July-September 2012 Number of infants pm8 Source: ICAP URS December 2012 Notes: Data is not available for all indicators in all countries. N=HIV exposed infants, including those born to women who tested positive in ANC and those who tested positive in maternity during the quarter. Data are only from clinics currently supported and reporting.

HIV-exposed infants, by country, July-September 2012 Number of infants pm8 Source: ICAP URS December 2012 Notes: Data are not available for all indicators in all countries. N=HIV-exposed infants, including women who tested positive in ANC and those who tested positive in maternity during the quarter. Data are only from clinics currently supported and reporting.

TB screening in HIV care and treatment clinics

Care and treatment clinics ever supported for TB screening

Number of new HIV patients screened for TB, April 2007-September 2012 As of September 2012: 880,260 enrolled in care 504,018 TB screened 1,310 clinics Number of patients Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data are from clinics that ever reported.

Care and treatment clinics currently supported for TB screening

TB Screening in HIV Care Settings as of September 30, 2012 Country Clinics supported Clinics reporting Côte d’Ivoire 24 DR Congo 17 12 Ethiopia 281 250 Lesotho 128 Kenya 249 Mozambique 77 64 Nigeria Rwanda South Africa Swaziland 62 Tanzania 127 109 TOTAL 966 708 (73%) Source: ICAP URS December 2012

Number of new HIV patients screened for TB, as of September 2012 540,197 enrolled in care 273,823 TB screened 708 clinics Number of patients Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data are only from clinics currently supported and reporting.

Proportion of new HIV patients symptom screened for TB, by quarter, as of September 30, 2012 Percent of patients S54 n=24,705 n=32,184 n=29,286 n=33,184 n=33,049 n=34,069 n=34,783 n=38,722 n=36,180 n=35,229 n=39,762 n=27,377 n=23,441 n=41,084 Source: ICAP URS December 2012 Note: Data are only from clinics currently supported and reporting. As of September 2010, new HIV care patients excludes patients who knew their TB status at enrollment.

Proportion of new HIV patients symptom screened for TB, by country, July-September 2012 Percent of patients s53 Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting. New HIV care patients excludes patients who knew their TB status.

Proportion of all new HIV patients diagnosed with TB and treated, by country, July-September 2012 Percent of patients S58 Source: ICAP URS December 2012 Notes: Denominator does not exclude patients who knew their TB status.

HIV testing in TB clinics

TB clinics ever supported

Cumulative number of new TB patients tested for HIV, as of September 2012 231,563 HIV tested 1,053 clinics Number of people Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012.. Notes: Data are from clinics ever supported.

TB clinics currently supported

HIV testing in TB clinics, as of September 30, 2012 Country Clinics supported Clinics reporting Côte d’Ivoire 7 DR Congo 29 25 Ethiopia 223 222 Kenya 300 298 Lesotho 17 Mozambique 69 Nigeria 8 6 Rwanda 2 South Africa 92 TOTAL 747 644 (86%) Source: ICAP URS December 2012

Cumulative number of new TB patients tested for HIV, as of September 2012 162,533 HIV tested 628 clinics Number of people Number of clinics trendtb Source: ICAP URS December 2012.. Notes: Data are only from clinics currently supported and reporting.

Proportion of new TB patients with documented HIV status, as of September 30, 2012 Percent of patients s63 Source: ICAP URS December 2012 Notes: Data are only from clinics currently supported and reporting

Proportion of new TB patients with documented HIV status, by country, July-September 2012 Percent of patients s65 Source: ICAP URS December 2012. Notes: Data are only from clinics currently supported and reporting. A documented HIV status in the TB register is the sum of patients with a known status at enrollment into TB care and those newly tested for HIV at the TB clinic

Proportion of new TB patients with documented status who were HIV+, by country, July-September 2012 Percent of patients s66 Source: ICAP URS December 2012. Notes: Data are only from clinics currently supported and reporting. A documented HIV status in the TB register is the sum of patients with a known status at enrollment into TB care and those newly tested for HIV at the TB clinic

Proportion of TB patients co-infected with HIV who enrolled in HIV care, by country, July-September 2012 Percent of patients s66 Source: ICAP URS December 2012. Notes: Data are only from clinics currently supported and reporting

HIV testing and counseling

Facilities with testing and counseling ever supported

Number of people tested for HIV, as of September 2012 6,624,929 HIV tested 370,997 HIV+ 1,452 facilities Number of people Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data are only from clinics currently supported and reporting.

Facilities with testing and counseling currently supported

Counseling and testing, as of September 31, 2012 Country Clinics supported Clinics reporting Côte d’Ivoire 30 DR Congo 37 21 Ethiopia 278 277 Kenya 163 158 Mozambique 113 60 Nigeria 33 Rwanda South Africa Tanzania 316 TOTAL 970 862 (89%) Source: ICAP URS December 2012

Number of people tested for HIV, as of September 2012 4,786,685 HIV tested 206,262 HIV+ 862 facilities Number of people Number of clinics Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data are only from facilities currently supported and reporting.

Number of points of service Number of points of service reporting, by country, January-September 2012 Number of points of service tc8 Source: ICAP URS Decemberr 2012 Notes: Data are only from clinics currently supported and reporting.

Number of patients counseled and tested, by point of service, July-September 2012 Most data from VCT clinics comes from Ethiopia, which may decrease the overall prevalence found in VCT clinics. Source: ICAP URS December 2012 Notes: Other includes: laboratory; family planning, well-baby, STI, and TB clinics; casualty/trauma; palliative care/hospice; customer care, cervical cancer screening; HIV care / ART (family testing); blood donation center; and other points of service. Countries or facilities who do not disaggregate testing data by point of service are listed under all points of service.

Proportion of patients Proportion of patients tested who were HIV+ and enrolled in care, by point of service, July-September 2012 Proportion of patients Most data from VCT clinics comes from Ethiopia, which may decrease the overall prevalence found in VCT clinics. Source: ICAP URS December 2012 Notes: Other includes: laboratory; family planning, well-baby, STI, and TB clinics; casualty/trauma; palliative care/hospice; customer care, cervical cancer screening; HIV care / ART (family testing); blood donation center; and other points of service. Countries or facilities who do not disaggregate testing data by point of service are listed under all points of service.

Number of patients counseled and tested, HIV+ and enrolled in care, by country, January-September 2012 Number of patients tc8 Source: ICAP URS December 2012

Proportion of patients Proportion of patients tested who were HIV+ and enrolled in care, by country, July-September 2012 Proportion of patients Most data from VCT clinics comes from Ethiopia, which may decrease the overall prevalence found in VCT clinics. Source: ICAP URS December 2012

Clinical laboratories Clinical laboratories are defined by PEPFAR as having: Dedicated laboratory personnel Capacity to diagnose HIV with rapid test, EIA or molecular methods Capacity to perform clinical laboratory tests in at least one of the following areas: hematology, clinical chemistry, serology, microbiology, CD4 testing / viral load, TB diagnostic identification, malaria infection diagnosis, OI diagnosis.

Clinical laboratories ever supported

Number of tests conducted, by type of test, as of September 30, 2012 1,132,966 CD4 count 609 laboratories 438,884 CD4 % 1,658,066 HIV rapid tests 392,414 AFB Number of tests Number of laboratories Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data are from labs ever supported.

Clinical laboratories currently supported

Clinical Laboratories as of September 30, 2012 Country Facilities supported Facilities reporting Côte d’Ivoire 9 DR Congo 6 Ethiopia 89 Kenya 204 166 Mozambique 66 Nigeria Rwanda South Africa Tanzania 148 97 TOTAL 522 272 (52%) Source: ICAP URS December 2012

Number of tests conducted, by type of test, as of September 30, 2012 272 laboratories 266,991 CD4 % 995,694 HIV rapid tests 254,623 AFB 690,792 CD4 count Number of tests Number of laboratories Pm1 236874 132171 1888 Eth, Moz, Nig, Taz, Apr 07, CI Jan 08, Tan Apr 08, CI Oct 08, SA Jan 09, Ken apr 10 Source: ICAP URS December 2012. Notes: Data are only from labs currently supported and reporting.

HIV-related tests conducted by country, July-September 2012 Number of tests Source: ICAP URS December 2012 Note: Data are only from clinics currently supported and reporting

Characteristics of clinical laboratories

Laboratories supported Laboratories reporting Laboratory characteristics Country Laboratories supported Laboratories reporting Côte d’Ivoire 7 16 DR Congo 5 6 Ethiopia 89 80 Kenya 213 175 Mozambique 66 53 Nigeria 8 32 Rwanda 47 South Africa Tanzania 148 112 TOTAL 542 521 (96%) Source: ICAP Lab PFaCTS Round 1, September 2011

Number of laboratories, by country (n=521) Source: ICAP Lab PFaCTS Round 1, September 2011

Type of laboratory support provided by ICAP (n=521) Percent of laboratories Source: ICAP Lab PFaCTS Round 1, September 2011

Proportion of laboratory tests conducted, by type of test (n=521) Percent of laboratories Source: ICAP Lab PFaCTS Round 1, September 2011

Co-location of equipment with general laboratory equipment (n=521) Percent of laboratories Source: ICAP Lab PFaCTS Round 1, September 2011

Percent of laboratories Proportion of laboratories that support lab tests at other points of service in the facility Percent of laboratories s8 Source: ICAP Lab PFaCTS Round 1, September 2011

Percent of laboratories Proportion of laboratories with regular power outages that have backup generators, by country Percent of laboratories Source: ICAP Lab PFaCTS, December 2012

Percent of laboratories Proportion of laboratories with supply shortages in the past year, by type of shortage and country Percent of laboratories Source: ICAP Lab PfaCTS, December 2012

For more information, please see: ICAP URS ICAP Data Dissemination Page Care and treatment PFACTS country reports Lab PFACTS country reports