ICAP HIV Testing and Counseling indicators Initial summary of data, January-March 2010 quarter ICAP

Background – HTC and ICAP Most country teams collect & report data on HIV testing & counseling (HTC) to MOH and USG teams Historically very limited data on HTC reported to ICAP-NY Introduced draft HTC indicators for comment in early 2009 HTC done as part of the TB, PMTCT and HEI programs not included (no double counting) Indicators reported by point of service within each site – e.g., VCT, family planning, OPD

Staff reviews idea with M&E Director Staff submits New/Revised Indicator Proposal Form Review committee reviews proposal (2weeks) Development team is formed. Draft SOP is developed and piloted (two months) Draft SOP disseminated for two-week comment period SOP finalized (1 month) ICAP staff conceptualizes idea for potential new or revised indicator Discussed during routine M&E call or Country Program call Comments/Concerns posted to Indicator workspace Training on final SOP and Implementation Data reported quarterly to ICAP-NY Develop data collection tools If approved ICAP-wide input Country- specific input Data collection registers exist Data collection registers do not exist Data disseminated to country teams via URS, analysis databases and reports URS Reporting Module (1-2 months) developed Flowchart of ICAP Data Indicator Proposal Procedures

ICAP HTC indicators Number of clients… 1.attending/admitted to clinic 2.HIV pre-test counseled 3.HIV pre-test counseled and tested 4.HIV tested who received test results 5.who tested HIV positive among clients who received their results 6.who tested HIV negative among clients who received their results 7.who tested HIV positive among all clients tested 8. who tested HIV positive and subsequently enrolled in HIV care and treatment Also: 9. Number of health care workers who successfully completed an in- service training program for HTC (country-level)

ICAP HTC indicators Gender and age group – indicators #1-8 FemalesMales < 18 months* 18 months to <15 yrs 15+ yrs *Requires PCR testing, since maternal HIV antibodies may be detected in antibody testing

Reporting by points of service (POS) Site A Site B Site C POS #1 POS #3 POS #2 POS #1 POS #3 POS #4 POS #2 POS #1 POS #2 ICAP country team office ICAP-NY

PEPFAR Next Generation indicators Indicator #P11.1.D Essential/reported Number of individuals who received Testing and Counseling (T&C) service for HIV and received their test results Disaggregation: Essential/reportedBy Sex: Male, Female Essential/reportedBy Age: <15, 15+ Essential/not reportedBy test result: Positive, Negative RecommendedBy type of counseling: Individual, Couples* RecommendedBy MARP type: CSW, IDU, MSM Indicator #H2.3.D Essential/reported Number of individuals trained in counseling and testing according to national and international standards ICAP indicators are aligned with PEPFAR NGI

Data entry and dissemination Data entered into the URS manually or via import tool Summarized on URS HTC dashboard and in Summary Reports Will include a summary table and narrative for HTC indicators in upcoming quarterly report to CDC-Atlanta Added to master slides posted on ‘wiki’ data dissemination workspace Core maps Initial indicator reporting period: October-December 2009

Identifying points of service

HTC points of service (n=24) All points of serviceOutreach VCTEye unit Outpatient (general)Well baby clinic Adult outpatientCasualty / trauma Pediatric outpatientPalliative care / hospice Inpatient (general)Reception / customer care Adult (male & female) inpatientCervical cancer screening Adult female inpatientSTI clinic Adult male inpatientHIV care/treatment (family testing) Pediatric inpatientTB Clinic (family testing) LaboratoryBlood Donation Center Family planningOther

Data entry and import

January-March 2010 HTC indicator data

Completeness of HTC indicator data January-March 2010 Admission to venue HIV counseling/ testing HIV test results Enrollment in HIV care Ethiopia Mozambique South Africa Cote d'Ivoire Tanzania Rwanda Nigeria Kenya Key: ReportedDid not report

Reporting pediatric data 5 countries reported data by age as specified in the ICAP HTC SOP: months 2.18 months -14 years years Ethiopia and Kenya reported only 0-14 years and 15+ years Rwanda reported patients aged 0-17 years and 18+ years

Number of sites supporting HIV counseling and testing, March 2007-March 2010 Source: ICAP URS March 2010 Note: Counseling and testing data was not reported until December 2009

88% of HTC supported sites reported

% of patients provided HIV testing by POS by country

Total n=392,803

n=214,014 n=43,110 n=37,007 n=31,336 n=19,794 n=18,566 n=16,018 n=12,958 # testing:

% of patients testing HIV-positive, by country # testing: n=12,958 n=214,014 n=19,794 n=18,566 n=31,336 n=37,007 n=16, 018 n=43,110

% of patients testing HIV-positive, by country, and national HIV prevalence # testing: n=12,958 n=214,014 n=19,794 n=18,566 n=31,336 n=37,007 n=16, 018 n=43,110

Cote d’Ivoire Ethiopia Kenya Moz. NG Rwanda South Africa Tanzania # testing: n=12,958 n=214,014 n=19,794 n=18,566 n=37,007 n=16, 018 n=43,110 n=31,336

62% Outpt. 35% VCT 3% Other 52% Outpt. 38% VCT 7% Inpt. 3% Other 48% Outpt. 23% Inpt. 22% Other 7% VCT 89% VCT 11% All PITC 98% VCT 2% All PITC 100% All POS 49% All POS 26% VCT 18% Other 5% Outpt. 1% Inpt. 78% VCT 9% Outpt. 9% Inpt. 4% Other

7% 4%4% 6% 8%

Countries reporting these data include TZ, MZ, SA, and CI 11% 4%

Counseling and testing uptake

Note: Clinic admission data not reported by Kenya and Nigeria % testing at VCT: 14% 74% 99% 89% 34% 36%

Enrollment in HIV care

Note: HIV care enrollment data not reported by Kenya,or Rwanda (n= 4,303) (n= 3,529) (n= 4,705) (n=7,596) (n=4,327) (n=1,131) # HIV-positive:

(n=16,617) (n=8,714) (n=2,668) (n=21,589) # HIV-positive: Note: HIV care enrollment data not reported by Kenya,or Rwanda

# HIV-positive: (n=12,397) (n=3,318) (n=619) (n=1,079) (n=7,923) Note: HIV care enrollment data not reported by Kenya,or Rwanda

Additional comments Jan-Mar 2010 data largely consistent with data from Oct-Dec 2009 Historical data from prior to October 2009 – coming soon from some countries Some limitations: –Missing data on clinic/POS admissions and enrollment in HIV care from several countries –Not all countries report data by point of service

Routine dissemination

URS HTC dashboard

URS HTC summary reports

Summary / conclusions ICAP supported almost 400,000 HIV tests during January-March 2010 Reports from 1,337 points of service from within 691 sites >99% of patients received their results More than 27,000 (7%) patients tested HIV- positive At least 16,899 (67%) HIV-positive patients linked into HIV care

Next steps Historical data Examine trends Disseminate to country teams Feedback – data/program improvement

Acknowledgements ICAP-NY: Charon Gwynn, Sarah Gorrell, Suzue Saito, Frank Brathwaite, other staff providing input on SOP M&E staff, ICAP country teams

Note: HIV care enrollment data not reported by Kenya,or Rwanda