I NSIGHTS INTO HIV C ARE S ERVICE C OMPREHENSIVENESS AND L ABORATORY C APACITY AT ICAP- SUPPORTED F ACILITIES : F INDINGS FROM PF A CTS 2013 Caitlin Madevu-Matson Charon Gwynn SI-NY

PF A CTS 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

PF A CTS I MPLEMENTATION 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 Care and Treatment PFaCTS 7 rounds, questions Laboratory PFaCTS 2 rounds, questions

CARE & TREATMENT PF A CTS Objectives Present results from Care and treatment PFaCTS Round 7 Describe the comprehensiveness of ICAP-supported programs

O UTLINE PFaCTS implementation Current characteristics – Context – Facility – Clinic Comprehensiveness of HIV Care Service Summary Implications

D EFINITIONS Facility Clinic

C OMPLETENESS OF PF A CTS REPORTING OVER TIME

75% 96%

O UTLINE 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

C OUNTRIES CONTRIBUTING TO PF A CTS R OUND 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%

F ACILITY LOCATION AND T YPE

A VAILABILITY OF HIV RELATED SERVICES (n=1017)

PMTCT S ERVICE V ARIATION ( N =991)

TB SERVICE V ARIATION ( N =1,017)

A VAILABILITY OF KEY PATIENT SUPPORT SERVICES (n=1017)

T YPE OF ART ADHERENCE SUPPORT AVAILABLE

O UTREACH ACTIVITIES BY TYPE OF PERSONNEL

S ECONDARY PREVENTION SERVICE AVAILABILITY

O UTLINE PFaCTS implementation Current characteristics – Context – Facility – Clinic Comprehensiveness of HIV Care Service Summary Implications

HIV C ARE C OMPREHENSIVENESS C OMPONENTS Questions Does ICAP support comprehensive HIV care programs? Has comprehensiveness of HIV care programs changed over time? Is there variability in the changes?

WHO Priority Interventions 1. Enabling people to know their HIV status VCT / PITC 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmission Interventions for IDU PMTCT 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Treatment and care for HIV Lab services for HIV monitoring

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

WHO Priority Interventions Comprehensive components from PFaCTS 1. Enabling people to know their HIV status VCT / PITCPITC on-site 2. Maximizing the health sector’s response to HIV prevention Preventing sexual transmissionEducation on behavior change, STI screening, condoms Interventions for IDUScreening and education on substance use PMTCTPMTCT on-site 3. Scaling up HIV/AIDS treatment and care Preventing and treating illness Cotrimoxazole and TB Nutritional counseling Treatment and care for HIV Adherence support Outreach services Lab services for HIV monitoring CD4 on- or off-site

C OMPREHENSIVE S ERVICES OVER TIME

C OMPREHENSIVE S ERVICES OVER TIME, SUBSET

C OMPREHENSIVE S ERVICES OVER TIME, BY FACILITY TYPE

O UTLINE PFaCTS implementation Current characteristics – Context – Facility – Clinic Comprehensiveness of HIV Care Service Summary Implications

CT S UMMARY (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

CT S UMMARY (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

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 I MPLICATIONS FOR HIV CARE AND TREATMENT

Laboratory PFaCTS

Outline Rationale & Objectives General findings Capacity score Summary& Implications

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)

R ATIONALE FOR L ABORATORY PF A CTS 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

ICAP’ S L ABORATORY C APACITY B UILDING F RAMEWORK ObjectiveComponents 1. Improve Integrated Laboratory Infrastructure physical infrastructure, equipment and accessories 2. Strengthen laboratory personnel capacity personnel capacity to provide high-quality diagnostic services 3. Improve Laboratory Quality Management System quality management systems & lab accreditation 4. Strengthen the laboratory network system laboratory referral system & EQA schemes

O BJECTIVES To summarize findings from Lab PFaCTS 2013 To compare laboratory capacity between years and by key characteristics

O UTLINE Rationale & Objectives General findings Capacity score Summary& Implications

PEPFAR D EFINITION OF C LINICAL L ABORATORY Laboratory that has the capacity to: Perform testing for the diagnosis of HIV infection with either rapid test, EIA or molecular methods; and Has dedicated laboratory personnel Perform clinical laboratory tests in any of the following areas: Hematology - Clinical chemistry - Serology Microbiology- CD4 testing - HIV viral loads TB diagnostic- Malaria diagnosis- OI diagnosis

L ABORATORIES COMPLETING PF A CTS 2013 # Supported# Reported% Reported Ethiopia Kenya Tanzania Mozambique Cote d'lvoire10440 DR Congo8788 All Countries

ICAP SUPPORTED LABORATORIES BY FACILITY TYPE AND COUNTRY

TYPE OF SUPPORT PROVIDED BY ICAP

TYPE OF HIV-RELATED TESTS PERFORMED ONSITE

TYPE OF BIOSAFETY EQUIPMENT

STAFF TRAINED IN KEY TESTS AND LABORATORY MANGEMENT SKILLS

QUALITY ASSURANCE/QUALITY CONTROL FOR HIV RELATED TESTS

O UTLINE Rationale & Objectives General findings Capacity score Summary& Implications

ICAP’ S L ABORATORY C APACITY B UILDING F RAMEWORK ObjectiveComponents 1. Improve Integrated Laboratory Infrastructure physical infrastructure, equipment and accessories 2. Strengthen laboratory personnel capacity personnel capacity to provide high-quality diagnostic services 3. Improve Laboratory Quality Management System quality management systems & lab accreditation 4. Strengthen the laboratory network system laboratory referral system & EQA schemes

L ABORATORY C APACITY S CORE Score DomainLab PFaCTS Variables 1. Improve Integrated Laboratory Infrastructure HIV related tests laboratory equipment biosafety equipment/materials supply chain management system supply shortages data collection & specimen transportation 2. Strengthen laboratory personnel capacity % staff received training on each test 3. Improve Laboratory Quality Management System SOP, Internal controls, internal and external proficiency testing Total Points = 100

CAPACITY SCORES BY FACILITY TYPE AND LOCATION

CAPACITY SCORES BY COUNTRY AND YEAR *Restricted to laboratories completing both 2011 and 2013 Pfacts rounds.

CAPACITY SCORES BY FACILITY AND LOCATION *Restricted to laboratories completing both 2011 and 2013 PFaCTs rounds.

O UTLINE Rationale & Objectives General findings Capacity score Summary& Implications

S UMMARY ICAP supports a wide range of capacity building activities in the countries where we work Technical support areas identified include QA/QC, human resources and infrastructure Capacity at ICAP laboratories – highest at secondary and tertiary and urban facilities – increased between 2011 and 2013

I MPLICATIONS Laboratory PFaCTS can be used to identify and address technical support area needs Use of capacity scoring allows for a comprehensive approach to monitoring capacity from routinely collected PFaCTS data

PF A CTS D ATA U SE Analysis of key PFaCTS variables can identify areas for targeted technical assistance as well as achievement of program successes Innovative approaches in the use of PFaCTS data help us better understand the programs we support

Where’s the Data?

URS

Wiki

Acknowledgements Country M&E, Laboratory and Clinical Teams Bereket Alemayehu, Yingfeng Wu, Suzue Saito, SI Specialists

Thank You

F OR MORE INFORMATION PFaCTS resources To view the questionnaires and reports for all rounds, visit the ICAP Data Dissemination page and select PFaCTS. To access more PFaCTS results, log into the URS