1. AIDS Prevention Initiative Nigeria Monitoring and Evaluation in the Transition Toyin Jolayemi – APIN Ltd Seema Meloni - Harvard

2. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 2 AIDS Prevention Initiative Nigeria Background Harvard supporting sites since 2004 Since 2008, APIN has been funded by CDC Nigeria to transition sites from Harvard Year 1 SHL 2 Satellites 1 PHC Year 2 LUTH NIMR Year 3 UCH Adeoyo 3 Satellites

3. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 3 AIDS Prevention Initiative Nigeria Service Delivery Based on National Guidelines and Harvard/APIN protocols

4. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 4 AIDS Prevention Initiative Nigeria Overall Enrollment Jul-Dec 08Jan-Jun 09Jul-Dec 09Jan-Jul 10 NIMR New on Care 1,3441,4001,2711,169 New on ART 970755653661 Current on Care 6,7007,2617,7417,932 Current on ART 4,6844,9225,1575,510 LUTH New on Care1,0481,077928896 New on ART657811705691 Current on Care5,1885,6615,9626,317 Current on ART3,9894,2374,6234,960

5. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 5 AIDS Prevention Initiative Nigeria QA/QI (1): Continuity of Care Jul-Dec 08Jan-Jun 09Jul-Dec 09Jan-Jul 10 NIMR % of patients with ≥1 clinical visit in the last 6 months and 6 months apart 70.568.676.771.5 % of ART patients who had ≥1 pharmacy pick-up and/or ≥1 clinical visit in the last 6 months 51.467.971.572.3 LUTH % of patients with ≥1 clinical visit in the last 6 months and 6 months apart 82.581.883.984.4 % of ART patients who had ≥1 pharmacy pick-up and/or ≥1 clinical visit in the last 6 months 55.861.264.968.4

6. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 6 AIDS Prevention Initiative Nigeria QA/QI (2): OIs including TB Jul-Dec 08Jan-Jun 09Jul-Dec 09Jan-Jul 10 NIMR % of patients who were screened for TB by clinical symptoms during the past 6 months 9797.998.497.8 % of patients initiated on TB treatment within 2 months of confirmed TB diagnosis 38.353.968.879.8 % of patients with at least one CD4 count ≤350 on CPT 49.587.487.787.5 LUTH % of patients who were screened for TB by clinical symptoms during the past 6 months 95.99797.297.4 % of patients initiated on TB treatment within 2 months of confirmed TB diagnosis 58.862.156.453.3 % of patients with at least one CD4 count ≤350 on CPT 48.868.580.178.7

7. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 7 AIDS Prevention Initiative Nigeria QA/QI (3): Patient Monitoring Jul-Dec 08Jan-Jun 09Jul-Dec 09Jan-Jul 10 NIMR % of new patients who got baseline CD4 91.390.085.683.5 % of patients who got ≥1 CD4 assessment during 6- month review period 94.996.175.788.5 LUTH % of new patients who got baseline CD4 92.692.792.094.5 % of patients who got ≥1 CD4 assessment during 6- month review period 90.784.987.990.8

8. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 8 AIDS Prevention Initiative Nigeria Cohort Analysis Date Range for 6 Month CD4 CountJul-Dec 08Jan-Jun 09Jul-Dec 09Jan-Jul 10 Starting Cohort Date RangeAug 07 - Jan 08Feb 08 – Jul 08Aug 08 – Jan 09Feb 09 – Jul 09 NIMR # of patients in the starting cohort 5361141752800 # with baseline CD4 count 481 (90%)980 (86%)685 (91%)727 (91%) Median baseline CD4 count 142143157144 # from the starting cohort still picking up ART at month 6 435 (82%)948 (83%)602 (80%)672 (84%) # with CD4 count at month 6 361 (83%)790 (83%)516 (86%)436 (65%) Median CD4 count at month 6 251309336318 LUTH # of patients in the starting cohort 526547588709 # with baseline CD4 count 511 (97%)518 (95%)563 (96%)658 (93%) Median baseline CD4 count 143144145188 # from the starting cohort still picking up ART at month 6 472 (90%)389 (71%)402 (68%)544 (77%) # with CD4 count at month 6 302 (64%)329 (85%)353 (88%)453 (83%) Median CD4 count at month 6 291284294325

9. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 9 AIDS Prevention Initiative Nigeria Clinical Outcomes Jul-Dec 08Jan-Jun 09Jul-Dec 09Jan-Jul 10 NIMR % with VL≤400 after 6 months on ART 8279.984.279.4 LUTH % with VL≤400 after 6 months on ART 70.370.174.281

10. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 10 AIDS Prevention Initiative Nigeria Transition of QA Efforts APIN Central Central QA committee in place QA indicators harmonised with GON QA/QI toolkit in place Training on QA/QI framework and processes Mentoring of Sites Site Site QA committee in place including focal person and data staff QA framework/plans in place QA activities ongoing Sites starting to run data for QI Training on QA/QI framework and processes Technical Assistance from Harvard QA /QI SOP and QUiC tool developed; Analysis for QI Support training and provide TA on QA/QI

11. Saturday, September 19, 2015 AIDS Prevention Initiative Nigeria Saturday, September 19, 2015 11 AIDS Prevention Initiative Nigeria Summary Development of tools to monitor the impact of transition on clinical outcomes is critical. Methods of analysis and ultimate significance require empirical approach. Increased communication with transitioned site personnel and patients will inform the process.