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ICAP Data Dissemination Meeting

ICAP Data Dissemination Meeting. August 31, 2011. Number of activities at currently supported facilities as of June 2011. Number of facilities. Source: ICAP Site Census, June 2011 Note: Some facilities offer more than one activity. Number of facilities ever supported and transitioned

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ICAP Data Dissemination Meeting

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  1. ICAP Data Dissemination Meeting August 31, 2011

  2. Number of activities at currently supported facilities as of June 2011 Number of facilities Source: ICAP Site Census, June 2011 Note: Some facilities offer more than one activity.

  3. Number of facilities ever supported and transitioned by ICAP as of June 2011 Number of facilities Number of facilities ever supported by ICAP Number of facilities transitioned or in transition Source: ICAP Site Census, June 2011

  4. ICAP accomplishments as of June 2011 (1) • 1.3 million patients enrolled into HIV care in ~900 facilities • 672,000 (52%) initiated ART • 58,000 (9%) <15 years of age • 380,000 (68%) of 560,000 patients enrolled in facilities that report TB screening data screened at enrollment • 1.8 million pregnant women HIV tested at ANC in ~ 1700 facilities • 113,000 (6%) tested positive + 20,000 (1%) known positive • 96,000 (72% of all positive) received ARV prophylaxis, including 12,000 who received triple therapy

  5. ICAP accomplishments as of June 2011 (2) • 3.7 million people tested for HIV in ~1000 facilities • 1.7 million (46%) tested in Ethiopia • ~1 million HIV simple rapid tests and ~650,000 CD4 count tests processed in ~500 laboratories

  6. Ongoing activities • Lab PfaCTS on-going (138/739 labs completed) • Care and treatment PfaCTS round 6 on-going (107/763 sites completed) • Capacity building indicators in development

  7. New data dissemination and use initatives • DataBytes • ICAP data dissemination webinars • ICAP methodology webinars

  8. Data dissemination webinars • April 6: Baseline characteristics and outcomes among youth enrolled in ICAP-supported care and treatment facilities (Matt Lamb) • November TBD: Priority indicators (Suzue Saito)

  9. Methodology webinars • June 22: Using aggregate data for program monitoring and evaluation: Case study examining decentralization of pediatric care and treatment services for HIV (Suzue Saito, Ruby Fayorsey) • September 22: Methods for addressing implementation research questions: experiences from ICAP studies (Harriet Nuwagaba-Biribonwoha) • October 13: Basic epidemiologic measures of disease occurrence (Bill Reidy) • November TBD: Using routinely-collected data to estimate patient retention in care and after ART initiation at ICAP-supported HIV care and treatment facilities (Matt Lamb) • December  7: Estimation of population size for most at-risk populations (Anna Deryabina)

  10. Trends in ART retention at ICAP-supported care and treatment sites Batya Elul Suzue Saito

  11. Source: Holmes,C. PEPFAR’s Contributions to the Global Scale‐up of Treatment. Joint WHO & UNAIDS Annual Consultation on Global Forecasts of Antiretroviral Demand9 December, 2010.

  12. Source: Cornell et al, 2010

  13. Methods (1) • PEPFAR retention indicator: No. patients still on ART at initiating site at 6/12 months divided by no. who initiated ART 6/12 months earlier • Patients ≤6 years and transfers out excluded • Reported quarterly for successive cohorts of patients initiating ART: 5812 6-m cohorts and 5338 12-m cohorts

  14. Methods (2) • Plotted trends over time in retention for July 2004 - June 2011 • Used relative risk regression to assess crude and adjusted relative risk of non-retention per 1 quarter increase in ART initiation date • Excluded first 2 quarters to account for data quality issues at start-up

  15. Median proportion of patients initiating ART included in 6/12 month cohorts, by country 6 month cohort 12 month cohort IQR across quarters

  16. Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities, all countries Trend : P=0.7299 Trend: P=0.0844 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  17. Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities Ethiopia Côte d'Ivoire Trend : P<0.0001 Trend : P<0.0001 Trend: P<0.0001 Trend: P<0.0001 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  18. Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities Lesotho Kenya Trend : P= 0.8220 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  19. Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities Mozambique Nigeria Trend : p=0.4302 Trend : P=0.0609 Trend: P=0.3939 Trend: P=<0.0001 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  20. Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities Rwanda South Africa Trend : P=0.5424 Trend : P=0.0039 Trend: P=0.0077 Trend: P=0.1162 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  21. Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities Tanzania Trend : P=0.4748 Trend: P=0.8395 Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.

  22. Adjusted RR* of non-retention after ART initiation per quarter increase in start date * Adjusted RR of retention per 1 unit increase in reporting quarter. Adjusted for age, sex, CD4 at ART initiation, facility type, and location. Bolding indicates significance at α=0.05 level.

  23. Adjusted RR (95% CI) for 6-month and 12-month non-retention after ART initiation Adjusted Risk Ratio Semi-urban vs. rural Urban-city vs. rural % children on ART % women on ART CD4 ≤ 200 at ART initiation 2ry/3ry vs. 1ry Quarter Private vs. 1ry 6 months after ART initiation, adjusting for age, sex, CD4 at ART initiation, location, and facility type 12 months after ART initiation, adjusting for age, sex, CD4 at ART initiation, location, and facility type

  24. Retention at ICAP-supported sites in context • Fox and Rosen meta-analysis: • 39 cohorts, 226,000 adults • 6 month retention: 86% • 12 month retention: 78%

  25. Conclusions (1) • Retention in ICAP-supported sites is on par with that observed in other cohorts and has remained steady over 7 years of scale-up • After adjusting for sex, age, CD4 at ART initiation, facility type, and location, cohort retention over time shows: • Overall no significant change in 6 m retention • Nominal decrease in 12 m retention • Significant improvement in 6 and 12 m retention in ETH • Nominal decrease in retention in CI (6 & 12 m), NG (6 & 12 m), SA (6 m), and RW (12 m)

  26. Conclusions (2) • Decrease in cohort retention in CI, NG, SA, RW likely due to: • Increase in number of facilities supported • Increase in number of patients enrolled (increase in cohort size) • Emphasis on de-centralization (undocumented transfers) • In some settings, political or labor strife • Data errors or change in definition • Relative risk for non-retention: • Higher risk for cohorts in higher- vs. lower-level sites (Decentralization?) • Higher risk for cohorts with lower median CD4 cell counts • Lower risk for cohorts with greater proportion of women initiating ART

  27. Thanks. . . • Matt Lamb • Wafaa El-Sadr • David Hoos • Michelle Moses-Eisenstein • Country teams • Tedd Ellerbrock

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