1. Plans for Analysis of USG Emergency Plan Multi-Country ART Program John Aberle-Grasse CDC, Global AIDS Program U.S. Department of Health and Human Services

2. Analysis Proposal Analyze the “quantity” and “quality” of HIV care and treatment programs supported by the USG multi-country partners across the 15 Emergency Plan focus countries Publish “simple” description of results in a prominent medical or public health journal, submitted in approximately 9-12 months

3. Analysis Rationale The Emergency Plan ART program is very large and complex and should be monitored and evaluated to assess progress both in scale-up and service quality Program success (and challenges) should be published to inform the medical and scientific community and the US public that supports the program

4. Analysis Rationale Track 1.0 grantees (4) and the Department of Defense and Family Health International provide direct ART services across multiple countries to over 1/3 of patients in the Emergency Plan This large (relatively) standardized ART program data and reporting represents a unique and significant opportunity to describe the extent and quality of HIV care and treatment being supported by the USG

5. Proposed Title and Authorship Working title- Scale up of Antiretroviral therapy by Emergency Plan Multi-country partners: 2004-2007 Authorship- Emergency Plan Multi-country ART Partner and Agency Group

6. Analysis Based on recommendations by the US Office of the Global AIDS Coordinator Adult Treatment Technical Workgroup for description of USG-funded HIV care and treatment programs Describe services provided between Track 1.0 program start up in 2004 through Sept 30, 2007

7. Quantity of Program (scale up) Calculate quarterly- FY04Q4 to FY07Q4 Patients ever enrolled in HIV care Patients currently in HIV care Patients ever started on ART Patients started on ART during quarter Patients currently on ART Facilities providing ART Analysis

8. Quality of Program- (cohort) Proportion alive and on ART (6, 12, 24 mos) Including transfer in, excluding transfer out Median difference in CD4 from start Proportion with undetectable viral load (<400 cells/µl) Proportion started on 2nd line ART Proportion not on ART (6, 12, 24 mos) Died Stopped Lost to follow up Of those enrolled in HIV care, proportion on care at 12 months Analysis

9. Administration of analysis Task Force to guide and move analysis Include participants from USG agencies and grantee partner groups Contact John Aberle-Grasse at this meeting, or phone, or email The USG work group includes: CDC GAP: Tedd Ellerbrock, Laura Porter, Seymour Williams, Hong-Ha Truong, John Aberle-Grasse USAID: Robert Ferris HRSA: Jin Park DoD: To be determined

10. ActivityDateComments Convene Task ForceSept 26 Data request sent to partnersOct 5Quantity & Quality data Quantity data dueNov 15Partners submit (routine) Data & analysis meetingNov 16-21Data problems & analysis Report for Track 1.0 completeDec 15Routine tables, etc Quantity data analysis dueJan 12Partners review Quality data dueJan 12Partners submit Quality data analysis dueFeb 15Partners review Full paper for reviewMar 28Partners review Analysis- Proposed time table

11. Thoughts for Discussion Do partners support this proposal? Have quarterly data from Track 1.0 partners, is data for DoD and FHI readily available? What disaggregation? (sex, age, country, partner, facility type) How best do we “simplify” and present multi- country, multi-partner “quality” analysis? Additional analysis of more detailed issues and data subsets Other thoughts?

12. For more information contact: John Aberle-Grasse CDC GAP 1600 Clifton Rd, MSE 30 Atlanta, GA 30333 404.639.6201 Email: JAberleGrasse@cdc.gov

13. Analysis Specific program attributes proposed to be measured include Program scale up Facilities providing ART Patients ever started on ART Patients started on ART each quarter Patients currently on ART Patients on HV care Program quality Of persons who enrolled in ART, what proportions are alive and on ART at 6, 12, 24, and 36 months of therapy? Of those who enrolled in ART but are not currently on ART, what proportions (a) died, (b) stopped therapy, (c) transferred, or (d) were lost to follow up at 6, 12, 24, and 36 months? Of persons on ART, what is the median differential between the CD4+ cell count at baseline and the CD4+ count at 6, 12, 24, and 36 months? Of those who are on ART, what proportion have undetectable viral load (<400 cells/µL) at 6, 12, 24, and 36 months? Of persons enrolled in care (i.e., both those receiving and not receiving ART), what proportion is in care and/or on ART at 12 months?