1. Program and Facility Characteristics Tracking System (PFaCTS) May 8, 2007 ICAP New York Data dissemination meeting

2. Outline Provisional data from first quarter of 2008
Proposed procedures for the development and implementation of new multi-country M&E indicators and data collection modules
Content area presentation
ICAP Program and Facility Characteristics Tracking System

3. I. Summary of ICAP-supported activities through March 2008
Care and treatment (cumulative)
256 of 284 sites reporting
458,848 patients have been cumulatively enrolled
in care since 2004, 213,549 of whom initiated ART.
TB screening in HIV patients (last quarter)
188 of 235 sites reporting
Of 30,050 newly enrolled patients, 68% were screened for TB at enrollment (compared with 65%, 61%, and 54% in the previous 3 quarters, respectively).
PMTCT (last quarter)
322 of 342 sites reporting
51,503 women attending ANC (first visit) were screened for HIV, 7,029 screened positive, and 2,579 received prophylaxis
8,070 PMTCT client partners were tested. 
Counseling and testing (last quarter)
198 sites (in 7 countries) providing services
131,540 individuals received counseling and testing for HIV and received their test results

6. Proposed procedures for the development and implementation of new multi-country M&E indicators and data collection modules

7. What constitutes a M&E data collection module (DCM)?
Any systematically collected indicator information that is collected across all ICAP country programs and facilities and is expected to be reported to ICAP-NY for the purposes of program monitoring and evaluation, program planning or analysis
Examples:
Quarterly care and treatment indicators
PFaCTS

8. Upcoming new indicators and DCMs
New indicators indicators
New suites of indicators as part of PEPFAR II
New data collection modules
Testing and counseling
Laboratory service indicators
Laboratory PFaCTS

9. Procedures for Developing new DCMs
A brief proposal for new DCMs must be submitted to the Director of the M&E unit
Proposal format and workspace page is under development
Proposals should include:
rationale for collecting the data
description of the type of data to be collected
summary of the existing infrastructure within ICAP programs to collect the data
proposed timeline
The ICAP Leadership will approve or reject the proposal for a new DCM
If approved, an MER-NY technical lead will be assigned to work with an ICAP-NY content expert and in-country M&E teams to develop an SOP for the DCM
The SOP will include:
A rationale for the DCM
Indicators/variables, definitions and data sources to be used
Procedures and roles/responsibilities for capturing data
Relevant existing sources of information (e.g., indicators, SOCs, etc) will be reviewed in the DCM SOP development process
Draft SOP will be piloted in at least one country; lessons learned will be incorporated in the SOP

10. Review & Implementation of Approved DCMs
The final draft of the DCM SOP will be shared for review and comment with ICAP-NY, Country Directors and relevant staff to discuss the rationale, importance and appropriateness of the DCM
Comments and issues on the proposed DCM will be taken, reviewed and resolved in the 2 weeks following the presentation of the DSM
Approximately 1 month after the comment period a finalized SOP will be distributed to the countries for implementation
The finalized SOP will be distributed to the countries
Country M&E teams and other relevant staff will be expected to begin implementing the SOP in the next reporting cycle (depending on the type of DCM)
Countries without the necessary infrastructure to implement the DCM will have more time, but will be expected to develop an implementation plan (with help from the M&E Liaison)

12. Presentation Outline Summary of recently submitted ICAP data
PFaCTS background
Program planning and implementation
with PFaCTS data
IV. Description and evaluation with PFaCTS data
V. Operational research with PFaCTS
VI. PFaCTS on URS

13. II. PFaCTS
Semi-annual facility assessment designed to capture information on:
Site characteristics
e.g., level of service, location
Facility characteristics
e.g., number of exam rooms
Program characteristics
e.g., program components, lab services, patient support
Contextual information
E.g., background HIV prevalence, urban/rural
Staffing information
E.g., staff configuration, staff turnover
First PFaCTS: January-June 2007

14. Strengths and limitations of PFaCTS
A helpful implementation tool
Gets at a wide array of program implementation (e.g., laboratory, patient-support services, context)
Measures aspects of implementation (e.g., comprehensiveness) that are not captured by conventional program indicators
Describes characteristics of facilities and programs, the contexts in which they operate, and their evolution
Structured approach and standard definitions
A helpful tool for operations research
Limitations
Limited depth with regard to information gathered on implementation of complex programmatic activities
Accuracy and validity needs assessment and attention
May improve with increased use
Hard to get standard application of definitions across so many settings

15. Program and Facility Characteristics Tracking System
Uses of PFaCTS:
Program planning and implementation: identifying gaps in care and tracking implementation of care and treatment programs
Description and evaluation: describe programs and scope of programs, assessing how programs are evolving
Evaluation and Operations Research: Examine associations between program, facility, and contextual information and patient outcomes, with both aggregate and patient-level data

16. treatment facilities supported
January-June 2007
July-December 2007
Number of care and
treatment facilities supported
255
274
Number of facilities reporting
care and treatment data
249
262
Number of facilities
completing PFaCTS
Round 1: 176
Round 2: 240
Current status
Number of facilities
completing both PFaCTS
175
Trends

18. III. Program planning and implementation

19. Support services available at sites

20. Laboratory assays available at sites

21. Staff configuration at sites

22. Trends in support services available at sites

23. Trends in laboratory assays available at sites

24. Trends in staff configuration at sites

25. IV. Description and Evaluation

26. Location and type of ICAP-supported HIV care and treatment sites

27. On-site services by location of HIV care and treatment facility
Rural sites
N=85
n(%)
Urban sites
N=154
VCT
85 (100)
154 (100)
TB clinic
ART pharmacy
59 (69)
137 (89)
PMTCT / ANC
Labor and delivery
49 (58)
111 (72)

28. Support services
What nutritional support services are being provided to patients at this facility?
Please choose all applicable responses. 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Nutritional counseling for adults
Nutritional evaluation
Infant feeding counseling
Multivitamins given to patients
Multivitamins & minerals given to patients
Vitamin A given to infants
Vitamin A given to women postpartum
Vitamin A given to other adults or non-infant children
Iron given to patients
Food support for adults
Infant feeding support (including formula, food basket post weaning, provision of other food supplements in support of weaning period)
Income generation activities to strengthen food security
None
Other_____________________

29. Support services (continued)
Is there an outreach program available at the site? 1 2
Yes No
Is a peer educator program available?
How often do patients at this facility see peer educators? 3 4 5
Once or more a month
Once every 1-3 months
Once every 4-6 months
Less frequently
Other ____________________

30. Support services (continued)
What ART adherence support activities are provided at this facility?
Please choose all applicable responses. 1 2 3 4 5 6 7 8 9 10 11 12
Counseling
Appointment slips
Written/pictorial patient education material
Pill boxes or blister packs
Calendars, checklists, or other reminders
Educational videotapes
Alarm clocks, wrist watches, beepers
Dedicated ART pharmacist
Pharmacist included on multidisciplinary team
Routine review of medication pick up
None
Other______________________

31. Proportion of ICAP-supported HIV care and treatment sites offering on-site patient support services by number of patients on ART (n=240)

32. Family-focused care model
Which of the following family-focused care service components are provided?
Please choose all applicable responses. 1 2 3 4 5 6 7 8
Querying index patients about family members’ HIV testing status
Testing or referral to VCT for adult family members with unknown HIV status
Testing or referral to VCT for pediatric family members with unknown HIV status
Encouraging enrollment of HIV positive family members into care and treatment
Family-centered support groups
Recording IDs of family members on patient charts
None
Other______________________

33. % of sites offering family-focused care service
Proportion of ICAP-supported HIV care and treatment sites offering family-focused care service components (n=240)
% of sites offering family-focused care service

34. Prevention related services
What prevention services are available for persons receiving care and treatment at this facility?
Please choose all applicable responses. 1 2 3 4 5 6 7 8
Counseling regarding disclosure to sexual partners
Education on sexual behavior changes and safer sex methods
Provision of condoms
Referral for on-site screening for sexually transmitted infections (STIs)
Education on high-risk substance-use behaviors and harm reduction practices
Screening for drug and alcohol abuse and when appropriate, referring for substance abuse treatment
None
Other________________________

35. % of patients accessing prevention services
Proportion of ICAP-supported HIV care and treatment sites with prevention services (n=240)
% of patients accessing prevention services

36. Laboratory services available to the care and treatment program
What is the availability and location of CD4 testing for patients at this facility?
What is the availability and location of CD4 percent testing for patients at this facility?
What is the availability and location of quantitative HIV RNA (viral load) testing for patients at this facility?
What is the availability and location of liver function testing for patients at this facility?
What is the availability and location of routine blood chemistry testing for patients at this facility? 1 2 3
Available on-site
Available off-site
Not available

37. Laboratory services (continued)
What is the availability of infant diagnostic testing for patients at this facility? 1 2 3 4
Dried blood smear or venous sampling, and laboratory testing (DNA PCR) available on-site
Dried blood smear or venous sampling available on-site, and laboratory testing (DNA PCR) available off-site
Dried blood smear or venous sampling, and laboratory testing (DNA PCR) available off-site
Not available

38. Proportion of ICAP-supported HIV care and treatment sites with access to key HIV-related laboratory assays (n=240)
ICAP Average=95%
% sites
* Key HIV-related laboratory assays include CD4, CD4 percent, HIV-RNA, LFT and blood chemistry.

39. Staffing Characteristics
How many non-pediatrician physicians are currently working in the facility?
Only include medical doctors and not medical assistants, medical officers, or medical technicians. Please exclude pediatricians.
Use the table below to note the number of physicians who attend to patients each day in the mornings and in the afternoons.
Question repeated for pediatricians, nurses, non-physician clinicians and other staff. S M T W Th F Sa AM PM

40. Number of full time equivalent providers
Number of full time equivalent providers at ICAP-supported HIV care and treatment sites by country and overall (n=240)
Number of full time equivalent providers 40

41. Mean number of ART patients per facility by country and overall, December 2007

42. Number of providers per 1000 patients on ART
Mean number of health care providers per 1000 patients on ART at ICAP-supported HIV care and treatment sites (n=240)
Number of providers per 1000 patients on ART

43. Assessing program evolution

44. Trend in proportion of ICAP-supported HIV care and treatment sites offering on-site services(n=175)

45. Trend in proportion of ICAP-supported HIV care and treatment sites offering on-site patient support services (n=175)

46. Proportion of ICAP-supported HIV care and treatment sites with access to laboratory assays (n=175)

47. V. Operational research

48. Are loss to follow-up rates associated with program and facility characteristics?
“Identifying Optimal Models of HIV Care Approaches in Sub-Saharan Africa” protocols funded by Doris Duke Charitable Foundation, CDC public health evaluations in Mozambique and South Africa

49. Availability of support services and lost to follow-up rates
Patient support groups
Peer educator program
Outreach program
Food support for adults
Food support for infants
Adherence support
Prevention services
Family planning provision
LTF rate *
25 de Setembro Health Center X
358
Akumi Health Center - Nacala 14
Anchilo Health Center
765
Catembe Health Center
Chicuque Rural Hospital
9.6
Chokwe Rural Hospital 45
Gurue Rural Hospital
231
* LTF rate = # patients lost to follow-up per 1000 person-years on ART

50. Through Sept 2007, subset for analysis
Lost to follow-up and person-years on ART
at ICAP-supported care and treatment sites
Through Sept 2007, subset for analysis
Number of sites ever reporting
N=164
Cumulative number ever on ART
104,412
Cumulative number lost to follow-up
8,573
Cumulative number of known deaths
6,211
Cumulative person-years on ART
81,479
Crude lost to follow-up rate†
105
Crude death rate (known deaths)† 76
Weighted and adjusted lost to follow-up rate†*
125
† Per 1000 person-years; weighted by cumulative ART enrolment and adjusted for country 50

51. Variability of LTF rates across facilities
LTF per 1000 person-years on ART
Facility

52. Variability of LTF rates across and within ICAP supported countries
LTF per 1000 person-years on ART

53. Lost to follow-up rates by availability of food support at ICAP-supported care and treatment sites
LTF per 1000 person-years on ART
mean=156
mean=134
Food support
No food support

54. LTF rate (multivariate)†
Linear regression results
LTF rate (multivariate)†
Rate Ratio
Support services available on-site
Adherence support
163*
0.76 (0.58, 0.96)
No adherence support (ref)
214
Ref
Food support
144*
0.77 (0.62, 0.96)
No Food support (ref)
187
Peer support
197
1.2 (0.97, 1.5)
No peer support (ref)
164
Outreach program
174
1.1 (0.88, 1.4)
No outreach program (ref)
160
ref
† per 1000 person-years on ART, weighted by cumulative ART enrolment and adjusted for country;
multivariate model also adjusted for type of site, location, age of program, provider to patient ratio
* p<.05

55. Next steps Round 3 of PFaCTS: June 2008
Enhance utilization of PFaCTS data for program tracking and planning
Descriptive analysis using PFaCTS data to describe scope of programs and evolution of programs during rapid scale up
Operational research:
- nutritional support and loss to follow-up
- program-level factors and CD4 count at ART initiation
- cost-effectiveness analysis to determine cost-effectiveness of support services

56. Acknowledgements Data collection and management:
- MER country teams and site staff
- MER-NY
Questionnaire development:
- ICAP leadership
- Desk officers
- Country directors
- Senior M&E advisors