Caitlin Madevu-Matson (cm3315@columbia.edu) Charon Gwynn (crg2128@columbia.edu) SI-NY

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Insights into HIV Care Service Comprehensiveness and Laboratory Capacity at ICAP-supported Facilities: Findings from PFaCTS 2013. Caitlin Madevu-Matson (cm3315@columbia.edu) Charon Gwynn (crg2128@columbia.edu) SI-NY. PFaCTS. - PowerPoint PPT Presentation

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<p>Slide 1</p> <p>Insights into HIV Care Service Comprehensiveness and Laboratory Capacity at ICAP-supported Facilities: </p> <p>Findings from PFaCTS 2013</p> <p>Caitlin Madevu-Matson (cm3315@columbia.edu) Charon Gwynn (crg2128@columbia.edu)SI-NY</p> <p>PIKU:Hi everyone, and welcome to the Data Dissemination webinar presented by ICAPs Monitoring and Evaluation unit. Today Caitlin Madevu-Matson and Charon Gwynn are going to present information gathered from ICAPs facility assessment survey, PFaCTS. They are going to focus on examining HIV care service comprehensiveness and laboratory capacity using information PFaCTS collects on HIV care and treatment clinics and laboratories and the facilities in which they operate.</p> <p>Now Id like to introduce Caitlin and Charon from the Strategic Information unit who will be presenting todays talk. If you have questions during the presentation you can type them into the chat box, and we will have time at the end of the presentation for a discussion on what was covered. With that, I turn things over to Caitlin Madevu-Matson.1PFaCTSStructured repeated assessment of facilities to describe the scope, diversity, capacity and comprehensiveness of ICAP-supported programsCaptures information not available from routine indicators :Context: Location, typeFacility characteristics: Related services, e.g. ANC, MCClinic and lab components: Staffing configuration and training, patient support services, laboratory quality essentialsData used for program planning, monitoring and evaluationReports and webinarsURSAnalyses with other data sources</p> <p>2CAITLIN:Thanks Piku. Hello, everyone. Today we are going to present information collected from ICAPs program and facility characteristics tracking system, which we call PFaCTS. PFaCTS is an assessment completed for facilities where ICAP supports HIV care and treatment clinics and laboratories to describe the scope, diversity, capacity and comprehensiveness of ICAP-supported programs. </p> <p>PFaCTS is a questionnaire carried out with health facility personnel that captures information that is not available within routine indicator data collection systems. It collects contextual information about each facility, such as location and facility type. PFaCTS also collects information about HIV-related services that are available within the larger facility such as antenatal care and male circumcision. Finally, the survey captures specific details of the HIV care and treatment clinic or laboratory, including staffing and training, patient support services, and laboratory quality essentials.</p> <p>PFaCTS data are summarized into reports and webinars like this one. The data are available on ICAPs Unified Reporting System, or URS, to use at site, district, country or ICAP-wide levels. Some have also used PFaCTS data in conjunction with other data sources such as patient level databases to examine the relationship between context and service availability with patient outcomes. In this webinar, we hope to show two new and innovative ways of using PFaCTS data.</p> <p>Please keep in mind that PFaCTS collects information about the availability of a service only, not whether or not patients receive it, or how many patients take advantage of the service.PFaCTS ImplementationAssessment toolsCore questions maintained from previous round, tool revised with clinical and programs unitsData collectionAssessments completed with health facility personnelQuestionnaires reviewed by in-country ICAP clinical and M&amp;E unitsData validated through checks and results uploaded to URS</p> <p>Care and Treatment PFaCTS7 rounds, 2007 - 201380 questionsLaboratory PFaCTS2 rounds, 2011 - 2013162 questions</p> <p>3There are two different PFaCTS assessments that have been implemented. ICAP started with an assessment carried out at facilities where ICAP supports HIV care and treatment programs. To date, the Care and Treatment assessment has completed 7 Rounds, and the final survey tool in 2013 contained a total of 80 questions. The other is carried out at facilities where ICAP supports clinical laboratories. The Laboratory assessment has completed 2 Rounds and the final survey tool in 2013 contained a total of 162 questions.</p> <p>For both assessments, each round of PFaCTS begins by revising the previous years data collection tool in collaboration with clinical and program units. Data are collected by ICAP country teams through in-person interviews with key health facility personnel and completed questionnaires are reviewed by ICAP clinical and M&amp;E advisors before submission. Results are then validated through the review of data checks and once finalized, the results are uploaded to the Unified Reporting System or URS, ICAPs web-based data management tool. </p> <p>Now I will move on to discuss the Care and Treatment assessment. Charon Gwynn will review the results of the Laboratory assessment later in the webinar. CARE &amp; TREATMENT PFaCTS ObjectivesPresent results from Care and treatment PFaCTS Round 7Describe the comprehensiveness of ICAP-supported programs</p> <p>In this section of the webinar, I am going to touch briefly on some of the information available in the Round 7 Care and treatment reports that were published last year and then present a new analysis on comprehensiveness of HIV care services using a comprehensiveness metric drawn from WHO guidance on priority interventions.4OutlinePFaCTS implementationCurrent characteristicsContext Facility ClinicComprehensiveness of HIV Care Service SummaryImplications</p> <p>5Here is the outline of this part of the webinar. We start with PFaCTS implementation specific to Care and Treatment.Definitions</p> <p>FacilityClinicThere are some key definitions to keep in mind during this presentation. In the context of PFaCTS, we use the term facility to refer to the larger institution supported by ICAP, such as the hospital or health center. The term clinic refers to the specific unit or department where care and treatment services are provided within that institution. 6Completeness of PFaCTS reporting over timeThis figure demonstrates the completeness of PFaCTS data collection over time. For each round we show the number of care and treatment clinics supported by ICAP at the time in light blue and the number which completed a PFaCTS assessment in dark blue. </p> <p>To date there have been 7 rounds of PFaCTS, beginning in January 2007 with 158 facilities participating through the most recent round completed in July 2013 that included 1,017 facilities. </p> <p>(**)7Completeness of PFaCTS reporting over time75%96%(**) ICAP country teams have consistently completed PFaCTS assessments for the majority of care and treatment clinics, increasing from 75% completeness in Round 1 to 96% in Round 7. This gives us a rich set of longitudinal data with which to track ICAP programs over time. 8OutlinePFaCTS implementationCurrent characteristicsContext : country, location and typeFacility : services provided outside the CT clinicClinic : services provided in the CT clinicComprehensiveness of HIV Care Service SummaryImplications</p> <p>9Now I will move to discussing the results from PFaCTS in 2013. We will explore briefly the context of the facilities, the facility services provided outside of the care and treatment clinic and the services offered by programs within the ICAP supported HIV care and treatment clinics.Countries contributing to PFaCTS Round 796% (1017/1062) of facilities with ICAP-supported care and treatment services completed PFaCTS Round 7In country completeness ranged from 79% to 100%</p> <p>This pie chart shows the proportionate representation of the different countries completing PFaCTS round 7. Nearly all facilities where ICAP supports HIV care and treatment services participated in Round 7: including Cote dIvoire, the Democratic Republic of the Congo, Ethiopia, Kenya, Mozambique, Swaziland, and Tanzania. In-country completeness ranged from 79% to 100%.10Facility location and Type11This figure describes the location and type of facilities where ICAP supports care and treatment. </p> <p>The bar on the left represents the geographic location of facilities. 51% of our care and treatment facilities are in rural settings, about a third are semi-urban, and 17% are urban. </p> <p>The bar on the right represents the types of facilities. 64% are public primary facilities, 15% are public secondary or tertiary facilities and 21% are classified as private or other. Availability of HIV related services (n=1017)Almost all facilities where ICAP currently supports care and treatment services also offer HIV testing and counseling through provider initiated counseling and testing and PMTCT services in antenatal care settings. 88% of the facilities reported that TB treatment was available at the facility.</p> <p>Now we will look in more detail at how facilities are providing PMTCT and TB services.12PMTCT Service Variation (n=991)This figure describes variation in PMTCT services provided across two different aspects. The bar on the left shows where ART is provided in ANC. Almost all facilities where ICAP supports care and treatment services also offer ART to eligible pregnant women in ANC at the same facility: 64% of the facilities provide ART within the ANC clinic, and 33% refer women to the HIV clinic for ART. Only 3% refer women to another facility.</p> <p>The bar on the right shows what WHO Option is being implemented. The majority of facilities where ICAP supports care and treatment services are implementing the World Health Organizations Option A where pregnant women are determined to be eligible for ART depending on certain CD4 or staging criteria. 3% of facilities are implementing Option B where all pregnant women are put on triple therapy for prophylaxis for the duration of their pregnancy, but not for lifelong treatment. Almost a third of facilities recently began implementing Option B+ where all pregnant women are eligible for lifelong ART. 13TB service Variation (n=1,017)This figure describes variation in TB services provided across 3 different aspects.</p> <p>59% of ICAP-supported care and treatment clinics offer Isoniazid Preventive Therapy, IPT, and 72% triage TB suspects.</p> <p>In the bar on the right, a total of 88% of facilities where ICAP supports care and treatment services provide TB treatment. Of these the majority offer TB treatment only in the TB clinic, shown in purple. 28% of facilities report that they offer TB treatment directly in the HIV care clinic for TB/HIV patients, shown in red and green. 14Availability of key patient support services (n=1017)15This figure shows the proportion of ICAP supported HIV care and treatment clinics that offer a number of critical patient support services. Nearly all clinics offer ART adherence counseling. Most supported clinics distribute male condoms and offer outreach programs to identify and contact patients who miss either clinical consultations or ARV pick ups. Nutritional treatment is becoming more common at supported clinics. </p> <p>Now we will look in more detail at how clinics are providing adherence, outreach and secondary prevention services.Type of ART adherence support available</p> <p>This slide summarizes the type of ART adherence support provided at ICAP-supported HIV clinics.In round 7 a majority of the clinics provide appointment reminder cards. Less commonly offered were handouts - such as pictorial patient education materials - Pill boxes, calendars or checklists to track ART ingestion, or screening of educational videos.16Outreach activities by type of personnelNow lets look at the type of personnel involved in outreach activities.Peer educators conducted outreach activities at 61% of the clinics and clinicians at 42%. Other personnel such as designated outreach workers and social workers conducted outreach activities less commonly. 17Secondary prevention service availabilityThis slide summarizes secondary prevention services offered at ICAP-supported HIV care and treatment clinics.</p> <p>Almost all clinics provide education on sexual behavior change, and the majority provide STI screening and education on high risk substance abuse. Just under half of clinics offer screening for drug and alcohol abuse. 18OutlinePFaCTS implementationCurrent characteristicsContextFacilityClinicComprehensiveness of HIV Care Service SummaryImplications</p> <p>19Now we will review the components of comprehensive HIV care service.</p> <p>HIV CareComprehensivenessComponentsQuestionsDoes ICAP support comprehensive HIV care programs?Has comprehensiveness of HIV care programs changed over time?Is there variability in the changes?20While it is important to evaluate the impact of offering specific services or combinations of services on patient outcomes to construct effective models of care, another vital but rarely examined aspect is the capacity to deliver comprehensive. As we have seen in this presentation, HIV care requires the provision of diverse and numerous services, so the ability to offer a complete comprehensive package in one facility may have its own impact on outcomes. In this webinar, we wanted to answer whether ICAP supports comprehensive HIV care programs and if so, has comprehensiveness of HIV care programs changed over time. We also wanted to know whether there is any variability in the change by characteristics like participation in all rounds of PFaCTS and by facility type. To define comprehensiveness, we used WHOs priority interventions for HIV/AIDS prevention, treatment and care guide from 2010.WHO Priority Interventions1. Enabling people to know their HIV statusVCT / PITC2. Maximizing the health sectors response to HIV preventionPreventing sexual transmissionInterventions for IDUPMTCT3. Scaling up HIV/AIDS treatment and carePreventing and treating illnessTreatment and care for HIVLab services for HIV monitoring21The WHO Priority Interventions fall into 3 areas. </p> <p>In the first area, Enabling people to know their HIV status, HIV testing is an important component through traditional voluntary counseling and testing (VCT) and provider initiated testing and counseling (PITC).</p> <p>In the second area, Maximizing the health sectors response to HIV prevention, preventing sexual transmission, interventions for injecting drug users (IDUs) and preventing mother to child transmission (PMTCT) are components.</p> <p>In the third area, Scaling up HIV/AIDS treatment and care, preventing and treating other illnesses, treatment and care for HIV, and laboratory services for HIV monitoring are components. WHO Priority InterventionsComprehensive components from PFaCTS1. Enabling people to know their HIV statusVCT / PITCPITC on-site2. Maximizing the health sectors response to HIV preventionPreventing sexual transmissionEducation on behavior change, STI screening, condomsInterventions for IDUScreening and education on substance usePMTCTPMTCT on-site3. Scaling up HIV/AIDS treatment and carePreventing and treating illnessCotrimoxazole and TBNutritional counselingTreatment and care for HIVAdherence support Outreach servicesLab service...</p>

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