icap data dissemination meeting
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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 - PowerPoint PPT PresentationTRANSCRIPT
ICAP Data Dissemination Meeting
August 31, 2011
Number of activities at currently supported facilities as of June 2011Nu
mbe
r of f
acili
ties
Source: ICAP Site Census, June 2011Note: Some facilities offer more than one activity.
Total Kenya Tanzania Mozambique Nigeria Lesotho South Africa Cote d'Ivoire Ethiopia Swaziland DR Congo Rwanda Zambia0
500
1000
1500
2000
25002,443
792687
196 176124 132 117
8563
14 532
15757
2 19 19 10 1 47 2
Num
ber o
f fac
ilitie
sNumber of facilities ever supported and transitioned
by ICAP as of June 2011
Source: ICAP Site Census, June 2011
Number of facilities ever supported by ICAP
Number of facilities transitioned or in transition
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
• 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
ICAP accomplishments as of June 2011 (2)
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
• DataBytes• ICAP data dissemination webinars• ICAP methodology webinars
New data dissemination and use initatives
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)
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)
Trends in ART retention at ICAP-supported care and treatment sites
Batya ElulSuzue Saito
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.
Source: Cornell et al, 2010
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
• 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
Methods (2)
Median proportion of patients initiating ART included in 6/12 month cohorts, by country
6 month cohort 12 month cohort IQR across quarters
Cote d'Ivo
ire
Ethiopia
Kenya
Leso
tho
Mozambiq
ueNige
ria
Rwanda
South
Africa
Tanza
nia
All countr
ies0%
20%
40%
60%
80%
100%
Perc
ent i
nclu
ded
1/1/20
05
1/1/20
06
1/1/20
07
1/1/20
08
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
100
200
300
400
500
600
80%, 295
79%, 19384
83%, 95
73%, 20343
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
Cohort retention (6 and 12 months) after ART initiationat 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.
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
10
20
30
40
50
42%, 205
55%, 517
75%, 12
45%, 488
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
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.
Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities
1/1/20
06
1/1/20
07
1/1/20
08
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
10
20
30
40
50
60
70
76%, 7081%, 2094
59%, 747
73%, 2240
Reporting Quarter
Perc
ent r
etai
ned Num
ber of clinics
Data entry error
7/1/20
06
7/1/20
07
7/1/20
08
7/1/20
09
7/1/20
100%
25%
50%
75%
100%
0
5
10
15
20
25
30
35
64%, 382 74%, 1436
64%, 140 64%, 1499
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
Trend: P=0.2857
Lesotho Kenya
Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.
Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities
Trend : P= 0.8220
1/1/20
05
1/1/20
06
1/1/20
07
1/1/20
08
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
20
40
60
80
100
120
140
160
75%, 77 82%, 4586
79%, 22391%, 3629
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
Trend : P=0.0717
Trend: P=0.5247
10/1/
2007
10/1/
2008
10/1/
2009
10/1/
2010
0%
25%
50%
75%
100%
0
5
10
15
20
25
30
3586%, 12781%, 1754
71%, 127
68%, 3489
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
7/1/20
05
7/1/20
06
7/1/20
07
7/1/20
08
7/1/20
09
7/1/20
100%
25%
50%
75%
100%
0
10
20
30
40
50
60
88%, 173
78%, 507593%, 14
69%, 4728
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
Mozambique Nigeria
Trend : P=0.0609
Trend: P=<0.0001
Trend : p=0.4302
Trend: P=0.3939
Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.
Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities
1/1/20
05
1/1/20
06
1/1/20
07
1/1/20
08
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
10
20
30
40
50
100%, 18
88%, 80100%, 23
79%, 52
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
1/1/20
07
1/1/20
08
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
10
20
30
4090%, 50
77%, 3117
93%, 28
50%, 3970
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
No reports
South AfricaRwanda
Trend : P=0.0039
Trend: P=0.1162
Trend : P=0.5424
Trend: P=0.0077
Note: Significance testing for trend analysis reflects crude RR of retention per 1 unit increase in reporting quarter.
Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities
1/1/20
05
1/1/20
06
1/1/20
07
1/1/20
08
1/1/20
09
1/1/20
10
1/1/20
110%
25%
50%
75%
100%
0
20
40
60
80
100
120
92%, 4974%, 2,161
100%, 269
67%, 1,747
Reporting Quarter
Perc
ent r
etai
ned
Number of clinics
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.
Cohort retention (6 and 12 months) after ART initiation at ICAP-supported facilities
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.
Country RR 95% CI RR 95% CI
6 months 12 months
All countries 1.00 0.99, 1.01 1.01 1.00, 1.02
Côte d'Ivoire 1.05 1.03,1.07 1.06 1.04, 1.09
Ethiopia 0.98 0.97, 0.99 0.98 0.97, 0.99
Kenya 0.99 0.97, 1.00 0.99 0.97, 1.01
Lesotho 1.00 0.97, 1.03 1.00 0.97, 1.04
Mozambique 1.01 0.99, 1.04 1.01 0.98, 1.04
Nigeria 1.02 1.00, 1.04 1.04 1.03, 1.06
Rwanda 1.00 0.97, 1.02 1.03 1.00, 1.05
South Africa 1.02 1.00, 1.04 1.00 0.99, 1.02
Tanzania 1.00 0.99, 1.01 1.00 0.99, 1.01
0.0
1.0
2.0
Adjusted RR (95% CI) for 6-month and 12-month non-retention after ART initiation
% women on ART
2ry/3ry vs. 1ry Urban-city vs. rural
Semi-urban vs. rural
Quarter % children on ART
Private vs. 1ry CD4 ≤ 200 at ART initiation
Adju
sted
Ris
k Ra
tio
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
Jan-05
Apr-05
Jul-05
Oct-05
Jan-06
Apr-06
Jul-06
Oct-06
Jan-07
Apr-07
Jul-07
Oct-07
Jan-08
Apr-08
Jul-08
Oct-08
Jan-09
Apr-09
Jul-09
Oct-09
Jan-10
Apr-10
Jul-10
Oct-10
Jan-11
Apr-11
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
83%
79%
80% 75%71%
71%73%
85%83.0% 82.0% 72.0%
ICAP: Percent retained 6 months ICAP: Percent retained 12 months Cornell: Percent retained 12 months
Reporting Quarter
Perc
ent r
etai
ned
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%
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)
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
Thanks. . .
• Matt Lamb• Wafaa El-Sadr• David Hoos• Michelle Moses-Eisenstein• Country teams• Tedd Ellerbrock