project heart update 8 th annual cdc/hrsa track 1.0 meeting nicole buono, project director
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Project HEART Overview
• Where we work• Results- Adult and ped care and
treatment and PMTCT• Ped counselors in Zambia in
improving enrollment and retention• Program quality data• Data quality• PY8 priorities
Trends in Number of Active Care and Treatment Sites, Project HEART
*Q1-4 numbering refers to calendar quarter (ie Q2 2010=Apr-Jun 2010)
Q4 20
04
Q1 20
05
Q2 20
05
Q3 20
05
Q4 20
05
Q1 20
06
Q2 20
06
Q3 20
06
Q4 20
06
Q1 20
07
Q2 20
07
Q3 20
07
Q4 20
07
Q1 20
08
Q2 20
08
Q3 20
08
Q4 20
08
Q1 20
09
Q2 20
09
Q3 20
09
Q4 20
09
Q1 20
10
Q2 20
100
20
40
60
80
100
120
140
160
180
Cote d'Ivoire Mozambique South Africa Tanzania Zambia
Quarter
Num
ber
of
site
s
Number and percent of PY6 target achieved:
Patients ever started on ART during PY6 (April 2009-March 2010)
Country
Number of patients ever on ART end of
PY6
PY6 target for total number of patients ever on ART end of PY6
% of target achieved
Cote d'Ivoire 65,023 63,000 103.2%
Mozambique 30,778 26,936 114.3%
South Africa 118,492 74,259 159.6%
Tanzania 56,150 44,999 124.8%
Zambia 150,946 132,000 114.4%
ALL 421,389 341,194 123.5%
Number and percent of PY6 target achieved:
New children started on ART during PY6 (April 2009-March 2010)
CountryNew Children on ART during
PY6
Target for New Children on ART during
PY6
% of targets achieved total in PY6 (Q2 09-Q1 10)
Cote d'Ivoire 856 1,000 85.6%Mozambique 1,313 1,640 80.1%South Africa 4,531 2,786 162.6%
Tanzania 1,418 1,672 84.8%Zambia 2,286 2,588 88.3%
ALL 10,404 9,686 107.4%
PY6 PMTCT Targets and Achievements
Cote d'Ivoire Mozambique South Africa Zambia0%
20%
40%
60%
80%
100%
120% 109%116%
101%
109%
99%
62%
91%
101%97%
52%
100%104%
Women receiving HIV test results Women testing + for HIV Women receiving ARV prophylaxis
Perc
enta
ge o
f PY6
Tar
get M
et
Project HEART PMTCT Data: PY6Cote
d'IvoireMozambique South Africa Zambia
Women receiving HIV test results 174,172 155,049 134,817 175,626Women testing + for HIV 7,900 13,012 32,191 22,674Women receiving ARV prophylaxis 6,221 8,177 35,612 22,346
Percent distribution of children ever started on ART by age group by the end of the quarter,
April – June 2010
Cote d'Ivoire Mozambique South Africa Tanzania Zambia0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
15.6
40.9
12.418.1
27.2
29.5
27.1
22.5
23.1
22.2
54.9
32.1
65.258.8
50.5
0-1 year 2-4 years 5-14 yearsCountries
Perc
enta
ge o
f ch
ildre
n
N=2849 N=2445 N=13001 N=10824N=4835
Zambia pediatric counselors and impact on enrollment and retention of children
• Pediatric ART enrollment and retention challenging
• 103 counselors in Zambia were trained using the two-
week ANECCA/CRS pediatric counseling course
• Used program data- the difference between 2008 and
2009 enrollment and attrition of children and adults
• Statistical analysis using paired t tests.
• Among 64 sites, 47 met the criteria for the enrollment
analysis and 55 for attrition, 30 sites with trained
pediatric counselors
Zambia Experience: Results
Before Trained Pediatric Counselors (Q3) After Trained Pediatric Counselors (Q4)0
2
4
6
8
10
12
14
16
18
20
Pediatric ART Enrollment in 30 sites that Introduced Pe-diatric Counsellors
Pediatric ART Enrollment (N)
Num
ber o
f Chi
lren
Enro
lled
p>0.01
Zambia Experience: Results (2)
Sites with Trained Counselors (N=31) Sites without Trained Counselors (N=24)0%
2%
4%
6%
8%
10%
12%
Comparison of Pediatric Attrition Rate (%) of Sites that Introduced Pediatric Counselors and Sites that Did Not
Average Pediatric Attrition Rate (%)
% A
ttriti
on R
ate
p=0.02
Zambia Experience: Conclusions
• The number of children enrolled in ART increased
more in ART treatment sites with trained pediatric
counselors than in sites without counselors,
outpacing adult enrollment; attrition also decreased
more in these sites.
• Limitations include inter-site variability and difficulty
identifying and controlling for confounders.
• A larger matched case-control study is recommended
to control for site variations.
Tanzania Performance 2009-2010
CD4 enroll CD4 review Eli on CTX Adh coun Missing char Not seen0
20
40
60
80
100
120
TZ QI performance 2009 at 34 sites 894 files vs. 2010 35 sites, 1617 files
performance 2009
Performance 2010
Côte d’Ivoire Quality Improvement 2007-2009
base CD4
Cd4 in re
view
Eli on CTX
Eli on ART
Adherence
counsel
ing
TB sc
reening
TB sp
utum/X ra
y
WT d
one
Missing fi
les
Not see
n during r
eview
period
0
10
20
30
40
50
60
70
80
90
100
QI measurement 2007- 2009 CIn=3559 files reviewed in 42 sites 2009
Oct 07 -April 08 July-Dec 08 Jan-Dec 09
Zambia Quality Improvement Performance 2009-2010
Base cd4 Base Ht & Wt
Cd4 at 9/12 Eligible on ART
PCP Proph Base ALT Creatinine 3/12 Visit Base HB0
10
20
30
40
50
60
70
80
90
100
Zambia QI Performance all sites March 2009 Vs. March 2010
Zambia QI performance March 2009
Zambia QI performance March 2010
Data Quality Update Country Accomplishments Remaining Work/Plan
Cote d’Ivoire
•Conducted internal assessments in 26 largest sites representing 75% of pts on ART• Site discrepancy average is 13%, only 5% if use cumulative patient data. •Variability across sites
•Internal assessments to be completed in remaining sites by September, 2010•Continue to work with CDC and MoH to harmonize definitions
Mozambique
•Patient monitoring database (PTS) fully functional in 26 of the 42 sites allowing for accurate tracking of pts “currently on ART”•Completed SOPs for provincial staff to conduct data quality checks
• Assessments in remaining paper-based sites to begin in May and completed this year. •Training provincial staff to do data quality checks
Tanzania•New Data Management Team has conducted internal assessment in all 165 C&T sites
• Working with districts on data utilization to improve quality
Data Quality Update (2)
Country Accomplishments Remaining Work/Plan
South Africa •CDC/South Africa asked all PEPFAR partners to suspend extensive DQA efforts until CDC/SA formalizes DQA guidelines.•South Africa has begun own assessments • M&E team attended JSI training
•Global M&E country backstop travelled to SA in May for DQA TA•In the final stages of hiring a long-term M&E consultant to assist SA team to implement M&E best practices.
Zambia •Internal DQA conducted in 24 of 65 sites•Results were mostly excellent with a few rural sites under-reporting due to lack of data entry staff.
•Plan is to complete internal DQAs in remaining sites by October 31, 2010.•Zambia is also working on addressing data entry staffing issues which may be causing under-reporting.
PY8 Priorities
• Prepare for smooth transition of programs in all countries
• Advance transition objectives, monitor and document transition
• Continue to improve program quality• Continue to focus on improved data
quality• Initiate project closeout (starts in PY7)
Acknowledgements
CÔTE D’IVOIRE• Anna Likos , Alexandre Ekra, and the
CDC/CI team• MOH CI, regional and district
authorities• Joseph Essombo, Anthony Tanoh
and the EGPAF/CI team
EGPAF Global• Rose McCulloughh• Nicole Buono• Stephen Lee• Richard Marlink• Theresa Wolters• Rozalin Wise• Stephanie Calves• Shauna Eisenberg• Solome Paulos• Elizabeth Flanagan• Nick Hellmann• Trish Karlin• Anja Giphart• Shobana Ramachandran• Eric Nawar• Penny Smith• Andrea Wahl• Dorace Trottier• Ashley Thompson• Sean Maher• Amelie Sow-Dia
……..AND ALL OF OUR PATIENTS, PARTNERS, STAFF AND DONORS
MOZAMBIQUE• Lisa Nelson, Kebba Jobarteh,
Charity Alfredo, Paula Morgan and CDC/Moz
• MOH Moz, provincial and district authorities
• Nancy Fitch, Cathrien Alons, and the EGPAF/Moz team
SOUTH AFRICA• Thurma Goldman, Jeff Klausner,
Lerato Lesole, and CDC/SA• DOH SA and provincial and district
authorities• Kuku Appiah, Pumla Lupondwana
and the EGPAF/SA team
TANZANIA• John Vertefeuille, Thomas
Finkbeiner, Mohamed Mfaume and CDC/TZ
• MOH TZ, regional and district authorities
• Anja Giphart, Jeroen van Padt Bosch and the EGPAF/TZ team
ZAMBIA• Larry Marum, Deborah Connor,
Isaac Zulu and CDC/Zambia• Susan Strasser and the
EGPAF/Zambia team• MOH Zambia, provincial and
district authorities• Jeff Stringer, Elizabeth Stringer,
Carolyn Bolton, Stewart Reid and the entire CIDRZ team
CDC/ Atlanta• Tedd Ellerbrock• Diane Flournoy• Bud Bowen• Janna Brooks• Josef Amman• Elliot Raizes• Tom Spira• Angeli Achrekar• Carla Johnson• Laura Porter• Joe Barker• John Aberle-Grasse
OUR PARTNERS HERE THIS WEEK
CIDRZ (Zambia)• Geoffrey SiliwizyaHealth Services Payment Authority (Cote d’Ivoire )• Kone IdrissaDistrict Medical Officer (Tanzania)• Cristo NkyaGauteng Province Medical Advisor (South Africa)• Zukiswa Pinini
This presentation was made possible through support provided by the U.S. Centers for Disease Control and Prevention (CDC), through the President’s Emergency Plan for AIDS Relief (PEPFAR), as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Project HEART”/Cooperative Agreement No. U62/CCU123451). The opinions expressed herein are those of the authors and do not necessarily reflect the views of CDC.
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