AIDS Prevention Initiative Nigeria Monitoring and Evaluation in the Transition Toyin Jolayemi – APIN Ltd Seema Meloni - Harvard.

AIDS Prevention Initiative Nigeria

Monitoring and Evaluation in the

Transition

Toyin Jolayemi – APIN LtdSeema Meloni - Harvard

Wednesday, April 19, 2023


Wednesday, April 19, 2023 2

Background

Harvard supporting sites since 2004 Since 2008, APIN has been funded by CDC Nigeria

to transition sites from Harvard




Service Delivery

Based on National Guidelines and Harvard/APIN protocols




Overall Enrollment

Jul-Dec 08 Jan-Jun 09 Jul-Dec 09 Jan-Jul 10

NIMR

New on Care 1,344 1,400 1,271 1,169

New on ART 970 755 653 661

Current on Care 6,700 7,261 7,741 7,932

Current on ART 4,684 4,922 5,157 5,510

LUTH

New on Care 1,048 1,077 928 896

New on ART 657 811 705 691

Current on Care 5,188 5,661 5,962 6,317

Current on ART 3,989 4,237 4,623 4,960




QA/QI (1): Continuity of Care


NIMR

% of patients with ≥1 clinical visit in the last 6 months and 6 months apart

70.5 68.6 76.7 71.5

% of ART patients who had ≥1 pharmacy pick-up and/or ≥1 clinical visit in the last 6 months

51.4 67.9 71.5 72.3

LUTH

% of patients with ≥1 clinical visit in the last 6 months and 6 months apart 82.5 81.8 83.9 84.4

% of ART patients who had ≥1 pharmacy pick-up and/or ≥1 clinical visit in the last 6 months

55.8 61.2 64.9 68.4




QA/QI (2): OIs including TB


NIMR% of patients who were screened for TB by clinical symptoms during the past 6 months 97 97.9 98.4 97.8

% of patients initiated on TB treatment within 2 months of confirmed TB diagnosis 38.3 53.9 68.8 79.8

% of patients with at least one CD4 count ≤350 on CPT 49.5 87.4 87.7 87.5

LUTH% of patients who were screened for TB by clinical symptoms during the past 6 months 95.9 97 97.2 97.4

% of patients initiated on TB treatment within 2 months of confirmed TB diagnosis 58.8 62.1 56.4 53.3

% of patients with at least one CD4 count ≤350 on CPT 48.8 68.5 80.1 78.7




QA/QI (3): Patient Monitoring


NIMR

% of new patients who got baseline CD4 91.3 90.0 85.6 83.5

% of patients who got ≥1 CD4 assessment during 6-month review period

94.9 96.1 75.7 88.5

LUTH

% of new patients who got baseline CD4 92.6 92.7 92.0 94.5

% of patients who got ≥1 CD4 assessment during 6-month review period

90.7 84.9 87.9 90.8




Cohort Analysis

Date Range for 6 Month CD4 Count Jul-Dec 08 Jan-Jun 09 Jul-Dec 09 Jan-Jul 10

Starting Cohort Date Range Aug 07 - Jan 08 Feb 08 – Jul 08 Aug 08 – Jan 09 Feb 09 – Jul 09

NIMR

# of patients in the starting cohort 536 1141 752 800

# with baseline CD4 count 481 (90%) 980 (86%) 685 (91%) 727 (91%)

Median baseline CD4 count 142 143 157 144

# from the starting cohort still picking up ART at month 6 435 (82%) 948 (83%) 602 (80%) 672 (84%)

# with CD4 count at month 6 361 (83%) 790 (83%) 516 (86%) 436 (65%)

Median CD4 count at month 6 251 309 336 318

LUTH

# of patients in the starting cohort 526 547 588 709

# with baseline CD4 count 511 (97%) 518 (95%) 563 (96%) 658 (93%)

Median baseline CD4 count 143 144 145 188

# from the starting cohort still picking up ART at month 6 472 (90%) 389 (71%) 402 (68%) 544 (77%)

# with CD4 count at month 6 302 (64%) 329 (85%) 353 (88%) 453 (83%)

Median CD4 count at month 6 291 284 294 325




Clinical Outcomes


NIMR

% with VL≤400 after 6 months on ART

82 79.9 84.2 79.4

LUTH

% with VL≤400 after 6 months on ART

70.3 70.1 74.2 81




Transition of QA Efforts

APIN Central Central QA committee in place QA indicators harmonised with

GON QA/QI toolkit in place Training on QA/QI framework

and processes Mentoring of Sites

Site Site QA committee in place including

focal person and data staff QA framework/plans in place QA activities ongoing Sites starting to run data for QI Training on QA/QI framework and

processes

Technical Assistance from Harvard QA /QI SOP and QUiC tool developed; Analysis for QI Support training and provide TA on QA/QI




Summary

Development of tools to monitor the impact of transition on clinical outcomes is critical.

Methods of analysis and ultimate significance require empirical approach.

Increased communication with transitioned site personnel and patients will inform the process.

AIDS Prevention Initiative Nigeria Monitoring and Evaluation in the Transition Toyin Jolayemi – APIN Ltd Seema Meloni - Harvard.

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