ICAP Quarterly Master Slide Set July-September 2007

ICAP Quarterly Master Slide SetJuly-September 2007

Site Census

• What: Ongoing, real-time inventory of all planned, current, and closed ICAP sites. Supported activities, funding source(s) and their targets are also captured

• Purpose: To have one up to date master list of sites, activities, funding sources, and targets that all ICAP staff can refer to for planning and evaluation

240214

10492

237

170196

243

409

0

200

400

Overa

ll

Care

& trea

tmen

t

TB scr

eenin

g fo

r HIV

pts

HIV te

sting

for T

B pts

PMTCT

PM

TCT+EID

PICT/

VCTLa

b

Source: ICAP Site Census, November 2007

Number of ICAP-supported sites by activity, September 2007 (n=409)

Nu

mb

er

of

site

s


Number of ICAP-supported sites by country, September 2007 (n=409)

Nu

mb

er

of

site

s

Programmatic components funded at ICAP-supported care and treatment sites (n=243),

September 2007

37%43%

49%

60%65%

81%

100%

0%

50%

100%

Care &Treatment

TBscreening inHIV patients

Lab HIV testingin TB

patients

PICT/VCT PMTCT Early infantdiagnosis

Type of activity


% c

are

and

trea

tmen

t si

tes

with

act

ivity

Program and Facility Characteristics Tracking System (PFaCTS)

• What: Collects program and facility information on ICAP-supported care and treatment programs semi-annually

• Purpose: To describe the scope, diversity, and comprehensiveness of ICAP-supported care and treatment programs, and evaluate multi-level factors that influence program performance and patient-level outcomes

0%

50%

100%

Urban Rural

Primary Secondary Tertiary

Location and type of ICAP-supported HIV care and treatment sites (n=177)

Source: PFaCTS, January 2007

120 57

% s

ites

On-site HIV service infrastructure at ICAP-supported HIV care and treatment sites by type of

service (n=177)


% s

ites

with

ser

vice

Number of on-site HIV service infrastructure* provided at ICAP-supported HIV care and

treatment sites (n=177)


*Services include: VCT, TB treatment, PMTCT, Labor and delivery, and ART pharmacy.

On-site HIV service infrastructure* at ICAP-supported HIV care and treatment sites by country

(n=177)


49%

75%82%

87%94%97%99%100%100%

0%

50%

100%

Swazila

nd

Leso

tho

Niger

ia

Ethiop

ia

Tanza

nia

Kenya

Rwanda

Moz

ambiq

ue

South

Afri

ca

* Sites that have >=4 of the following on-site services are represented in the graph: VCT, TB treatment, PMTCT, Labor and delivery and ART pharmacy.

ICAP Average

=80%

% s

ites

with

ser

vice

Type of patient support services available at ICAP-supported HIV care and treatment sites (n=177)


* Only counts those sites that provide adherence support by trained personnel. Other categories of adherence support activities are not represented here.

% s

ites

with

ser

vice

Number of patient support services provided at ICAP-supported HIV care and treatment sites (n=177)


* Services include: ART adherence support, outreach program, peer educator program, food support for adults, food support for infants.

0% 0% 0% 0%

6%9%

21%

33%

68%

0%

50%

100%

Comprehensiveness* of on-site patient support services at ICAP-supported HIV care and treatment

sites (n=177)


* Comprehensiveness is defined as availability of >=4 of the following on-site patient-support services: ART adherence support, outreach program, peer educator program, food support for infants, and food support for adults.

ICAP Average

=20%

% o

f si

tes

with

ser

vice

Laboratory test availability at ICAP-supported HIV care and treatment sites (n=177)


% s

ites

with

labo

rato

ry t

est

s

Number of laboratory test services* available through ICAP-supported HIV care and treatment sites (n=177)


* Services include: CD4, CD4 percent, HIV-RNA, early infant diagnosis, LFT, and blood chemistry. ** No sites had access to all 6 laboratory test services.

47%

66%

83%86%87%90%96%97%100%

0%

50%

100%


Availability of core HIV-related laboratory tests through ICAP-supported HIV care and treatment sites (n=177)

* Comprehensiveness is defined as availability of >=4 of the following laboratory test services: Services include: CD4, CD4 percent, HIV-RNA, LFT, and blood chemistry. PCR laboratory tests are excluded.

ICAP Average

=86%

% s

ites

with

labo

rato

ry t

est

s

0% 0%

12%24%

30%

67%

83%90%92%

0%

50%

100%


Availability of PCR laboratory tests through ICAP-supported HIV care and treatment sites (n=177)

ICAP Average

=58%

% s

ites

with

PC

R t

ests

0

50

100

Overa

ll

Nigeria

Rwanda

South

Africa

Ethiopia

Tanzan

ia

Moza

mbiq

ue

Kenya

Leso

tho

Physicians Health officers/medical assistants Nurses

Mean number of health care providers per 1000 patients on ART at ICAP-supported HIV care and

treatment sites (n=177)


Num

ber

of

hea

lth c

are

pro

vid

ers

per/

100

0 pa

tient

s on

AR

T

Mean number of outreach workers per 1000 patients on ART at ICAP-supported HIV care and

treatment sites (n=79)*

Source: P-FaCTS, January 2007

*For sites with outreach programs

ICAP Average

=15.1

HIV care and treatment services

0

200,000

400,000

Jul 04 Oct 04 Jan 05 Apr 05 Jul 05 Oct 05 Jan 06 Apr 06 Jul 06 Oct 06 Jan 07 Apr 07 Jul 07

Nu

mb

er

of

pa

tie

nts

0

100

200

Nu

mb

er

of

fac

iliti

es

HIV care ART Facilities reporting

Kenya, Lesotho, Rwanda, S. Africa, Tanzania

Mozambique

Ethiopia

Nigeria, Swaziland,

Zambia

Cumulative enrollment at ICAP-supported HIV care and treatment programs (ever-supported),

July 2004 - September 2007*

Source: ICAP URS, November 2007

326,859

150,562

*Includes all transitioned sites with data carried over.

0

20,000

40,000


Nu

mb

er

of

pa

tie

nts

0

100

200

Nu

mb

er

of

fac

iliti

es


Mozambique

Ethiopia

Cumulative pediatric enrollment in ICAP-supported HIV care and treatment programs (ever-supported),

July 2004 - September 2007*34,216

13,438

*Includes all transitioned sites with data carried over.


Nigeria, Swaziland,

Zambia


0

200,000

400,000


Nu

mb

er o

f p

atie

nts

0

100

200

Nu

mb

er o

f fa

cilit

ies



Mozambique

Ethiopia

Nigeria, Swaziland,

Zambia

Cumulative enrollment in ICAP-supported HIV care and treatment programs (currently supported),

July 2004 - September 2007*300,743

136,252

*Excludes all transitioned sites.


0

15,000

30,000


Nu

mb

er

of

pa

tie

nts

0

100

200

Nu

mb

er

of

fac

iliti

es


Kenya,

Rwanda, S. Africa, Tanzania

Mozambique

Ethiopia

Nigeria

Cumulative pediatric enrollment in ICAP-supported HIV care and treatment programs (currently supported),

July 2004 - September 200730,670

12,253


*Excludes all transitioned sites.

Current, projected, and target cumulative enrollment in ICAP-supported care and treatment programs by

ART status*

262,173

114,689

311,206

137,520

257,604

106,794

0

100,000

200,000

300,000

HIV care ART

Current enrollment, Sept 07Projected enrollment, Feb 08Target enrollment, Feb 08


Num

ber

of p

atie

nts

* Targets were available for MCAP countries, including Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, South Africa and Tanzania.

Current, projected and target cumulative HIV care enrollment in ICAP-supported care and treatment

programs by country

0

50,000

100,000

Ethiopia Kenya Mozambique Nigeria Rwanda South Africa Tanzania



Num

ber

of p

atie

nts

Current, projected and target cumulative ART enrollment in ICAP-supported care and treatment

programs by country

0

20,000

40,000

Ethiopia Kenya Mozambique Nigeria Rwanda South Africa Tanzania



Num

ber

of p

atie

nts

0

50,000

100,000

150,000

Cumulative and current enrollment in ART care at ICAP-supported HIV care and treatment programs,

July 2004 - September 2007

Cumulative initiating ART

ART patients retained in care


Lost to follow up

Dead*

Num

ber

of p

atie

nts

* Includes known deaths only.

Mozambique

Ethiopia

South Africa

RwandaLesotho

KenyaTanzania

NigeriaSwaziland

Zambia

0

100,000

200,000

300,000

Jul

04

Oct

04

Jan

05

Apr 0

5

Jul

05

Oct

05

Jan

06

Apr 0

6

Jul

06

Oct

06

Jan

07

Apr 0

7

Jul

07

Cumulative enrollment in HIV care in ICAP-supported HIV care and treatment programs by country,

July 2004 - September 2007 (n=300,743)

Num

ber

of p

atie

nts

Cumulative enrollment on ART at ICAP-supported HIV care and treatment programs by country, July 2004 - September 2007 (n=136,252)


Mozambique

South Africa

Ethiopia

Rwanda

Swaziland

TanzaniaKenya

Lesotho

NigeriaZambia

0

50,000

100,000

150,000

Jul

04

Oct

04

Jan

05

Apr 0

5

Jul

05

Oct

05

Jan

06

Apr 0

6

Jul

06

Oct

06

Jan

07

Apr 0

7

Jul

07

Num

ber

of p

atie

nts

Cumulative enrollment in ICAP-supported HIV care and treatment programs by ART status, age, and sex,

July 2004 – September 2007Total care enrollment (n=300,743) Total ART enrollment (n=136,252)


0

100,000

200,000

300,000

Jul04

Oct04

Jan05

Apr05

Jul05

Oct05

Jan06

Apr06

Jul06

Oct06

Jan07

Apr07

Jul07

0

100,000

200,000

300,000

Jul04

Oct04

Jan05

Apr05

Jul05

Oct05

Jan06

Apr06

Jul06

Oct06

Jan07

Apr07

Jul07

Children <15

Men 15+

Women 15+

Children <15

Men 15+

Women 15+

Proportion of patients ever enrolled in HIV care who initiated ART in ICAP-supported care and treatment

programs by country as of September 2007*

31%35%

40%42%

44%48%49%

56%57%

43%

0%

25%

50%

n=40, 575 n=19,869n=29,169 n=13,098 n= 96,816n=21,743 n=288,818 n=40,903


% p

atie

nts

initi

atin

g A

RT

n=4,635 n=22,010

*Data not available for Swaziland.

60% 58% 59%

29% 34% 31%

11% 8% 10%

0%

50%

100%

Pre-ART ART Overall

Women 15+ Men 15+ Children <15

Cumulative enrollment in ICAP-supported HIV care and treatment programs by age and sex

as of September 2007


n=164,491 n=136,252 N=300,743

% p

atie

nts

59%67% 66% 63% 62% 61% 60% 59%

1%

31%

29% 27%28% 31%

28% 29% 34%33%

1%

10%4% 7% 10% 8%

11% 11% 7% 10% 8%

98%

57%54%

37%

0%

50%

100%


Cumulative HIV care enrollment in ICAP-supported HIV care and treatment programs by age, sex, and

country as of September 2007


n=40,903n=29,169n=13,098 n=22, 010 n=19,869 n=96,816n=40,575 n=21,743 n=11,925n=300,743 n=4,635

% p

atie

nts

in H

IV c

are

58%65% 64% 63% 61% 60% 59% 59%

54%

1%

33%

31%28% 31% 32% 30% 30% 34%

37%

2%

9%5%

8% 6% 7% 10% 10%7% 9%

6%

96%

53%

42%

0%

50%

100%


Cumulative ART enrollment in ICAP-supported HIV care and treatment programs by age, sex, and country

as of September 2007


n=1,938n=14,161n=23,060 n=7,700 n=9,589 n=30,490n=5,795 n=8,721 n=11,925n=136,252 n=22,873

% p

atie

nts

on A

RT

60%

49% 46%

24% 23%16%

5%

17%

20% 27%

29%

25%

22%23%

48%

35%36%

18%

26%

22%

27%25%

29%

58%54%

31%38%35%

52%49%

0%

50%

100%

0-1 year 2-4 years 5-14 years Unknown

Cumulative pediatric HIV care enrollment in ICAP-supported HIV care and treatment programs by age and

country as of September 2007* n=782 n=2,841n=1,255 n=1,513 n=3,460n=9,757n=4,564 n=2,432 n=3,220n=29,824



% p

edia

tric

pat

ient

s in

HIV

car

e

41%

30% 29%

18%11%

7%3%

34%

30%27%

28%

16%

24%

43%

50%

6% 7%

31%

8%

19% 20%

27%

28% 22%34%

24%

61%65%48% 58%

33%48%

69%

0%

50%

100%

0-1 year 2-4 years 5-14 years Unknown

Cumulative pediatric ART enrollment in ICAP-supported HIV care and treatment programs by age and country

as of September 2007* n=846 n=667n=2,720 n=1,850 n=1,296n=1,867n=348 n=375 n=1,442n=11,411



% p

edia

tric

pat

ient

s on

AR

T

4%13% 9% 7% 2% 2% 1%

8%

11%8% 9%

11% 7% 8%3%

13%

89%76%

84% 84% 87% 91% 91% 97%87%

0%

50%

100%

Overa

ll

Nigeria

South

Afri

ca

Tanza

nia

Kenya

Moz

ambi

que

Ethiop

ia

Rwanda

Leso

tho

% Eligible, but not started % Eligible, started % Not eligible

ART eligibility and initiation among patients receiving HIV care in ICAP-supported HIV care and treatment

programs during July-September 2007*

*Data not available for Swaziland and Zambia.


% p

atie

nts

ART regimens distributed to adults in ICAP-supported HIV care and treatment programs

during July-September 2007*Overall

n=86,485

Ethiopia

n=15,058

Kenya

n=5,528

Lesotho

n=4,266

Mozambique

n=22,670

Nigeria

n=4,904

Rwanda

n=9,932

South Africa

n=17,098

Tanzania

n=7,029

1st line regimen

d4T-3TC-NVP

40,887

(50%)8,225 (55%)

4,743

(86%)2,688 (49%)

13,641

(60%)2,330 (48%)

4,487 (45%)

2,443

(14%)

5,018

(71%)

d4T-3TC-EFV

20,528

(25%)3,054 (20%)

595

(11%)

720

(13%)

1,383

(6%)

159

(3%)

783

(8%)

13,742

(80%)

812

(12%)

ZDV-3TC-NVP

9,119

(11%)2,309 (15%)

103

(2%)

580

(10%)

552

(2%)2,179 (44%)

3,147 (32%)

152

(1%)

677

(10%)

ZDV-3TC-EFV

3,496

(4%)

1,036

(7%)

41

(1%)

243

(4%)

35

(0.2%)

229

(5%)

1,097

(11%)

543

(3%)

515

(7%)

2nd line regimen

981

(1%)

376

(2%)

21

(0.4%)

32

(1%)

106

(0.5%)

7

(0.1%)

337

(3%)

127

(1%)

7

(0.1%)

Unknown regimen

7,208

(8%)

58

(0.4%)

25

(0.5%)

3

(0.1%)

6,953

(31%)

0

(0%)

81

(1%)

91

(1%)

0

(0%)

*Data not available for Swaziland and Zambia.


Overalln=7,989

Ethiopian=1,032

Kenyan=639

Lesothon=252

Mozambiquen=2,368

Nigerian=300

Rwandan=1,161

South Africa*n=1,702

Tanzanian=535

1st line regimen

d4T-3TC-NVP 2,128(27%)

210(20%)

311 (49%)

142 (22%)

690 (29%)

17(6%)

514 (44%)

35(2%)

209(39%)

d4T-3TC-EFV 1,462(18%)

78(8%)

61 (10%)

18 (3%)

52 (2%)

15 (5%)

124 (11%)

1,096(64%)

18(3%)

ZDV-3TC-NVP 2,044(26%)

557 (54%)

196 (31%)

77 (12%)

394 (17%)

204 (68%)

323 (28%)

29(2%)

264(49%)

ZDV-3TC-EFV 639(8%)

91 (9%)

37(5%)

8 (1%)

13(1%)

64 (21%)

175 (15%)

207(12%)

44(8%)

Other** 272(3%)

0(0%)

0(0%)

0(0%)

0(0%)

0(0%)

0(0%)

272(16%)

0(0%)

2nd line regimen** 213(3%)

0(0%)

4 (1%)

0 (0%)

52(2%)

0 (0%)

20 (2%)

48(3%)

0(0%)

Unknown 1,231(15%)

89(9%)

30 (5%)

7(1%)

1,167 (49%)

0(0%)

5(0.4%)

15(1%)

0(0%)

ART regimens distributed to children in ICAP-supported HIV care and treatment programs during

July-September 2007*

* Data not available for Swaziland and Zambia.** In South Africa, d4T-3TC-LPV/r is also prescribed as a first-line regimen for pediatric patients.


Completeness of CD4 count data at baseline and 6 months after ART initiation among multiple cohorts,


85%

97% 97% 95%88%

76% 74% 74%

60%

46%

75%

63%

51% 50% 47%

33%25% 25%

0%

50%

100%

Overa

ll

Rwanda

South

Afri

ca

Ethiop

ia

Leso

tho

Kenya

Moz

ambi

que

Nigeria

Tanza

nia

Baseline (6-mo cohort) 6-month


*CD4 data available for a subset of ART patients, and data not available for Swaziland and Zambia.

% p

atie

nts

with

CD

4 co

unt

Completeness of CD4 count data at baseline and 12 months after ART initiation among multiple cohorts,


83%

99% 96% 93% 94%

58%

75%

86%

45%40%

51%46%

38% 38% 40% 43%

16% 18%

0%

50%

100%

Overa

ll

Rwanda

South

Afri

ca

Ethiop

ia

Leso

tho

Kenya

Moz

ambi

que

Nigeria

Tanza

nia

Baseline (12-mo cohort) 12-month


*CD4 data available for a subset of ART patients, and data not available for Swaziland and Zambia.

% p

atie

nts

with

CD

4 co

unt

Weighted Average median CD4 count at baseline and 6 and 12 months after ART initiation among

multiple cohorts, July-September 2007*

135

202

153 143 129 122 118 111 109

311346

305331 326

288 303

241251264251283

304322326

277 286

339

0

250

500

CD

4 c

ell

cou

nt (

cells

/uL)

Baseline CD4 6-month CD4 12-month CD4

**CD4 data available for a subset of ART patients, and data not available for Swaziland and Zambia.


Average median CD4 count (cells/µL) increase after 6 and12 months of ART in ICAP-supported care and

treatment programs by country, July-September 2007*

137

154 152 147136 134 134

124114

181

208

171

205221

182192

168

147

0

100

200

Me

dia

n in

cre

as

e in

CD

4 c

ell

co

un

t

6 months 12 months*CD4 data available for a subset of ART patients.


Net proportion of patients discontinuing ART at ICAP-supported HIV care and treatment programs

as of September 2007*

Continued ART 117,157

86%

Discontinued 19,095

14%

*Excludes patients who transferred out and unknowns.

** Includes known deaths only.

Lost to follow-up 57%

Dead** 38%

Stopped ART 5%


10.5 per 1,000 person-years

79 per 1,000 person-years

119 per 1,000 person-years

57%

82% 79%

57% 57% 54% 53% 48%

0%

38%

17% 20%

42% 41%36%

47%43%

75%

86%

5% 1% 1% 1% 2%10%

0%9% 11% 14%

0%

50%

100%

Lost to follow-up **Died Stopped ART

Reasons for ART discontinuation in ICAP-supported HIV care and treatment programs by

country as of September 2007*

•Excludes patients who transferred out.•** Includes known deaths only.


% p

atie

nts

0

50,000

100,000

Oct 04 Jan 05 Apr 05 Jul 05 Oct 06 Jan 06 Apr 06 Jul 06 Oct 06 Jan 07 Apr 07 Jul 07

Cu

mu

lati

ve p

erso

n-y

ears

on

AR

T

0

100

200

300

Cu

mu

lati

ve e

ven

ts p

er 1

,000

per

son

-yea

rs

Cumulative Person-Years on ART Known deaths and lost to follow up Known deaths Lost to follow-up

Cumulative person-years on ART, rates of stopped ART, death, and lost to follow up at ICAP-supported care and treatment programs, October 2004 – September 2007

PMTCT services

Pregnant women counseled and tested inICAP-supported PMTCT programs,

by quarter, April-September 2007

0

25,000

50,000

Apr-Jun Jul-Sept

1st ANC Counseled Tested Seroprevalence ART prophylaxis


Num

ber

of

wom

en

Pregnant women counseled and tested inICAP-supported PMTCT programs,

April-September 2007

0

15,000

30,000

Nigeria Mozambique Ethiopia Rwanda Tanzania

1st ANC Counseled Tested Seroprevalence ART prophylaxis


Num

ber

of

wom

en

HIV-infected pregnant women receiving ART prophylaxis in ANC at ICAP-supported PMTCT

programs, April-September 2007

0%

50%

100%

Overall Ethiopia Tanzania Mozambique Nigeria Rwanda

sd-NVP AZT + sd-NVP HAART

n=157 n=235 n=1,112 n=829 n=339n=2,672


Num

ber

of

wom

en

TB/HIV services

52%

91%

80%

57%54%

46%

33%27%

63%

24%20%

5% 5%

55%

22%26%

13%

39%

87%

9%

0%

50%

100%

Overall South Africa* Rwanda Nigeria Tanzania Kenya Mozambique

Screened Screened positive Diagnosed/Initiated TB treatment

Screening and treatment for active TB among HIV positive persons enrolled in ICAP-supported care and treatment

programs, by country January-September 2007


% a

ll pa

tient

s

n=42,364 n=1,097 n=5,837 n=8,582 n=8,102 n=7,695 n=11,051

75%

98%

74%

67%

52%

23%

46%

13%

38%

63%

80%

72%

50%50%48%

36%

100%

0%

50%

100%

Overall Nigeria Ethiopia Mozambique South Africa Kenya

Tested HIV-positive Enrolled in care and treatment

HIV testing and linkages with care and treatment for TB patients enrolled in ICAP-supported TB treatment programs, by country January-September 2007

* Kenya did not report the number of new TB patients. The number represents the number who were tested.


% a

ll pa

tient

s

New TB patients n=17,637 n=1,858 n=14,664 n=707 n=408 n=2,768*

41%

54% 52%

0%

50%

100%

Jan 07 Apr 07 Jul 07

Proportion of new HIV patients screened at enrollment over time in ICAP-supported care and treatment

programs, January 2007-September 2007


76%

66%

75%

0%

50%

100%

Jan 07 Apr 07 Jul 07

Proportion of new TB patients tested for HIV over time in ICAP-supported TB treatment programs,

January 2007-September 2007


ICAP Quarterly Master Slide Set July-September 2007

Documents