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Use of Patient-Level HIV Care and Treatment Reports for Focused Site Support, Evidence-Based Decision Making, and More!. Matthew Lamb ICAP-NY [email protected] Outline. Brief overview: where the data comes from and how the feedback reports are generated

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Use of Patient-Level HIV Care and Treatment Reports for Focused Site Support, Evidence-Based Decision Making, and More!

Matthew Lamb

ICAP-NY

[email protected]


Outline Focused Site Support,

  • Brief overview: where the data comes from and how the feedback reports are generated

  • How is patient-level data useful for clinical, programmatic, and SI purposes?

  • How to read and use the patient-level feedback reports

  • Examples of use of patient-level data for epidemiologic research


ICAP’s patient-level database Focused Site Support,

Unique databases used in-country by ICAP

SA

RW

TZ

ET

KY

MZ

Import and de-identification tool

ICAP Patient-Level Database

Analyses for abstracts and manuscripts

Analysis File

(one per country)

Country-level reports

Adult

Pediatric

Standards of Care (SOC)

Site-level reports

Cohort Reports

Standards of Care (SOC)

Report Creator

Today’s focus


Patient-level feedback reports Focused Site Support,


Patient-level information is available for 60% of patients ever attending ICAP-supported care and treatment clinics in 4 countries

1 Rwanda totals are through March 2011 2South Africa totals are through March 2010


ICAP’s ever attending ICAP-supported care and treatment clinics in 4 countriespatient-level reports provide one tool to critically evaluate program performance

  • Country-level reports

    • Regular data dissemination meetings

    • Identification of problematic areas and/or sites

    • Identification of high-performing sites

    • Tracking trends in program achievement over time

  • Site-level reports

    • Preparation for site visits by M&E, clinical, and program staff

    • Data Quality Assurance

    • Trends in enrollment and active patient population


Patient-level reports are complementary to other information collected for reporting

  • What proportion of patients are initiating ART at advanced disease stage? Does this differ between sites?

  • Does most LTF occur before or after ART initiation?

  • Does the proportion of total program attrition attributable to LTF or recorded death differ substantially between sites?

  • What proportion of patients are missing records of both CD4+ cell count and WHO staging at enrollment and ART initiation? Does this differ between sites?


Country-level reports collected for reporting

  • Adult Country Report

  • Pediatric Country Report

  • Country-level SOC Report


Country-level Adult and Pediatric reports: Layout collected for reporting

  • Summary paragraph

  • Listing of sites (name and URS ID) contributing to the report

  • Key characteristics of active patients, by gender

  • Trends in number of active patients over time and % on ART

  • Age and gender distribution at enrollment

  • Between-site comparisons of enrollment characteristics

    • CD4, WHO Stage, ART eligibility, cotrimoxazole provision, tuberculosis treatment

  • Between-site comparisons of ART initiation characteristics

    • CD4, WHO Stage, advanced disease at initiation, regimen characteristics

  • Patient outcomes after enrollment into HIV care and ART initiation

    • Recorded Death, LTF, attrition, combined and between-site comparisons


Country Reports: Summary collected for reporting

Cumulative enrollment in HIV care and on ART

Active patients this quarter

Active adult patients this quarter

Follow-up characteristics of those no longer active (LTF, death, transfer)


Country Reports: Site listing collected for reporting

SiteID used for the rest of the report


Country Reports: Characteristics of Active patients at enrollment into HIV care and ART initiation

Overall and separate by gender

Patients not returning for a follow-up visit may

not have their CD4+ counts recorded


Country Reports: Trends in active enrollment over time enrollment into HIV care and ART initiation

74.1%

36.8%


Between-site comparisons from Country Reports enrollment into HIV care and ART initiation


Country Reports: Advanced HIV infection at ART initiation enrollment into HIV care and ART initiation

Percent

SiteID



Country Reports: Summary Attrition (LTP)

  • Provides a useful snapshot summarizing key characteristics of the patient population enrolling into HIV care and initiating ART

  • Enables a quick means of comparing key characteristics across sites within the same country

    • Regional reports can also be generated

  • Very useful for ICAP-NY and in-country clinical, SI, and programmatic staff to assess overall characteristics and differences between sites

  • More detail on specific sites can be found in the site-level reports…


Site Reports Attrition (LTP)

  • Provide in-depth, site-specific summaries

  • Useful in preparation for site visits, and to delve deeper into issues identified from the country reports


Site Reports: Layout similar to Country Report Attrition (LTP)

  • Summary paragraph

  • Trends in new patient enrollment over time and % on ART

  • Key characteristics of active patients, total and separated by adult/pediatric

  • Enrollment characteristics

    • Point of entry, age and gender distribution, CD4, WHO Stage, ART eligibility, cotrimoxazole provision, tuberculosis treatment, anthropometric measures

  • ART initiation characteristics

    • CD4, WHO Stage, advanced disease at initiation, regimen characteristics

  • Patient outcomes after enrollment into HIV care and ART initiation

    • Outcomes before and after ART initiation

    • Survival curves




Site Reports: Patient retention of decentralization


Site Reports: Summary of decentralization

  • Gives in-depth detail on characteristics of patients attending a given site, focusing on characteristics at enrollment into HIV care, ART initiation, and retention after these benchmarks

  • Useful for site visit preparation to identify issues for focused supportive supervision


ICAP Standards of Care (SOC) Reports of decentralization

  • Calculates ICAP Priority Indicators of HIV care and other Standards of Care from the electronic patient-level databases

  • Intended to provide information on the quality of HIV care and changes over time

  • Available as an overall country SOC report and for each site reporting data


ICAP Standards of Care (SOC) Reports: Priority Indicators of decentralization

Most recent quarter





SOC Reports: Summary Indicators

  • Allows us to track progress towards achievement of ICAP Standards of Care over time, and to look more deeply into issues affecting the quality of HIV care

  • Many SOCs are calculated, such as:

    • Proportion with CD4 within 1 month of enrollment

    • Proportion eligible receiving CTX

    • Proportion initiating ART within 1 month of eligibility

    • Proportion with CD4 in the last 6 months

    • And more

  • Useful in combination with Standards of Care calculated through sampling of clinical records

    • Comparing results between these will allow us to assess the quality of the electronic patient-level database


We welcome suggestions for corrections, edits, and additions!

  • These reports have evolved over time based on feedback from users

  • If you see something that doesn’t seem right, please let us know and we can investigate

  • Also, future ideas for enhancements are in the works

    • HIV care cascade

    • Changes to ART eligibility as countries adopt new guidelines

    • Others?


The Automated Reports are available on the URS additions!

http://urs2.icap.columbia.edu


The Automated Reports are available on the URS additions!

http://urs2.icap.columbia.edu


Beyond the automated reports additions!

… and many more in the pipeline


Questions? additions!

http://urs2.icap.columbia.edu


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