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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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slide1

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]

slide2

Outline

  • 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
slide3

ICAP’s patient-level database

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

slide5

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

slide6

ICAP’s patient-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
slide7

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?
slide8

Country-level reports

  • Adult Country Report
  • Pediatric Country Report
  • Country-level SOC Report
slide9

Country-level Adult and Pediatric reports: Layout

  • 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
slide10

Country Reports: Summary

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)

slide11

Country Reports: Site listing

SiteID used for the rest of the report

slide12

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

slide17

Country Reports: Summary

  • 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…
slide18

Site Reports

  • Provide in-depth, site-specific summaries
  • Useful in preparation for site visits, and to delve deeper into issues identified from the country reports
slide19

Site Reports: Layout similar to Country Report

  • 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
slide23

Site Reports: Summary

  • 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
slide24

ICAP Standards of Care (SOC) Reports

  • 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
slide29

SOC Reports: Summary

  • 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
slide30

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?
slide33

Beyond the automated reports

… and many more in the pipeline

slide34

Questions?

http://urs2.icap.columbia.edu

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