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Insights into HIV Care Service Comprehensiveness and Laboratory Capacity at ICAP-supported Facilities: Findings from PFaCTS 2013. Caitlin Madevu-Matson ([email protected]) Charon Gwynn ([email protected]) SI-NY. PFaCTS.

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Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Insights into HIV Care Service Comprehensiveness and Laboratory Capacity at ICAP-supported Facilities: Findings from PFaCTS 2013

Caitlin Madevu-Matson ([email protected])Charon Gwynn ([email protected])SI-NY


Pfacts

PFaCTS

  • Structured repeated assessment of facilities to describe the scope, diversity, capacity and comprehensiveness of ICAP-supported programs

  • Captures information not available from routine indicators :

    • Context: Location, type

    • Facility characteristics: Related services, e.g. ANC, MC

    • Clinic and lab components: Staffing configuration and training, patient support services, laboratory quality essentials

  • Data used for program planning, monitoring and evaluation

    • Reports and webinars

    • URS

    • Analyses with other data sources


Pfacts implementation

PFaCTS Implementation

  • Care and Treatment PFaCTS

    • 7 rounds, 2007 - 2013

    • 80 questions

  • Laboratory PFaCTS

    • 2 rounds, 2011 - 2013

    • 162 questions

  • Assessment tools

    • Core questions maintained from previous round, tool revised with clinical and programs units

  • Data collection

    • Assessments completed with health facility personnel

    • Questionnaires reviewed by in-country ICAP clinical and M&E units

  • Data validated through checks and results uploaded to URS


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

  • CARE & TREATMENT PFaCTS

Objectives

  • Present results from Care and treatment PFaCTS Round 7

  • Describe the comprehensiveness of ICAP-supported programs


O utline

PFaCTS implementation

Current characteristics

Context

Facility

Clinic

Comprehensiveness of HIV Care Service

Summary

Implications

Outline


Definitions

Definitions

Facility

Clinic


C ompleteness of pfacts reporting over time

Completeness of PFaCTS reportingover time


C ompleteness of pfacts reporting over time1

Completeness of PFaCTS reportingover time

96%

75%


O utline1

PFaCTS implementation

Current characteristics

Context : country, location and type

Facility : services provided outside the CT clinic

Clinic : services provided in the CT clinic

Comprehensiveness of HIV Care Service

Summary

Implications

Outline


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Countries contributing to PFaCTS Round 7

  • 96% (1017/1062) of facilities with ICAP-supported care and treatment services completed PFaCTS Round 7

  • In country completeness ranged from 79% to 100%


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Facility location and Type


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Availability of HIV related services (n=1017)


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

PMTCT Service Variation (n=991)


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

TB service Variation (n=1,017)


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Availability of key patient support services (n=1017)


Type of art adherence support available

Type of ART adherence support available


Outreach activities by type of personnel

Outreach activities by type of personnel


Secondary p revention service availability

Secondary prevention service availability


O utline2

PFaCTS implementation

Current characteristics

Context

Facility

Clinic

Comprehensiveness of HIV Care Service

Summary

Implications

Outline


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

HIV Care

Comprehensiveness

Components

Questions

  • Does ICAP support comprehensive HIV care programs?

  • Has comprehensiveness of HIV care programs changed over time?

  • Is there variability in the changes?


Comprehensive services over time

Comprehensive Services over time


Comprehensive services over time subset

Comprehensive Services over time, subset


Comprehensive services over time by facility type

Comprehensive Services over time, by facility type


O utline3

PFaCTS implementation

Current characteristics

Context

Facility

Clinic

Comprehensiveness of HIV Care Service

Summary

Implications

Outline


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

CT Summary (1)

  • Overall, ICAP facilities maintained high survey completeness

  • High on-site availability of essential HIV care services

    • Counseling and testing

    • PMTCT

    • TB treatment

    • ART adherence counseling

    • Outreach

    • Nutritional counseling

    • Secondary prevention


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

CT Summary (2)

  • The comprehensiveness of essential HIV care services at all ICAP-supported facilities increased rapidly in 2009 and seems to have stabilized

  • Higher proportion of facilities have comprehensive services in

    • Facilities supported by ICAP for longer time

    • Public primary and secondary/tertiary compared to private/other


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Implications for HIV care and treatment

  • ICAP-supported facilities provide comprehensive services even though most facilities are rural and public primary facilities

  • Scale up and expansion of ICAP support to new areas may mean not all facilities will be equipped to offer comprehensive services

  • Combine PFaCTS results with routinely collected program and clinical data

    • Confirm if availability of comprehensive services is beneficial for program and patient outcomes

    • Advocate for wider implementation of comprehensive service delivery models


Laboratory pfacts

Laboratory PFaCTS


Outline

Outline

  • Rationale & Objectives

  • General findings

  • Capacity score

  • Summary& Implications


Laboratory pfacts1

Laboratory PFaCTS

  • Captures information on the scope, diversity, and capacity of ICAP-supported laboratories

  • Provides information on laboratory quality essentials (QEs)

    • Infrastructure and equipment

    • Human resources

    • Quality assurance activities

    • Facility safety

    • Supply chain management

  • Two rounds of PFaCTS conducted to date (2011 & 2013)


Rationale for laboratory pfacts

Rationale for Laboratory PFaCTS

  • At the facility level:

    • Measure capacity and progress toward accreditation

    • Gap analysis and development of laboratory specific improvement plan

  • At the program level:

    • Identify gaps in implementing QEs across supported labs

    • Prioritization and strategy development


Icap s laboratory capacity building framework

ICAP’s Laboratory Capacity Building Framework


Objectives

Objectives

  • To summarize findings from Lab PFaCTS 2013

  • To compare laboratory capacity between years and by key characteristics


Outline1

Outline

  • Rationale & Objectives

  • General findings

  • Capacity score

  • Summary& Implications


Pepfar definition of clinical laboratory

PEPFAR Definition of Clinical Laboratory


Laboratories completing pfacts 2013

Laboratories completing PFaCTS 2013


Icap supported laboratories by facility type and country

ICAP SUPPORTED LABORATORIES BY FACILITY TYPE AND COUNTRY


Type of support provided by icap

TYPE OF SUPPORT PROVIDED BY ICAP


Type of hiv related tests performed onsite

TYPE OF HIV-RELATED TESTS PERFORMED ONSITE


Type of biosafety equipment

TYPE OF BIOSAFETY EQUIPMENT


Staff trained in key tests and laboratory mangement skills

STAFF TRAINED IN KEY TESTS AND LABORATORY MANGEMENT SKILLS


Quality assurance quality control for hiv related tests

QUALITY ASSURANCE/QUALITY CONTROL FOR HIV RELATED TESTS


Outline2

Outline

  • Rationale & Objectives

  • General findings

  • Capacity score

  • Summary& Implications


Icap s laboratory capacity building framework1

ICAP’s Laboratory Capacity Building Framework


Laboratory capacity score

Laboratory Capacity Score

Total Points = 100


Capacity scores by facility type and location

CAPACITY SCORES BY FACILITY TYPE AND LOCATION


Capacity scores by country and year

CAPACITY SCORES BY COUNTRY AND YEAR

*Restricted to laboratories completing both 2011 and 2013 Pfacts rounds.


Capacity scores by facility and location

CAPACITY SCORES BY FACILITY AND LOCATION

*Restricted to laboratories completing both 2011 and 2013 PFaCTs rounds.


Outline3

Outline

  • Rationale & Objectives

  • General findings

  • Capacity score

  • Summary& Implications


Summary

Summary

  • ICAP supports a wide range of capacity building activities in the countries where we work

  • Technical support areas identified include QA/QC, human resources and infrastructure

  • Capacity at ICAP laboratories

    • highest at secondary and tertiary and urban facilities

    • increased between 2011 and 2013


Implications

Implications

  • Laboratory PFaCTS can be used to identify and address technical support area needs

  • Use of capacity scoring allows for a comprehensive approach to monitoring capacity from routinely collected PFaCTS data


Pfacts data use

PFaCTSData Use

  • Analysis of key PFaCTS variables can identify areas for targeted technical assistance as well as achievement of program successes

  • Innovative approaches in the use of PFaCTS data help us better understand the programs we support


Where s the data

Where’s the Data?


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

URS


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Wiki


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

Wiki


Acknowledgements

Acknowledgements

  • Country M&E, Laboratory and Clinical Teams

  • Bereket Alemayehu, Yingfeng Wu, Suzue Saito, SI Specialists


Thank you

Thank You


Caitlin madevu matson cm3315 columbia edu charon gwynn crg2128 columbia edu si ny

For more information

  • PFaCTS resources

  • To view the questionnaires and reports for all rounds, visit the ICAP Data Dissemination page and select PFaCTS.

    • http://icapdatadissemination.wikischolars.columbia.edu/Welcome

  • To access more PFaCTS results, log into the URS

    • https://urs2.icap.columbia.edu/


  • Login