Project HEART Update

8th Annual CDC/HRSA Track 1.0 Meeting

Nicole Buono, Project Director

Project HEART Overview

• Where we work• Results- Adult and ped care and

treatment and PMTCT• Ped counselors in Zambia in

improving enrollment and retention• Program quality data• Data quality• PY8 priorities

Where We Work: Côte d’Ivoire Site Map

Where We Work: Mozambique Site Map

Where We Work: South Africa Site Map

Where We Work: Tanzania Site Map

Where We Work: Zambia Site Map

Trends in Number of Active Care and Treatment Sites, Project HEART

*Q1-4 numbering refers to calendar quarter (ie Q2 2010=Apr-Jun 2010)

Q4 20

04

Q1 20

05

Q2 20

05

Q3 20

05

Q4 20

05

Q1 20

06

Q2 20

06

Q3 20

06

Q4 20

06

Q1 20

07

Q2 20

07

Q3 20

07

Q4 20

07

Q1 20

08

Q2 20

08

Q3 20

08

Q4 20

08

Q1 20

09

Q2 20

09

Q3 20

09

Q4 20

09

Q1 20

10

Q2 20

100

20

40

60

80

100

120

140

160

180

Cote d'Ivoire Mozambique South Africa Tanzania Zambia

Quarter

Num

ber

of

site

s

Number and percent of PY6 target achieved:

Patients ever started on ART during PY6 (April 2009-March 2010)

Country

Number of patients ever on ART end of

PY6

PY6 target for total number of patients ever on ART end of PY6

% of target achieved

Cote d'Ivoire 65,023 63,000 103.2%

Mozambique 30,778 26,936 114.3%

South Africa 118,492 74,259 159.6%

Tanzania 56,150 44,999 124.8%

Zambia 150,946 132,000 114.4%

ALL 421,389 341,194 123.5%

Number and percent of PY6 target achieved:

New children started on ART during PY6 (April 2009-March 2010)

CountryNew Children on ART during

PY6

Target for New Children on ART during

PY6

% of targets achieved total in PY6 (Q2 09-Q1 10)

Cote d'Ivoire 856 1,000 85.6%Mozambique 1,313 1,640 80.1%South Africa 4,531 2,786 162.6%

Tanzania 1,418 1,672 84.8%Zambia 2,286 2,588 88.3%

ALL 10,404 9,686 107.4%

PY6 PMTCT Targets and Achievements

Cote d'Ivoire Mozambique South Africa Zambia0%

20%

40%

60%

80%

100%

120% 109%116%

101%

109%

99%

62%

91%

101%97%

52%

100%104%

Women receiving HIV test results Women testing + for HIV Women receiving ARV prophylaxis

Perc

enta

ge o

f PY6

Tar

get M

et

Project HEART PMTCT Data: PY6Cote

d'IvoireMozambique South Africa Zambia

Women receiving HIV test results 174,172 155,049 134,817 175,626Women testing + for HIV 7,900 13,012 32,191 22,674Women receiving ARV prophylaxis 6,221 8,177 35,612 22,346

Percent distribution of children ever started on ART by age group by the end of the quarter,

April – June 2010

Cote d'Ivoire Mozambique South Africa Tanzania Zambia0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

15.6

40.9

12.418.1

27.2

29.5

27.1

22.5

23.1

22.2

54.9

32.1

65.258.8

50.5

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

Perc

enta

ge o

f ch

ildre

n

N=2849 N=2445 N=13001 N=10824N=4835

Zambia pediatric counselors and impact on enrollment and retention of children

• Pediatric ART enrollment and retention challenging

• 103 counselors in Zambia were trained using the two-

week ANECCA/CRS pediatric counseling course

• Used program data- the difference between 2008 and

2009 enrollment and attrition of children and adults

• Statistical analysis using paired t tests.

• Among 64 sites, 47 met the criteria for the enrollment

analysis and 55 for attrition, 30 sites with trained

pediatric counselors

Zambia Experience: Results

Before Trained Pediatric Counselors (Q3) After Trained Pediatric Counselors (Q4)0

2

4

6

8

10

12

14

16

18

20

Pediatric ART Enrollment in 30 sites that Introduced Pe-diatric Counsellors

Pediatric ART Enrollment (N)

Num

ber o

f Chi

lren

Enro

lled

p>0.01

Zambia Experience: Results (2)

Sites with Trained Counselors (N=31) Sites without Trained Counselors (N=24)0%

2%

4%

6%

8%

10%

12%

Comparison of Pediatric Attrition Rate (%) of Sites that Introduced Pediatric Counselors and Sites that Did Not

Average Pediatric Attrition Rate (%)

% A

ttriti

on R

ate

p=0.02

Zambia Experience: Conclusions

• The number of children enrolled in ART increased

more in ART treatment sites with trained pediatric

counselors than in sites without counselors,

outpacing adult enrollment; attrition also decreased

more in these sites.

• Limitations include inter-site variability and difficulty

identifying and controlling for confounders.

• A larger matched case-control study is recommended

to control for site variations.

Tanzania Performance 2009-2010

CD4 enroll CD4 review Eli on CTX Adh coun Missing char Not seen0

20

40

60

80

100

120

TZ QI performance 2009 at 34 sites 894 files vs. 2010 35 sites, 1617 files

performance 2009

Performance 2010

Côte d’Ivoire Quality Improvement 2007-2009

base CD4

Cd4 in re

view

Eli on CTX

Eli on ART

Adherence

counsel

ing

TB sc

reening

TB sp

utum/X ra

y

WT d

one

Missing fi

les

Not see

n during r

eview

period

0

10

20

30

40

50

60

70

80

90

100

QI measurement 2007- 2009 CIn=3559 files reviewed in 42 sites 2009

Oct 07 -April 08 July-Dec 08 Jan-Dec 09

Zambia Quality Improvement Performance 2009-2010

Base cd4 Base Ht & Wt

Cd4 at 9/12 Eligible on ART

PCP Proph Base ALT Creatinine 3/12 Visit Base HB0

10

20

30

40

50

60

70

80

90

100

Zambia QI Performance all sites March 2009 Vs. March 2010

Zambia QI performance March 2009

Zambia QI performance March 2010

Data Quality Update Country Accomplishments Remaining Work/Plan

Cote d’Ivoire

•Conducted internal assessments in 26 largest sites representing 75% of pts on ART• Site discrepancy average is 13%, only 5% if use cumulative patient data. •Variability across sites

•Internal assessments to be completed in remaining sites by September, 2010•Continue to work with CDC and MoH to harmonize definitions

Mozambique

•Patient monitoring database (PTS) fully functional in 26 of the 42 sites allowing for accurate tracking of pts “currently on ART”•Completed SOPs for provincial staff to conduct data quality checks

• Assessments in remaining paper-based sites to begin in May and completed this year. •Training provincial staff to do data quality checks

Tanzania•New Data Management Team has conducted internal assessment in all 165 C&T sites

• Working with districts on data utilization to improve quality

Data Quality Update (2)

Country Accomplishments Remaining Work/Plan

South Africa •CDC/South Africa asked all PEPFAR partners to suspend extensive DQA efforts until CDC/SA formalizes DQA guidelines.•South Africa has begun own assessments • M&E team attended JSI training

•Global M&E country backstop travelled to SA in May for DQA TA•In the final stages of hiring a long-term M&E consultant to assist SA team to implement M&E best practices.

Zambia •Internal DQA conducted in 24 of 65 sites•Results were mostly excellent with a few rural sites under-reporting due to lack of data entry staff.

•Plan is to complete internal DQAs in remaining sites by October 31, 2010.•Zambia is also working on addressing data entry staffing issues which may be causing under-reporting.

PY8 Priorities

• Prepare for smooth transition of programs in all countries

• Advance transition objectives, monitor and document transition

• Continue to improve program quality• Continue to focus on improved data

quality• Initiate project closeout (starts in PY7)

Acknowledgements

CÔTE D’IVOIRE• Anna Likos , Alexandre Ekra, and the

CDC/CI team• MOH CI, regional and district

authorities• Joseph Essombo, Anthony Tanoh

and the EGPAF/CI team

EGPAF Global• Rose McCulloughh• Nicole Buono• Stephen Lee• Richard Marlink• Theresa Wolters• Rozalin Wise• Stephanie Calves• Shauna Eisenberg• Solome Paulos• Elizabeth Flanagan• Nick Hellmann• Trish Karlin• Anja Giphart• Shobana Ramachandran• Eric Nawar• Penny Smith• Andrea Wahl• Dorace Trottier• Ashley Thompson• Sean Maher• Amelie Sow-Dia

……..AND ALL OF OUR PATIENTS, PARTNERS, STAFF AND DONORS

MOZAMBIQUE• Lisa Nelson, Kebba Jobarteh,

Charity Alfredo, Paula Morgan and CDC/Moz

• MOH Moz, provincial and district authorities

• Nancy Fitch, Cathrien Alons, and the EGPAF/Moz team

SOUTH AFRICA• Thurma Goldman, Jeff Klausner,

Lerato Lesole, and CDC/SA• DOH SA and provincial and district

authorities• Kuku Appiah, Pumla Lupondwana

and the EGPAF/SA team

TANZANIA• John Vertefeuille, Thomas

Finkbeiner, Mohamed Mfaume and CDC/TZ

• MOH TZ, regional and district authorities

• Anja Giphart, Jeroen van Padt Bosch and the EGPAF/TZ team

ZAMBIA• Larry Marum, Deborah Connor,

Isaac Zulu and CDC/Zambia• Susan Strasser and the

EGPAF/Zambia team• MOH Zambia, provincial and

district authorities• Jeff Stringer, Elizabeth Stringer,

Carolyn Bolton, Stewart Reid and the entire CIDRZ team

CDC/ Atlanta• Tedd Ellerbrock• Diane Flournoy• Bud Bowen• Janna Brooks• Josef Amman• Elliot Raizes• Tom Spira• Angeli Achrekar• Carla Johnson• Laura Porter• Joe Barker• John Aberle-Grasse

OUR PARTNERS HERE THIS WEEK

CIDRZ (Zambia)• Geoffrey SiliwizyaHealth Services Payment Authority (Cote d’Ivoire )• Kone IdrissaDistrict Medical Officer (Tanzania)• Cristo NkyaGauteng Province Medical Advisor (South Africa)• Zukiswa Pinini

This presentation was made possible through support provided by the U.S. Centers for Disease Control and Prevention (CDC), through the President’s Emergency Plan for AIDS Relief (PEPFAR), as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Project HEART”/Cooperative Agreement No. U62/CCU123451). The opinions expressed herein are those of the authors and do not necessarily reflect the views of CDC.