ICAP HIV Testing and

Counseling indicators

Initial summary of data,January-March 2010

quarter

ICAP

Background – HTC and ICAP• Most country teams collect & report data on HIV testing &

counseling (HTC) to MOH and USG teams• Historically very limited data on HTC reported to ICAP-NY• Introduced draft HTC indicators for comment in early 2009• HTC done as part of the TB, PMTCT and HEI programs

not included (no double counting) • Indicators reported by point of service within each site –

e.g., VCT, family planning, OPD

Staff reviews idea with M&E

Director

Staff submits New/Revised

Indicator Proposal Form

Review committee reviews proposal

(2weeks)

Development team is formed. Draft SOP

is developed and piloted (two months)

Draft SOP disseminated for two-week comment period

SOP finalized (1 month)

ICAP staff conceptualizes idea for

potential new or revised indicator

Discussed during routine M&E call or Country Program call

Comments/Concerns posted to Indicator workspace

Training on final SOP and Implementation

Data reported quarterly to ICAP-NY

Develop data collection tools

If approved If approved

ICAP-wide input

Country-specific input

Data collection registers exist

Data collection registers do not exist

Data disseminated to country teams via URS, analysis databases and reports

URS Reporting Module (1-2 months) developed

Flowchart of ICAP Data Indicator Proposal Procedures

ICAP HTC indicatorsNumber of clients…

1. attending/admitted to clinic

2. HIV pre-test counseled

3. HIV pre-test counseled and tested

4. HIV tested who received test results

5.who tested HIV positive among clients who received their results

6.who tested HIV negative among clients who received their results

7. who tested HIV positive among all clients tested8. who tested HIV positive and subsequently enrolled in HIV care

and treatment

Also:9. Number of health care workers who successfully completed an

in-service training program for HTC (country-level)

ICAP HTC indicatorsGender and age group – indicators #1-8

Females Males

< 18 months* < 18 months*

18 months to <15 yrs

18 months to <15 yrs

15+ yrs 15+ yrs

*Requires PCR testing, since maternal HIV antibodies may be detected in antibody testing

Reporting by points of service (POS)

Site ASite B

Site C

POS #1

POS #3

POS #2 POS #1

POS #3POS #4

POS #2

POS #1

POS #2

ICAP country team office

ICAP-NY

PEPFAR Next Generation indicators

Indicator #P11.1.DEssential/reported

Number of individuals who received Testing and Counseling (T&C) service for HIV and received their test results

Disaggregation:

Essential/reported By Sex: Male, Female

Essential/reported By Age: <15, 15+

Essential/not reported

By test result: Positive, Negative

Recommended By type of counseling: Individual, Couples*Recommended By MARP type: CSW, IDU, MSMIndicator #H2.3.DEssential/reported

Number of individuals trained in counseling and testing according to national and international standards

• ICAP indicators are aligned with PEPFAR NGI

Data entry and dissemination• Data entered into the URS manually or via import tool• Summarized on URS HTC dashboard and in Summary

Reports• Will include a summary table and narrative for HTC

indicators in upcoming quarterly report to CDC-Atlanta• Added to master slides posted on ‘wiki’ data

dissemination workspace• Core maps• Initial indicator reporting period: October-December 2009

Identifying points of service

HTC points of service (n=24)All points of service Outreach

VCT Eye unit

Outpatient (general) Well baby clinic

Adult outpatient Casualty / trauma

Pediatric outpatient Palliative care / hospice

Inpatient (general) Reception / customer careAdult (male & female) inpatient Cervical cancer screening

Adult female inpatient STI clinic

Adult male inpatientHIV care/treatment (family testing)

Pediatric inpatient TB Clinic (family testing)

Laboratory Blood Donation Center

Family planning Other

Data entry and import

January-March 2010 HTC indicator data

Completeness of HTC indicator dataJanuary-March 2010

Admission to venue

HIV counseling/

testingHIV test results

Enrollment in HIV care

Ethiopia        Mozambique        South Africa        Cote d'Ivoire        Tanzania        Rwanda        Nigeria        Kenya        

Key: Reported Did not

report

Reporting pediatric data

• 5 countries reported data by age as specified in the ICAP HTC SOP:

1. 0-18 months

2. 18 months -14 years

3. 15+ years

• Ethiopia and Kenya reported only 0-14 years and 15+ years

• Rwanda reported patients aged 0-17 years and 18+ years

Number of sites supporting HIV counseling and testing, March 2007-March 2010

Source: ICAP URS March 2010Note: Counseling and testing data was not reported until December 2009

0

100

200

300

400

500

600

700

800

Mar-07 Sep-07 Mar-08 Sep-08 Mar-09 Sep-09 Mar-10

0

20

40

60

80

100

120

140

160

Sites supported vs. reporting HTC dataJan-Mar 2010

No. of sites supported

No. Of sites reporting

88% of HTC supported

sites reported

% of patients provided HIV testing by POS by country

All POS, 100%

Nigeria

VCT, 99%

All PITC, 1%

Rwanda

VCT, 89%

All PITC, 11%

Mozambique

Outpatient (general), 58%

VCT, 36%

Family planning, 4%

Well baby clinic, 1%

Cote d'Ivoire

All POS41%

VCT34%

HIV care,13%

Other4%

Outpatient (general)3%

TB Clinic3%

Inpatient (general)1%

Peds inpatient1%

South Africa

Adult outpatient, 58%

VCT, 14%

Pedi-atric

outpa-tient, 13%

Adult inpa-tient, 5%

Pe-di-

atric inpa-tient, 2%

Family planning, 3%

Outreach, 1%

Casualty / trauma, 2%

STI clinic, 1%

Ethiopia

Outpatient (general)

41%

Family planning16%

Laboratory10%

Inpatient (general)

10%

Pediatric inpa-tient7%

VCT5%

Adult female inpatient

5%

Adult male inpatient5%

Casualty / trauma1%

Adult inpatient<1%

Kenya

% of patients provided HIV testing by POS by country

VCT73%

Outpatient (general)9%

All points of service7%

Inpatient (general)2%

Adult female inpatient2%

Adult male inpatient1%

Pediatric inpatient2%

Laboratory1%

Family planning1%

Outreach0%

Pediatric outpatient0%

Adult outpatient0%

STI clinic0% TB Clinic

0%

Tanzania

% of patients provided HIV testing by POS by country

0%

10%

20%

30%

40%

50%

60%

-

50,000

100,000

150,000

200,000

250,000

Number of patients provided HIV testing & counseling, by country

January-March 2010

# of patients provided HTC % of all patients provided HTC

Total n=392,803

0%5%10%15%20%25%30%35%40%45%

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Number of patients provided HTC, by point of service, and % of all patients receiving HTC

# patients receiving HTC % of all patients receiving HTC

0%

20%

40%

60%

80%

100%

Percent receiving test results, by country

n=214,014 n=43,110 n=37,007 n=31,336 n=19,794 n=18,566 n=16,018 n=12,958# testing:

% of patients testing HIV-positive, by country

Cote d'Ivoire Ethiopia Kenya Mozambique Nigeria Rwanda South Africa Tanzania0%

10%

20%

30%

40%

% positive Jan-March 2010

# testing: n=12,958 n=214,014 n=19,794 n=18,566 n=31,336 n=37,007 n=16, 018 n=43,110

% of patients testing HIV-positive, by country, and national HIV prevalence

Cote d'Ivoire Ethiopia Kenya Mozambique Nigeria Rwanda South Africa Tanzania0%

10%

20%

30%

40%

% positive Jan-March 2010 National prevalence

# testing: n=12,958 n=214,014 n=19,794 n=18,566 n=31,336 n=37,007 n=16, 018 n=43,110

02,0004,0006,0008,00010,00012,00014,000

0%5%

10%15%20%25%30%35%40%

VCT

Adu

lt ou

tpati

ent

All

POS

Peds

out

patie

nt

Out

patie

nt-A

ll

Adu

lt in

patie

nt

Fam

ily p

lann

ing

Pedi

atri

c in

patie

nt

Casu

alty

/ tr

aum

a

Out

reac

h

Inpa

tient

-All

Labo

rato

ry

All

PITC

HIV

car

e (f

amily

…

Adu

lt fe

mal

e …

STI c

linic

Adu

lt m

ale

inpa

tient

Oth

er P

OS

TB c

linic

(fam

ily …

Wel

l bab

y cl

inic

% and number testing HIV positive, by point of service

% testing HIV positive # testing HIV positive

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%VC

T

Out

patie

nt

Oth

er

VCT

Out

patie

nt

Inpa

tient

Oth

er

VCT

Out

patie

nt

Inpa

tient

Oth

er

VCT

All P

ITC

All P

OS

VCT

All P

ITC

VCT

Out

patie

nt

Inpa

tient

Oth

er

All P

OS

VCT

Out

patie

nt

Inpa

tient

Oth

er

Cote d'Ivoire Ethiopia Kenya Moz. NG Rwanda South Africa Tanzania

% HIV positive, by country and POS type

Cote d’Ivoire Ethiopia Kenya Moz. NG Rwanda South Africa Tanzania # testing: n=12,958 n=214,014 n=19,794 n=18,566 n=37,007 n=16, 018 n=43,110 n=31,336

0

1000

2000

3000

4000

5000

6000

7000

8000

# testing HIV-positive by country and POS

All POS/PITC

Other

Inpatient

Outpatient

VCT

62% Outpt.35% VCT3% Other

52% Outpt.38% VCT7% Inpt.3% Other

48% Outpt.23% Inpt.22% Other7% VCT

89% VCT11% All PITC

98% VCT2% All PITC

100% All POS 49% All POS26% VCT18% Other5% Outpt.1% Inpt. 78% VCT

9% Outpt.9% Inpt.4% Other

-

50,000

100,000

150,000

200,000

250,000

300,000

Females Males 0-14 yrs 15+ yrs

HIV testing by gender and age groupAll countries

Tested

HIV-positive

Note: among 2,816 patients

age 0-18 months testing in TZ,

MZ, SA, and CI, 320 (11%) tested

HIV-positive.

7%4%6%

8%

0

10000

20000

30000

40000

50000

60000

70000

80000

0-18 mos 18m-14y

Pediatric HIV testing

Tested

HIV-positive

Countries reporting these data include TZ, MZ, SA, and CI

11%4%

Counseling and testing uptake

0%20%40%60%80%

100%

Uptake of HIV counseling and testing 5 countries reporting patient admissions data

% counseled

% tested

Note: Clinic admission data not reported by Kenya and Nigeria

% testing at VCT: 14% 74% 99% 89% 34% 36%

Enrollment in HIV care

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Ethiopia Tanzania Nigeria Mozambique South Africa Cote d'Ivoire

% of patients testing HIV positive who enrolled in HIV care during the quarter

Note: HIV care enrollment data not reported by Kenya,or Rwanda

(n= 4,303) (n= 3,529) (n= 4,705) (n=7,596) (n=4,327) (n=1,131)# HIV-positive:

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Females Males 18m-14yrs 15+ yrs

% testing HIV positive who enrolled in HIV care during the quarter

(n=16,617) (n=8,714) (n=2,668) (n=21,589)# HIV-positive:

Note: HIV care enrollment data not reported by Kenya,or Rwanda

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

VCT Outpatient Inpatient Other All POS/PITC

Percent of patients testing HIV positive who enrolled in HIV care during the quarter

# HIV-positive: (n=12,397) (n=3,318) (n=619) (n=1,079) (n=7,923)

Note: HIV care enrollment data not reported by Kenya,or Rwanda

Additional comments

• Jan-Mar 2010 data largely consistent with data from Oct-Dec 2009

• Historical data from prior to October 2009 – coming soon from some countries

• Some limitations: – Missing data on clinic/POS admissions and

enrollment in HIV care from several countries– Not all countries report data by point of service

Routine dissemination

URS HTC dashboard

URS HTC summary reports

Summary / conclusions• ICAP supported almost 400,000 HIV tests

during January-March 2010• Reports from 1,337 points of service from

within 691 sites• >99% of patients received their results• More than 27,000 (7%) patients tested HIV-

positive• At least 16,899 (67%) HIV-positive patients

linked into HIV care

Next steps

• Historical data• Examine trends• Disseminate to country teams• Feedback – data/program improvement

Acknowledgements

• ICAP-NY: Charon Gwynn, Sarah Gorrell, Suzue Saito, Frank Brathwaite, other staff providing input on SOP

• M&E staff, ICAP country teams

02000400060008000100001200014000

0%10%20%30%40%50%60%70%80%90%

100%VC

T

Adu

lt ou

tpati

ent

All

POS

Peds

out

patie

nt

Out

patie

nt-A

ll

Adu

lt in

patie

nt

Fam

ily p

lann

ing

Pedi

atri

c in

patie

nt

Casu

alty

/ tr

aum

a

Out

reac

h

Inpa

tient

-All

Labo

rato

ry

All

PITC

HIV

car

e (f

amily

…

Adu

lt fe

mal

e …

STI c

linic

Adu

lt m

ale

inpa

tient

Oth

er P

OS

TB c

linic

(fam

ily …

Wel

l bab

y cl

inic

% of HIV positive testers who enrolled in HIV care during the quarter, and # HIV-positive

% in HIV care # testing HIV positive

Note: HIV care enrollment data not reported by Kenya,or Rwanda