Download - Matthew Lamb ICAP-NY mrl2013@columbia
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Use of Patient-Level HIV Care and Treatment Reports for Focused Site Support, Evidence-Based Decision Making, and More!
Matthew [email protected]
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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
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KY MZ TZ
Import and de-identification tool
Report Creator
ET RWUnique databases used in-country by ICAP
ICAP’s patient-level database
SA
Analysis File(one per country)
Analyses for abstracts and manuscripts
Country-level reports
AdultPediatricStandards of Care (SOC)
Site-level reports
Cohort ReportsStandards of Care (SOC)
Today’s focus
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Patient-level feedback reports
Country-level Reports Site-level Reports
Adult Country Report Site Report
Pediatric Country Report
Standards of Care (SOC) Reports
Standards of Care (SOC) Reports
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Patient-level information is available for 60% of patients ever attending ICAP-supported care and treatment clinics in 4 countries
URS reporting, Q1 2013 Patient-level data reporting, Q1 2013
Country Sites reporting Enrolling in HIV Care
Initiating ART Sites reporting (% of URS total)
Enrolling in HIV Care (% of URS total)
Initiating ART (% of URS total)
Ethiopia 276 197,756 127,799 48 (17%) 108,793 (55%) 65,579 (51%)
Kenya 260 240,172 124,858 46 (18%) 99,492 (41%) 50,064 (40%)
Mozambique 71 189,852 72,381 32 (45%) 147,341 (78%) 56,996 (79%)
Tanzania 208 125,852 67,968 74 (36%) 102,412 (81%) 58,100 (85%)
Total 815 753,632 393,006 200 (25%) 458,038 (61%) 230,739 (59%)
Countries no longer providing patient-level dataRwanda1 48 57,263 33,309 41 (85%) 43,427 (76%) 27,130 (81%)
South Africa2 66 113,549 71,608 3 (5%) 6,973 (6%) 4,597 (6%)
1 Rwanda totals are through March 2011 2South Africa totals are through March 2010
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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
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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?
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Country-level reports
• Adult Country Report
• Pediatric Country Report
• Country-level SOC Report
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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
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Cumulative enrollment in HIV care and on ART
Active adult patients this
quarter
Active patients this quarter
Follow-up characteristics
of those no longer active (LTF, death,
transfer)
Country Reports: Summary
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Country Reports: Site listing
SiteID used for the rest of the report
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Country Reports: Characteristics of Active patients at enrollment into HIV care and ART initiation
Patients not returning for a follow-up visit
may not have their CD4+
counts recorded
Overall and separate by gender
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Country Reports: Trends in active enrollment over time
36.8%
74.1%
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Between-site comparisons from Country Reports
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Country Reports: Advanced HIV infection at ART initiation
SiteID
Per
cent
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Country Reports: Between-site comparison of Death, LTF, and Attrition (LTP)
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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…
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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
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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
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Site Reports: new patient enrollment over time shows impact of decentralization
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Site Reports: Immunologic characteristics at enrollment
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Site Reports: Patient retention
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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
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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
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Most recent quarter
ICAP Standards of Care (SOC) Reports: Priority Indicators
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ICAP Standards of Care (SOC) Reports: Pre-ART Standards of Care
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ICAP Standards of Care (SOC) Reports: ART Standards of Care
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ICAP Standards of Care (SOC) Reports: Notes on the Indicators
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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
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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?
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The Automated Reports are available on the URShttp://urs2.icap.columbia.edu
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The Automated Reports are available on the URShttp://urs2.icap.columbia.edu
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Beyond the automated reports
… and many more in the pipeline