pmtct impact measurement and emtct validation update on global guidance
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PMTCT Impact Measurement and EMTCT Validation Update on Global Guidance. Chika Hayashi, World Health Organization. Outline. Background Measuring PMTCT Impact EMTCT Validation. WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global Guidance. Background. - PowerPoint PPT PresentationTRANSCRIPT
PMTCT Impact Measurement and EMTCT Validation
Update on Global Guidance
Chika Hayashi, World Health Organization
Outline
1. Background
2. Measuring PMTCT Impact
3. EMTCT Validation
Background
WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global Guidance
• Global Plan sets 10 ambitious targets for 2015.
Exciting:Intervention coverage Outcome Measures• New Child HIV Infections• HIV-associated deaths in pregnancy• MTCT rate
Problem:• PMTCT outcomes are not reported routinely, and
available data in the 22 priority countries does not represent population-level outcomes.
Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, launched June 2011.
n
Attrition means available facility-based PMTCT data does not capture the full target
population
Short Guide: 5 Methods to Measure PMTCT Impact 1. Modelling
2. Facility-based Survey and Follow-Up
3. Cohort Approach
4. Population-based Surveys
5. Use of EID/Child HIV Testing Data
1.Short Guide 2. Detailed
Guidance 3. Write some texthere
WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global Guidance
Population-based Surveys to
Measure PMTCT Impact
March 2012 Consultation
1. HIV prevalence among all children 1-23 months (by age groups: 1-11 months; 12-23 months)
2. HIV prevalence among HIV-exposed children 11-23 months (born to an HIV+ mother)
3. Proportion of HIV- children 12-23
months born to women who are currently HIV+ (HIV-free survival)
4. Infant Mortality Rate among children born to HIV+ mothers (deaths due to any cause)
WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global GuidanceExisting Population-based Surveys for Measuring PMTCT Impact
Indicators
WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global Guidance
WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global Guidance
Indicator CalculationsPreliminary CalculationsReference: Bernard Barrere , M EASURE DHS, ICFI.
0
50
100
150
200
250
Malawi DHS 2010
Deaths per 1,000
Preliminary Calcula-tionsReference: Bernard Barrere, MEASURE DHS, ICFI.
<1 1-2 <5
• 4 proposed indicators calculated using data from existing surveys with child HIV testing
• Uganda AIS 2004-05, Malawi DHS 2010, Mozambique AIS 2009,
Rwanda DHS 2010
• Keep in mind surveys were not sampled for the proposed PMTCT indicators; that was not the primary objective
U5MR by mother’s current HIV status
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WHO – PMTCT Impact Measurement and EMTCT Validation: Update on Global Guidance
Considerations
Mozambique AIS 2009(child testing in only half the households), Uganda AIS 04-05• HIV prevalence 1-23 month:
Mz 2.1% (0.7% - 3.6%)Ug 0.9% (0.5% - 1.3%)
• HIV prevalence 1-23 month among children with HIV+ mothers(MTCT) :
Mz 18.5% (3.3% - 33.7%), n=62Ug 15.1% (9% - 21%), n=123
• Proportion of HIV negative children 12-23 born to women currently HIV+ (HIV-free surival):
Mz 68.3% (42.4%-94.2%), n=28Ug 89.8% (82.5%-97.0%), n=61
• Large confidence intervals for most of the suggested indicators and large sample required to provide reliable point estimates.
• Low testing coverage rate among young children may introduce a bias.
• Large sample sizes have serious cost implications for the surveys, and put additional burden on survey logistics, such as training, fieldwork and supervision.
• Hypothetical cost, 10% adult prevalence$1.4 million (n= 9,000 households) $1.8 million (n= 13,000 households) $ 2.2 million (n=18,000 households)
Preliminary CalculationsReference: Bernard Barrere, MEASURE DHS, ICFI.
Small numbers
Large CI
Cohort Approachto
Measure PMTCT ImpactJune 2012 Consultation
Routine Cohort Outcome Monitoring SystemPreviously, we described how to overcome the lack of cohort data (link existing records, or active follow-up).After the consultation, emphasis is on establishing systems to routinely collect cohort data.
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HIV+ preg women (PW)
Identified HIV+ PW women
ARV
EID
EID
Final Outcome
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1. Key indicators and time points to meausre them
2. Routine cohort outcome monitoring system as ideal system, in both low and high prevalence countries
3. Minimum essential elements to set up a routine system.
(e.g. Unique IDs, tracking strategy)
4. Other ways to construct cohort data if routine system does not exist, with real examples
5. Handling missing data and
approaches to estimate outcomes of those LFU; sensitivity analyses
6. Annexes
1. Sampling considerations for representativeness
2. Patient confidentiality
3. Standard way to report results
Guidance Document for the Cohort Approach (Mother-Child Follow Up)
Detailed Guidance documents for comment1. Generic protocol to measure the
effectiveness and impact of national PMTCT programmes at population-level using a facility-based survey approach.
2. Considerations for measuring the impact of PMTCT programmes using standard population-based surveys in selected high HIV prevalence countries
3. Guidance on cohort/mother-baby pair follow-up .4. Guidance on management, analysis and interpretation of EID/child HIV
testing data
Next Steps: Impact Guidance
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Send email to:
[email protected] join:EZ-Collab workspace on PMTCT impact measurement
EMTCT Validation Consultation
June 2012 Consultation
What are the criteria and processes to validated EMTCT of HIV and syphilis?
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Impact measure with process measures, e.g. <0.5 new cases/1,000 births, with >95% ANC,>95% testing coverage> 90% ARV coverage
• How to define EMTCT?< 5% MTCT rate?
Zero child HIV cases from MTCT?All 4 prong targets?
High intervention coverage for 3 years?
Same criteria for all countries?
Acceptable measurement method? Quality?
Impact data must be directly measured through active case
reporting/monitoring system or special studies, triangulate with
modelling.Detailed guidance on data
standards to review and report.
Processes to validate EMTCT?
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NVC responsible for preparing validation background work, including ensuring EMTCT criteria is met in selected geographical areas and key populations.
Review programme indicators every year and impact every
3 years until routine system is available
Ministry of Health
National Validation Committee (NVC)Collects, reviews and decides on the national
documentation through consultations
Regional Validation Committee (RVC) Reviews country reports and country
surveillance system comply with global and regional minimum validation
standards
Global Validation Committee (GVC)
Reviews country/RVC reports (including any data from field visits) to ensure consistency and compliance with the
minimum global criteria.
WHO
Also an opportunity to improve data and
programmes
Acknowledgements• Experts and national MOH and programme staff sharing
their experiences, thoughts and time in all related PMTCT Impact and EMTCT Validation Consultations
• IATT PMTCT M&E WG Members: CHAI (Kate Sabot), ICAP (Fatima Tsouiris, Rosalind Carter)
• CDC: Thu-Ha Dinh, Eddas Bennett• Measure DHS, ICFI: Bernard Barrere• UNAIDS: Mary Mahy• UNICEF: Pricilla Idele, consultant: Zhuzhi Moore• WHO: Nathan Shaffer, Yves Souteyrand, Nigel Rollins,
Txema Calleja, Lori Newman, Monica Alonso