ICAP Quarterly Master Slide SetApril-June 2008

Site Census

• What: Ongoing, real-time inventory of all planned, current, and closed ICAP sites. Supported activities, funding source(s) and their targets are also captured

• Purpose: To have one up to date master list of sites, activities, funding sources, and targets that all ICAP staff can refer to for planning and evaluation

Number of ICAP-supported sites by activity, June 2008 (n=619)

Nu

mb

er

of s

ites

Number of ICAP-supported sites by country, June 2008 (n=619)

Nu

mb

er

of s

ites

Programmatic components funded at ICAP-supported care and treatment sites (n=332),

June 2008

% c

are

and

trea

tme

nt s

ites

with

act

ivity

Type of activity

Program and Facility Characteristics Tracking System (PFaCTS)

• What: Collects program and facility information on ICAP-supported care and treatment programs semi-annually

• Purpose: To describe the scope, diversity, and comprehensiveness of ICAP-supported care and treatment programs, and evaluate multi-level factors that influence program performance and patient-level outcomes

25%

72%

69%

28%7%

0%

50%

100%

Urban RuralPrimary Secondary Tertiary

Location and type of ICAP-supported HIV care and treatment sites (n=296)

n=166 n=130

% s

ites

Proportion of ICAP-supported HIV care and treatment sites offering HIV-related services

on site (n=303)97% 98% 100% 98%

77%

0%

50%

100%

VCT PMTCT Labor andDelivery

TB treatment ART pharmacy

% s

ites

with

se

rvic

e

3 services; 1%

4 services; 26%

5 services; 73%

Proportion of ICAP-supported HIV care and treatment sites offering HIV-related services on site

by number of services offered (n=284)

Proportion of ICAP-supported HIV care and treatment sites offering ≥4 HIV-related services on

site (n=257)

100% 100% 100% 100% 100% 100% 100% 98% 97%

0%

50%

100%

Leso

tho

Ethio

pia

Moz

ambiq

ue

South

Afri

ca

Niger

ia

Rwanda

Cote

D'Ivoir

e

Kenya

Tanza

nia

ICAP Average

=99%

% s

ites

with

≥4

serv

ice

s

Proportion of ICAP-supported HIV care and treatment sites offering on-site patient support

services by type of service offered (n=303)

87%

55%

40% 39%24%

0%

50%

100%

ARTadherence

support

Outreach Peereducatorprogram

Foodsupport for

children andinfants

Foodsupport for

adults

% s

ites

with

se

rvic

e

1 service; 38%

2 services; 17%

3 services; 15%

4 & 5 services;

29%

Proportion of ICAP-supported HIV care and treatment sites offering on-site patient support services by number of services offered (n=248)

0%0%0%

78%

69%

32%24%

13%0% 0%

0%

50%

100%

South

Afri

ca

Rwanda

Moz

ambiq

ue

Kenya

Niger

ia

Swazila

nd

Leso

tho

Tanza

nia

Ethio

pia

Cote D

'Ivoir

e

Proportion of ICAP-supported HIV care and treatment sites with ≥4 on-site patient support

services (n=248)

ICAP Average

=29%

% o

f site

s w

ith ≥

4 s

ervi

ces

Proportion of ICAP-supported HIV care and treatment sites with access to laboratory assays

(n=303)

48%36% 34%

5% 6%

47%59% 60%

83%

33%

0%

50%

100%

LFT CD4 count CD4 percent Infant diagnosis/PCR

HIV-RNA

Available on site Available off site

% s

ites

3-4 assays, 14%

1-2 assays, 2%

5-6 assays, 84%

Proportion of ICAP-supported HIV care and treatment sites with access to laboratory assays

by number of assays (n=300)

86%100% 100% 100% 100% 95% 89% 89% 88% 87%

0%

50%

100%

Swazila

nd

South

Afri

ca

Leso

tho

Rwanda

Ethiop

ia

Moza

mbiq

ue

Cote D

'Ivoir

e

Nigeria

Kenya

Tanzan

ia

Proportion of ICAP-supported HIV care and treatment sites with access to key HIV-related

laboratory assays (n=277)ICAP

Average=92%

% s

ites

100% 100% 100% 100% 100% 93% 91% 90%76%

0%

50%

100%

South

Afri

ca

Swazila

nd

Leso

tho

Rwanda

Nigeria

Moza

mbiq

ue

Kenya

Ethiop

ia

Tanzan

ia

Proportion of ICAP-supported HIV care and treatment sites with access to PCR laboratory

assays (n=283)ICAP

Average=90%

% s

ites

0

30

60

90

120

150

Overa

ll

Kenya

Tanza

nia

Rwanda

Niger

ia

Leso

tho

South

Afri

ca

Moz

ambiq

ue

Ethiop

ia

Physicians Health Officers/Medical Assistants Nurses

Mean number of health care providers per 1000 patients on ART at ICAP-supported HIV care and

treatment sites (n=303)

Num

ber

of p

rovi

ders

per

/100

0 pa

tient

s on

AR

T

0

10

20

South

Afri

ca

Cote

D'Voi

re

Rwanda

Leso

tho

Tanza

nia

Moz

ambiq

ue

Niger

ia

Ethiop

ia

Kenya

Mean number of outreach workers per 1000 patients on ART at ICAP-supported HIV care and

treatment sites (n=163)

ICAP Average

=6.9

Num

ber

of o

utre

ach

wor

kers

pe

r/10

00 p

atie

nts

on A

RT

0%

50%

100%

Food supportfor adults

Food supportfor adults or

infants

Outreach Adherencesupport

Peereducators

Jan 07 July 07 Jan 08

Trend in proportion of ICAP-supported HIV care and treatment sites offering on-site patient support services

(n=170)

0%

50%

100%

150%

July 07 Jan 08

Trend in proportion of ICAP-supported HIV care and treatment sites offering prevention services (n=224)

Counseling regarding disclosure

Education on behavior and safe sex

Provision of condoms

Referral for on-site screening for STIs

Education on high-risk substance use

Screening for drug and alcohol abuse

HIV care and treatment services

14%

48%40% 39%

32%

6%1%

12%

23%

9%

28%

4%

0%

50%

100%

Proportion of ART patients in sub-Saharan Africa that initiated ART at an ICAP-supported site,

December 2007

% o

f all

pa

tient

s o

n A

RT

Sub-S

ahar

an co

untri

es

where

ICAP w

orks

Cameroon, Cote d’Ivoire,

Kenya, Lesotho, Rwanda, S. Africa, TanzaniaUganda,Thailand

Mozambique

Ethiopia

Cumulative enrollment at ICAP-supported HIV care and treatment programs (ever-supported)

522,399 in care

237,337 on ARTN

um

ber

of

pat

ien

ts Nu

mb

er of facilities

Nigeria,

Swaziland,

Zambia

362 sites

Cumulative pediatric enrollment in ICAP-supported HIV care and treatment programs (ever-supported)

58,505 in care

20,996 on ART

Nu

mb

er o

f p

atie

nts

Nu

mb

er of facilities

Cameroon, Cote d’Ivoire,

Kenya, Lesotho, Rwanda, S. Africa, TanzaniaUganda,Thailand

Mozambique

Ethiopia

Nigeria,

Swaziland,

Zambia

362 sites

Cumulative enrollment in ICAP-supported HIV care and treatment programs (currently supported)

442,668 in care

202,303 on ART

Nu

mb

er o

f p

atie

nts

Nu

mb

er of facilities

Cameroon, Cote d’Ivoire,

Kenya, Lesotho, Rwanda, S. Africa, TanzaniaUganda,Thailand

Mozambique

Ethiopia

Nigeria,

Swaziland,

Zambia

320 sites

Cumulative pediatric enrollment in ICAP-supported HIV care and treatment programs (currently supported)

297 sites

18,210 on ART

Nu

mb

er o

f p

atie

nts

Nu

mb

er of facilities

Cameroon, Cote d’Ivoire,

Kenya, Lesotho, Rwanda, S. Africa, TanzaniaUganda,Thailand

Mozambique

Ethiopia

Nigeria,

Swaziland,

Zambia44,271 in care

Current and target cumulative enrollment in ICAP-supported care and treatment programs

174,819

418,969

200,785

393,781

0

225,000

450,000

HIV care ART

Current enrollment, June 08

COP 08 enrollment target

94% of target

87% of target

Nu

mb

er o

f p

atie

nts

Current and target cumulative HIV care enrollment in ICAP-supported care and treatment

programs by country

0

50000

100000

150000

Cote

d'Ivo

ire

Ethiop

ia

Kenya

Moz

ambi

que

Nigeria

Rwanda

South

Afri

ca

Tanza

nia

Current enrollment, June 08

COP 08 enrollment target

Nu

mb

er o

f p

atie

nts

3% of target

99% of target

66% of target

108% of target76% of target

108% of target

87% of target

107% of target

Current and target cumulative ART enrollment in ICAP-supported care and treatment programs

by country

Nu

mb

er o

f p

atie

nts

0

25,000

50,000

Cote

d'Ivo

ire

Ethiop

ia

Kenya

Moz

ambiq

ue

Nigeria

Rwanda

South

Afri

ca

Tanz

ania

Current enrollment, June 08

COP 08 enrollment target

7% of target

98% of target

116% of target

48% of target

96% of target

101% of target

83% of target

89% of target

Mozambique

Ethiopia

South Africa

Kenya

Rwanda

Tanzania

Lesotho

Nigeria

SwazilandZambia

Cote d'Ivoire

0

150,000

300,000

450,000

June

05

June

06

June

07

June

08

Cumulative enrollment in HIV care in ICAP-supported HIV care and treatment programs by country

(n=442,668)

Nu

mb

er o

f p

atie

nts

Cumulative enrollment on ART at ICAP-supported HIV care and treatment programs by country

(n=202,303)

Mozambique

Ethiopia

South Africa

Rwanda

KenyaTanzania

Swaziland

Lesotho

NigeriaZambia

Cote d'Ivoire

0

105,000

210,000

Jun

e 05

Jun

e 06

Jun

e 07

Jun

e 08

Nu

mb

er o

f p

atie

nts

Cumulative and current enrollment in ART care at ICAP-supported HIV care and treatment programs

(n= 190,378*)

Nu

mb

er

of p

atie

nts

ART patients retained in care

Cumulative initiating ART

Lost to follow up

Reported dead

ART patients retained in care

* Excludes Zambia and Swaziland as no follow up data were reported for ART patients

Cumulative enrollment in ICAP-supported HIV care and treatment programs by ART status, age, and sex

Total care enrollment (n=442,668) Total ART enrollment (n=202,303)

Women 15+

Men 15+

Children <15

0

150,000

300,000

450,000

Women 15+

Men 15+

Children < 15

0

105,000

210,000

Proportion of patients ever enrolled in HIV care who initiated ART in ICAP-supported care and treatment

programs* as of June 2008

46%

69% 59%55% 53%

47%44% 43% 43%

40%

32%

0%

30%

60%

Ove

rall

Cote d

'Ivoire

South A

frica

Ethio

pia

Rwan

da

Tanzania

Nigeria

Kenya

Lesoth

o

Zambia

Moza

mbiq

ue

n=528

n=35,

158

n=57,

559

n=3

0,47

6

n=

139,

056

n=46,

562

n=4

42,6

88

n=55,

528

% p

atie

nts

initi

atin

g A

RT

n=2

8,91

4

n=6

,959

n=3

0,00

3

* Excludes Swaziland as no HIV care data were reported

60% 58% 59%

29% 33% 31%

11% 9% 10%

0%

50%

100%

Pre-ART ART Overall

Women 15+ Men 15+ Children <15

Cumulative enrollment in ICAP-supported HIV care and treatment programs* by age and sex

as of June 2008 n=240,365 n=202,303 n=442,668

% p

atie

nts

* Excludes Swaziland as no HIV care data were reported

59%

69% 68% 66%61% 62% 62%

59%

1%

9%

99%

55%59%

58%

9%7%11%11%

7%10%8%

3%3%

10%

0%

50%

100%

Overa

ll

Cote

d'Ivoire

Lesot

ho

South

Afri

ca

Niger

ia

Tanza

nia

Kenya

Rwanda

Swazila

nd

Moza

mbiq

ue

Ethio

pia

Zambia

Women 15+ Children <15

Cumulative HIV care enrollment of women and children in ICAP-supported HIV care and treatment

programs as of June 2008

n=57,

559

n=46,

562

n=55,

528

n=5

28

n=28,

914

n=1

39,0

56

n=30,

003

n=30,

476

n=35,

158

n=442

,668

n=6,9

59

% p

atie

nts

in H

IV c

are

n=11,

925

58%

65% 65% 64% 64%61% 60% 59% 59%

1%6%

98%

56% 53%

9%

2%4% 5%

8% 7%11% 11%

7% 9%

0%

50%

100%

Overa

ll

Cote d

'Ivoi

re

Lesoth

o

Niger

ia

South A

frica

Tanza

nia

Kenya

Rwanda

Swazila

nd

Moz

ambi

que

Ethio

pia

Zambi

a

Women 15+ Children <15

Cumulative ART enrollment by women and children in ICAP-supported HIV care and treatment programs as

of June 2008

n=18,

729

n=20,

053

n=12,5

87

n=2

39

n=32,

738

n=3

1,64

9

n=12

,816

n=14,

348

11,9

25

202,303

n=2

,743

% p

atie

nts

on A

RT

n=44,

349

67%

55%

46%

23%19%

15% 15%

6%

14%

20%

24%

31%

20%

29%

19%

25%

46%

65%

3%0% 0% 5%

0% 0% 0% 0%

19%

0%

17%

37%36%

28%

23% 23%

23%

29%

50%56%

36% 41%

24%

53% 56%

0%

50%

100%

Overall Zambia Nigeria Moz SouthAfrica

Lesotho Ethiopia Tanzania Kenya Rwanda Coted'Ivoire

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

Cumulative pediatric HIV care enrollment in ICAP-supported HIV care and treatment programs*

as of June 2008 n=2,280 n=947n=12,196 n=3,753 n=4,909n=4,250n=3,095 n=5,386 n=17n=43,431*

% p

edi

atr

ic p

atie

nts

in H

IV c

are

n=6,898

* Excludes Swaziland as no pediatric breakdown were reported

45%41%

31%

18%12%

7% 7%0%

21%33%

29%

30%

20%

57%

35%

34%

50%

43%

4% 2% 7%0% 0% 0% 0% 0%

23%

0%

21%22%

8%

26%

29%23%26%

24%

67%

53%

24%

56%48%67%58%

0%

50%

100%

Overall Zambia Nigeria Moz Lesotho SouthAfrica

Ethiopia Tanzania Kenya Rwanda Coted'Ivoire

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

Cumulative pediatric ART enrollment in ICAP-supported HIV care and treatment programs*

as of June 2008n=2,230 n=1,969n=622 n=1,962 n=989n=497n=2,685 n=2,558 n=7n=17,306

% p

edi

atr

ic p

atie

nts

on

AR

T

n=3,787

* Excludes Swaziland as no pediatric breakdown were reported

22%37% 37%

29%20% 17%

9% 8% 7%

78%63%

71%80% 83%

91% 92% 93% 97%

3%

63%

0%

50%

100%

Ove

rall

South

Afri

ca

Tanza

nia

Kenya

Moz

ambiq

ue

Rwanda

Niger

ia

Ethio

pia

Cote d

'Ivoi

re

Leso

tho

% Eligible, but not started % Eligible, started

ART initiation among patients eligible for ART in ICAP-supported HIV care and treatment programs,

April-June 2008 (n=25,485)

% p

atie

nts

elig

ible

for

AR

T

n=263 n=1,683n=5,046 n=1,547 n=3,273n=2,305 n=2,808n=25,485 n=5,576 n=2,984

Overall (Adults)

n=123,484Overall (Children)

n=13,944

1st line regimen

d4T-3TC-NVP67,795

(55%)4,373(31%)

d4T-3TC-EFV 28,484 (23%)2,061(15%)

ZDV-3TC-NVP 18,054 (15%)3,341(24%)

ZDV-3TC-EFV5,635

(5%)834(6%)

Other* N/A414(3%)

2nd line regimen1,504

(1%)188(1%)

Unknown regimen

2,012

(2%)2,733(20%)

ART regimens distributed to adults in ICAP-supported HIV care and treatment programs,

April-June 2008

* In South Africa, d4T-3TC-LPV/r is also prescribed as a first-line regimen for pediatric patients.

ART regimens distributed to adults in ICAP-supported HIV care and treatment programs,

April-June 2008Cote

d’Ivoire

n=355

Eth

n=19,480

Kenya

n=11,006

Lesotho

n=7,000

Moz

n=31,183

Nigeria

n=10,773

Rwanda

n=11,571

South Africa

n=22,014

TZ

n=10,046

Zambia

n=54

1st line regimen

d4T-3TC-NVP

259

(73%)

10,212

(52%)

8,992

(82%)3,556(51%)

25,731

(83%)

4,042

(38%)

4,637

(40%)

2,812

(13%)

7,521

(75%)

33

(61%)

d4T-3TC-EFV

62

(17%)

4,147

(21%)

1,139

(10%)

1,173

(17%)

2,201

(7%)

207

(2%)

788

(7%)

17,788

(81%)

979

(10%)

0

(0%)

ZDV-3TC-NVP

18

(5%)3,319 (17%)

515

(5%)

1,208

(17%)

1,723

(6%)

5,553

(52%)4,560 (39%)

250

(1%)

908

(9%)

0

(0%)

ZDV-3TC-EFV

2(1%)

1,697

(9%)

140

(1%)

706

(10%)

91

(0%)

287

(3%)

1,176

(10%)

906

(4%)

630

(6%)

0

(0%)

2nd line regimen

7(2%)

60

(0%)

194

(2%)

357

(5%)

287

(1%)

0

(0%)

410

4%

179

(1%)

10

(0%)

0

(0%)

Unknown regimen

7

(2%)

45

(0%)

26

(0%)

0

(0%)

1,150

(4%)

684

(6%)

0

(0%)

79

(0%)

0

(0%)

21

(39%)

Cote d’Ivoire

n=7

Ethiopian=1,549

Kenyan=1,589

Lesothon=295

Moz n=2,962

Nigerian=527

Rwandan= 1,504

South Africa*n=2,289

Tanzanian=774

Zambian=2,448

1st line regimen

d4T-3TC-NVP

5(71%)

374(24%)

5790(36%)

139(47%)

1,252 (42%)

26(5%)

593 (39%)

35(2%)

381(49%)

989(40%)

d4T-3TC-EFV

0122(8%)

98(6%)

56(19%)

97(3%)

33 (6%)

118 (8%)

1,520(66%)

16(2%)

1(0%)

ZDV-3TC-NVP

2(29%)

891 (58%)

745(47%)

27 (9%)

345 (12%)

395 (75%)

589 (39%)

24(1%)

323(42%)

0(0%)

ZDV-3TC-EFV

2(50%)

156 (10%)

131(8%)

7 (2%)

7(0%)

72 (14%)

185(12%)

222(10%)

54(7%)

0(0%)

Other*0

(0%)0

(0%)0

(0%)0

(0%)0

(0%)0

(0%)0

(0%)414

(18%)0

(0%)0

(0%)

2nd line regimen

0 (0%)

1(0%)

20(1%)

0(0%)

90(3%)

0 (0%)

16(1%)

61(3%)

0(0%)

0(0%)

Unknown regimen

0(0%)

5(0%)

16(1%)

66(22%)

1,171(40%)

1(0%)

3(0%)

13(1%)

0(0%)

1,458(60%)

ART regimens distributed to children in ICAP-supported HIV care and treatment programs,

April-June 2008

* In South Africa, d4T-3TC-LPV/r is also prescribed as a first-line regimen for pediatric patients.

Proportion of patients with CD4 count at baseline, 6, and 12 months after ART initiation,

as of June 2008

% p

atie

nts

wit

h C

D4

cou

nt

Average median CD4 count at baseline and 6 and 12 months after ART initiation, as of June 2008

Change in Median CD4 count (cells/µL) at 6 and12 months of ART, as of June 2008

Ch

ang

e in

med

ian

CD

4 co

un

t

Status of ART patients at ICAP-supported HIV care and treatment programs as of June 2008

(n=190,378*)

Continued ART 155,616

82%Discontinued

34,76218%

Lost to follow-up

62%

Reported dead 34%

Stopped ART 4%8.4 per 1,000 person-years

72.5 per 1,000 person-years

142.1 per 1,000 person-years

* Excludes Swaziland as no follow up data were reported for ART patients

62%85% 76%

64% 56% 55% 52% 47%28%

0%

34%

14% 24%29% 43% 38% 43% 53%

64%100% 93%

4% 1% 0% 8% 1% 7% 5% 0%9%

0% 7%

0%0%

50%

100%

Overa

ll

Kenya

Leso

tho

Moz

ambiq

ue

Ethiop

ia

South

Afric

a

Tanza

nia

Nigeria

Rwanda

Cote d

'Ivoir

e

Zambia

Lost to follow-up Reported dead Stopped ART

Reasons for ART discontinuation in ICAP-supported HIV care and treatment programs as of

June 2008

% p

atie

nts

n=34

,762

n=4,

838

n=6,

285

n=8,

508

n=1,

446

n=6,

299

n=3,

564

n=1,132

n=1,

446

n=3

n=18

2

Person-years on ART and discontinuation rates at ICAP-supported care and treatment programs

Cum

ulat

ive

pers

on-y

ears

on

AR

T Cum

ulative events per 1,000 person-years

PMTCT services

Pregnant women counseled and tested inICAP-supported PMTCT programs,

January 2007 – June 2008248742

217184

14317 11433

239183

0

50,000

100,000

150,000

200,000

250,000

Nu

mb

er

of

wo

me

n

1st ANC Counseled Tested HIV positive ART prophylaxis

Pregnant women counseled and tested inICAP-supported PMTCT programs

January 2007 – June 2008

96%

87%

7%

67%

0%

50%

100%

Nu

mb

er

of

wo

me

n

Counseled Tested HIV positive ART prophylaxis

Pregnant women counseled and tested inICAP-supported PMTCT programs over time

34101

38997

50834

59854

60056

31838

38470

48045

57563

58459

27097

33413

44310

52302

55329

2111

2247

3135

3368

3105

1086

1817

2265

2373

2985

0

20,000

40,000

60,000

Jun 07 Sep 07 Dec 07 Mar 08 Jun 08

Nu

mb

er o

f wo

me

n

1st ANC Counseled Tested HIV positive ART prophylaxis

Pregnant women counseled and tested inICAP-supported PMTCT programs over time

93%98%

95% 96% 97%

79%85% 87% 87%

92%

8% 7% 7% 6% 6%

56%

81%

72% 71%

90%

0%

50%

100%

Jun 07n=34,101

Sep 07n = 38,977

Dec 07n = 50,834

Mar 08n = 59,854

Jun 08n = 60,0056

Nu

mb

er o

f wo

me

n

Counseled Tested HIV positive ART prophylaxis

Pregnant women counseled and tested inICAP-supported PMTCT programs

by country, January 2007 - June 2008

0%

50%

100%

Nigeria Mozambique Ethiopia Rwanda Lesotho Cote d'Ivoire

% w

om

en

Counseled Tested HIV positive ART prophylaxis

n=105,680

n=62,402 n=25,052

n=2,100n=44,774

n=2,570

Type of ART prophylaxis at ICAP-supported PMTCT programs, January 2007 - April 2008

n=921 n=5657 n=3405 n=993 n=412n=11433 n=45

TB/HIV services

Proportion of HIV patients screened, screened positive and initiated TB treatment in ICAP-supported care and

treatment programs as of June 2008

% p

atie

nts

n=119,030 n=1,097 n=15,522 n=13,450 n=24,427 n=18,926 n=34,495New HIV patients n=60

Proportion of TB patients HIV tested, tested positive and started HIV care at ICAP-supported TB treatment

programs as of June 2008

% p

atie

nts

New TB patients n=49,205 n=343 n=4,099 n=7,055 n=525n=29,282 n=3,550 n=3,953

Proportion of newly enrolled HIV patients screened for TB at enrollment over time in ICAP-supported care and

treatment programs

n=8,685 n=13,950 n=17,563 n=19,085New HIV patients n=23,992 n=24,702

Proportion of new TB patients tested for HIV over time in ICAP-supported TB treatment programs

n=7,444 n=6,921 n=7,512 n=7,326New TB patients

Counseling and Testing services

Cumulative number of individuals who received counseling and testing for HIV at ICAP-supported

HIV care and treatment programs, as of June 2008