Productivity & Yield analysis

Transcription

1 HIV TestinG toolkit Productivity & Yield analysis

2 For toolkits, training resources, and more, visit NASTAD.org National Alliance of State & Territorial AIDS Directors (NASTAD) 444 North Capitol Street NW, Suite 339 Washington, DC Phone: (202) NASTAD.org NASTAD NASTAD NASTAD1992 This resource was prepared by the National Alliance of State and Territorial AIDS Directors (NASTAD) under cooperative agreement number U65PS from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

3 Productivity and Yield Analysis R egular monitoring is critical to the success of HIV testing and linkage programs. Regular monitoring of testing and linkage programs helps to assure that services are meeting overarching goals to: (1) identify HIV infections and (2) link HIV-infected persons with HIV medical care, while also optimizing public health resources. The productivity and yield analysis is one tool that health departments and HIV testing and linkage providers can use to monitor services. The productivity and yield analysis will help you to evaluate the extent to which the recruitment, testing, and linkage strategies used by your HIV testing and linkage providers are successful in achieving the overarching goals for HIV testing and linkage programs and for achieving programmatic objectives of assuring access to services among priority populations. The productivity and yield analysis will help you to identify the factors that help or hinder your program s ability to meet its goals and programmatic objectives and suggest strategies to improve your program. This tool is intended to help you to conduct a basic productivity and yield analysis, using data that you already collect in conjunction with CDC HIV prevention funding. You should adjust the scope of the analysis and make modifications to the worksheet to better meet your program s specific needs and priorities. For example, you may wish to adjust the age groupings or risk exposure categories to Regular monitoring is critical to the success of HIV testing and linkage programs. more closely reflect the populations which are most relevant to your program; add columns to capture linkage to care among patients who were previously diagnosed with HIV; or add columns to examine the success of referral to priority services (e.g., substance abuse treatment) for particular populations. To be most helpful, the productivity and yield analysis can, and should be, conducted at multiple levels and from multiple perspectives. The productivity and yield analysis focused on an individual HIV testing and linkage site will provide different information than when performed for an entire state, which likely represents multiple providers of services and approaches to testing and linkage. Similarly, the productivity and yield analysis could be focused by testing approach (e.g., for routine testing or targeted testing); type of provider (e.g., clinics or community-based providers); populations (e.g., agencies serving men who have sex with men, adolescents, or racial/ethnic populations); venues (e.g., outreach settings, correctional facilities); geographic location (e.g., rural communities, particular zip codes); as well as by other factors (e.g., agencies which use rapid testing, employ linkage navigators, are funded by a particular revenue stream). Health departments are encouraged to share this tool with individual HIV testing and linkage providers to support local use of the tool. HIV Testing toolkit: Selecting a Strategy 1

4 Conducting the Productivity and Yield Analysis The productivity and yield analysis process consists of four (4) steps: 1 Set Targets 2 Calculate Productivity and Yield 3 Identify Contributing Factors 4 Determine Strategies for Improvement Each of these steps are explained below. 1 Set Targets At minimum, the productivity and yield analysis should address the overarching goals for HIV testing and linkage: (1) identifying new HIV infections; and (2) linking newly-diagnosed individuals to HIV medical care. Targets should reflect what is reasonable and feasible given the capacity and resources available to support HIV testing and linkage services. Targets should also reflect your priorities in terms of the populations that are served by your HIV testing and linkage program(s). Sometimes targets are dictated by the requirements of a funder (e.g., percentage of new HIV-positive test results). Targets may also be suggested by other sources such as program standards or guidelines (e.g., proportion of HIV-infected individuals who are successfully linked to HIV medical care). More often, you will need to set targets. One simple way of setting targets involves looking at service data retrospectively, identifying trends over time, and projecting reasonable future achievements. This same approach to setting targets can be used for yield of new positives, successful linkage to care, or other variables you decided to include in the yield and productivity analysis. You should also consider setting targets for specific populations, as relevant for your program(s). Target setting for specific populations should be informed by your epidemiologic profile, and/or the populations served by the agencies and/or programs supported for HIV testing and linkage services. 2 Calculate Productivity and Yield Begin by deciding the scope of your analysis (e.g., statewide, regional, individual site, or group of agencies) and the period of the analysis (e.g., past year, quarter, month). For each analysis you plan to perform, gather the necessary program data. At minimum, you will need the number of: Tests performed New HIV infections identified Newly diagnosed individuals linked to care 2 HIV Testing toolkit: Selecting a Strategy

5 You should segment these data according to the client characteristics (e.g., risk exposure, age) that you plan to include in your analysis. If you decide to include additional variables not currently on the worksheet, such as previously diagnosed individuals linked to care, you will also need to gather these data. Enter your data into the Yield and Productivity Worksheet (the instructions for completion are included on the first tab of the worksheet). Progress toward meeting your targets will be automatically calculated. The Yield and Productivity Worksheet is provided in an Microsoft Excel format and is unlocked to allow you to add additional variables of interest or adjust the population characteristics. See Figure 1 below for an example of what a portion of a completed worksheet will look like. Figure 1: Example Completed HIV Testing and Linkage Yield and Productivity Analysis Worksheet Scope of Analysis: HIV Testing and Linkage in This State Time Period: Fiscal Year 2015 CLIENT CHARACTERISTICS TARGET # OF TESTS HIV HIV TESTING AND LINKAGE PRODUCTIVITY AND YIELD ANALYSIS Date Completed: July 2015 HIV TEST VOLUME HIV SEROPOSITIVITY LINKAGE TO CARE TARGET # TESTS % OF % TO TARGET # # NEW % OF NEW % NEW % TO LINKED TO # LINKED % HIV+ TESTS TARGET NEW HIV+ HIV+ HIV+ HIV+ TARGET CARE TO CARE LINKED (90%) % TO TARGET TOTAL % % 60.2% % 86.2% AGE < 13 years % 75.0% % 0.0% 0.0% 0 0 #DIV/0! #DIV/0! years % 81.7% % 3.7% 90.0% % 111.1% years % 60.0% % 1.9% 18.7% % 69.0% years % 91.9% % 1.3% 58.0% % 63.2% years % 97.7% % 0.7% 50.0% % 77.8% years % 66.6% % 0.7% 113.3% % 98.0% years % 41.6% % 0.8% 135.0% % 102.9% years % 67.9% % 0.7% 175.0% % 104.8% years % 65.4% % 4.3% 280.0% % 103.2% years % 44.4% % 0.5% 20.0% % 111.1% > 60 years % 154.0% % 0.6% 100.0% % 111.1% TOTAL % 70.5% % 1.0% 60.2% % 86.2% GENDER Male % 61.1% % 1.2% 63.3% % 82.5% Female % 92.8% % 0.7% 80.4% % 96.9% Transgender male- to- female % 26.4% % 2.3% 6.0% % 37.0% Transgender female- to- male % 24.0% % 8.3% 20.0% % 111.1% TOTAL % 70.5% % 1.0% 60.2% % 86.2% RACE & ETHNICITY American Indian/Alaska Native % 141.2% % 0.8% 75.0% % 37.0% Asian % % % 0.1% 10.0% % 111.1% Black/African American % 69.5% % 1.2% 68.5% % 85.8% Native Hawaiian/Pacific Islander % 582.0% % 0.0% 0.0% 0 0 #DIV/0! #DIV/0! White % 57.6% % 0.7% 42.9% % 92.6% Other % 77.0% % 1.3% 200.0% % 55.6% Unknown % 658.0% % 1.2% 400.0% % 55.6% TOTAL % 70.5% % 1.0% 60.2% % 86.2% Hispanic % 11.4% % 2.1% 24.0% % 74.1% RISK MSM % 55.5% % 1.4% 50.7% % 96.5% MSM/IDU % 31.5% % 7.9% 71.4% % 88.9% IDU % 128.9% % 0.5% 49.2% % 59.0% High Risk Sex Partner % 70.9% % 2.3% 75.0% % 87.7% Sex Partner to IDU % 221.1% % 0.1% 20.0% % 55.6% Female Sex Partner to MSM % 8.9% % 0.9% 10.0% % 111.1% Sex Partner to HIV % 48.0% % 5.5% 87.0% % 88.1% Other Heterosexual % 42.4% % 0.1% 20.0% % 83.3% Other Risk % 68.8% % 0.1% 20.0% % 111.1% Unknown Risk % 146.5% % 0.6% 260.0% % 68.4% TOTAL % 70.5% % 1.0% 60.2% % 86.2% Once you have entered data into the worksheet and the calculations are complete, review the data to identify progress in meeting targets. In particular, you should identify the areas where you are at, above, and below the targets. This will help you to focus your attention in identifying factors that contribute to your relative success in meeting targets, and for identifying strategies for program improvement. A template to help you organize data for the next steps in your analysis is provided in Attachment A. HIV Testing toolkit: Selecting a Strategy 3

6 An example of a partially completed template is provided in Table 2 on page 6. The example uses data from the worksheet illustrated in Figure 1. For each of the three program domains addressed by the productivity and yield analysis, data for population groupings are arranged according to whether the data represents meeting the target ( on target ), exceeding the target ( above target ), or failing to meet the target ( below target ). Services which may not be precisely on target, but may be close (e.g., within 3% - 5%) are included within the on target. Table 1: Interpreting Productivity and Yield: Progress Towards Meeting Target Interpreting Productivity and Yield On Target Above Target Below Target Recruitment < 13, 35-39, yo High-risk heterosexual and other risk 13-19, 25-34, >60 yo IDU, Unknown, Sex partner of IDU 20-24, 40-44, yo MSM, MSM/IDU, other heterosexual Identifying New HIV-Infections N/A 13-19; 35-54; >60 yo MSM/IDU, sex partner HIV+, unknown risk <13, 20-34; yo MSM, IDU, sex partner to IDU, other heterosexual, other risk Linking HIVinfected Clients to Care MSM/IDU Sex partner to HIV , yo MSM, female sex partner to MSM, other risk yo IDU, sex partner to IDU, unknown risk 3 Identify Contributing Factors The next step in the process of conducting the productivity and yield analysis is to identify the factors that contribute to your success in meeting established targets, i.e., the population-specific, operational, policy, or structural factors that contribute to or hinder success. For established programming, it is appropriate to look at changes that may have occurred since the last productivity and yield analysis was performed. Some questions that may be used to guide discussion of contributing factors are presented in Figure 2, below. Figure 2: Identifying Contributing Factors: Guiding Questions Are the target populations present in/accessing HIV testing and linkage at venue(s)? Are program marketing and promotional strategies effective? Are there aspects of services that might make testing and linkage easier or more appealing to clients? Has something about the HIV testing and linkage venue(s) changed (e.g., location, hours, availability of other services) that impact population access and use of services? To what extent is the model of services (e.g., routine or targeted testing, client navigation or assisted referral) appropriate to and adequate in meeting the needs of populations served? To what extent is staffing and workflow adequate and appropriate to achieving targets? 4 HIV Testing toolkit: Selecting a Strategy

7 Identification of the factors contributing to being off target should be undertaken in consultation with staff familiar with and/or involved in delivery of services. At the health department, this may include staff who oversee service contracts or conduct quality assurance activities. For an individual service provider this may include staff that provide services directly to clients (e.g., outreach workers, counselors, navigators) as well as program coordinators and supervisors. You should also consider including program epidemiologists, program evaluators, or others who manage and interpret data. The template provided in Attachment A will help you organize data regarding the contributing factors and help to prepare you for the next steps in your analysis. Using data provided in Figure 1, an example of how contributing factors can be included in the analysis is provided in Table 3 on page 7. HIV Testing toolkit: Selecting a Strategy 5

8 Table 2: Interpreting Productivity and Yield: Identifying Contributing Factors Interpreting Productivity and Yield: Identifying Contributing Factors On Target Above Target Below Target Considerations Recruitment < 13, 35-39, yo High-risk heterosexual and other risk 13-19, 25-34, >60 yo IDU, Unknown, Sex partner of IDU 20-24, 40-44, yo MSM, MSM/ IDU, other heterosexual Five new school health centers brought on board, underestimated uptake among adolescents; Urgent care out-posting demo project disproportionately reached >60 pop; failed to reach younger pops as intended Closure of City STD clinic decreased access to yo and MSM Needle exchange sites expanded testing for hepatitis C, created more interest in HIV testing and brought in partners Partners counseling and testing expansion has had lower uptake than anticipated Identifying New HIV- Infections N/A 13-19, 35-54, >60 yo MSM/IDU, sex partner HIV+, unknown risk <13, 20-34, yo MSM, IDU, sex partner to IDU, other heterosexual, other risk Closure of City STD clinic decreased testing for yo and MSM previously accounted for 15% of new HIV+; IDU and sex partner to IDU incidence of HIV is very low, but HCV infection identified through expanded testing in needle exchange sites was 30% Yield of new HIV+ decreased dramatically in community health centers that previously accounted for 50% of new positives in yo substantially impacts overall progress to achieving target Linking HIV-infected Clients to Care MSM/IDU Sex partner to HIV , yo MSM, female sex partner to MSM, other risk yo IDU, sex partner to IDU, unknown risk DPH policy sets target at 90% ACME testing services accounts for approximately 1/3 of new positives in yo group, with only 60% successful linkage, this is affecting overall progress to achieving target IDU linkage to care consistently below other populations, all testing providers except at ACME community health services (95%) where opiate dependency treatment integrated into HIV primary care 6 HIV Testing toolkit: Selecting a Strategy

9 4 Determine Strategies for Improvement The final step in the productivity and yield analysis is to determine strategies for program improvement. This step should be undertaken in consultation with staff familiar with and/or involved in delivery of services. It may also be helpful and appropriate to involve members of the target population in discussions to identify strategies for improvement. For each of the population-specific, operational, policy, and structural factors identified, you should identify one or more strategies to address the factor. The template provided in Attachment A will help you organize information regarding strategies to address contributing factors and to complete your analysis. Building on the prior example and using data provided in Figure 1, examples of how strategies should be included in the analysis are provided in Table 3, below. Table 3: Interpreting Productivity and Yield: Strategies for Improvement Recruitment Contributing Factors Five new school health centers brought on board, underestimated uptake among adolescents; Urgent care out-posting demo project disproportionately reached >60 pop; failed to reach younger pops as intended Closure of City STD clinic decreased access to yo and MSM Needle exchange sites expanded testing for hepatitis C, created more interest in HIV testing and brought in partners Partners counseling and testing expansion has had lower uptake than anticipated Strategies Maintain health center support; identify strategies to promote testing to increase uptake of testing services Review recruitment strategies used in urgent care demo to determine reasons for suboptimal testing in younger populations present in the venue Conduct evaluation (e.g., focus groups) with young MSM to determine appropriate locations for testing; assess feasibility of expanding hours of LGBT clinic run by ACME Community Health Services Continue integrated HIV-HCV testing at needle exchange Review recruitment strategies to determine reasons for lower than anticipated uptake In the example above, evaluation of appropriate locations for HIV testing and linkage services was identified as a strategy for improvement (highlighted by the red box). It is important to note in some circumstances, such as when the contributing factors have been identified are structural (e.g., clinic closures), further investigation may be an appropriate strategy to achieve program improvement. HIV Testing toolkit: Selecting a Strategy 7

10 Implementation of strategies for program improvement should be monitored and the status and outcome of implementation efforts should be considered in future productivity and yield analyses, particularly in setting targets. Program improvement is generally incremental so your future targets should reflect this. In the example illustrated in Table 3, a clinic closure substantially impacted testing among men who have sex with men. The formative evaluation needed to identify appropriate venues and build or assure organizational capacity may take some time and your targets should reflect this. 8 HIV Testing toolkit: Selecting a Strategy

11 InterpretIng productivity and yield On Target Above Target Below Target Contributing Factors Recruitment Identifying New HIV- Infections Linking HIV-infected Clients to Care attachment a: InterpretIng productivity and yield Strategies

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