M&E needs for Option B+: highlights from the IATT B+ M&E Framework James Houston MD, MPH Medical Officer Center for Global Health, Division of Global HIV, Maternal Child Health Branch IATT Webinar July 29 th, 2015 Center for Global Health Division of Global HIV, Maternal Child Branch
IATT MONITORING & EVALUATION FRAMEWORK FOR B+ (IATT B+ M&E FRAMEWORK) HTTP://WWW.EMTCT-IATT.ORG/M-AND-E- FRAMEWORK/
Introduction Initiating women on ART within the MCH platform is a new service delivery model that has implications for how program data are collected, reported and used. Four recommendations: 1. PMTCT programs must move beyond coverage to look at retention (Routine monitoring recommendation 2, page 8) 2. Need to Integrate ART and PMTCT M&E systems (Routine monitoring recommendation 4, page 14) 3. Need for enhanced monitoring during implementation of B+ (Enhanced monitoring recommendation 1, page 20) 4. Conduct process and systems evaluations in the early phases of roll out of B+ (Evaluation recommendation 1, page 30)
Moving beyond coverage to look at retention Integration of ART into MCH requires measurement of retention for mothers on ART to ensure quality is the same as rest of ART program Integration of ART into MCH is an opportunity to improve retention for HIV exposed infants until end of breastfeeding period Measurement of retention for mothers and infants requires adapting current M&E system to allow for cohort monitoring
Three different cohorts: PMTCT Cohorts ART cohorts of patients initiating ART ANC cohorts of pregnant women at 1 st ANC visit Birth cohorts of HIV-exposed infants Birth Cohorts: Require organization of records by birth month of infant Population Shared Event Over time Outcome Infants born to HIVinfected mother Month and year of infants birth Final outcome at 18 months Retention and final HIV status
Purpose of Cohort Outcomes Analysis Permits evaluation of the outcomes of the PMTCT program using paper based M&E systems Highlights program quality concerns for intervention Comparison of data over time (year of ART initiation) and between groups of patients (by health facility)
Integrate ART and PMTCT M&E systems Combined review of B/B+ program data by ART and PMTCT program managers Integrated Program Monitoring Technical Working Group Review recommended ART and PMTCT indicators Review of collection tools for ART and PMTCT to identify gaps and revise tools Collect and review data from PMTCT and ART together at facility, sub-national and national levels
Enhanced Monitoring for B+ Critical indicators to assess programme quality during B+ implementation are outlined including: (Table 4, pg 25) Category Enhanced Indicator Rationale Rapid HIV testing quality assurance Stock out of critical commodities 1) % of sites that participate in PT (proficiency testing) 2) % of sites that use a register to monitor quality 3) % of sites that report at least one stock out Correct implementation of rapid testing algorithm and participation in PT program Either rapid test kits, maternal ART, or EID DBS kits
Enhanced Monitoring for B+ Critical indicators to assess programme quality during B+ implementation are outlined including: (Table 4, pg 25) Category Enhanced Indicator Rationale Early retention Viral load suppression 4) % of women who are retained on ART at one month 5) % of women who are retained at 3, 6, or 9 months 7) % of ART patients with an undetectable viral load at 12 months Experience with B+ suggests a large % of lost to follow up occurs between the ART initiation visit (visit 1) and the first follow up visit (visit 2). Viral load serves as a marker for ART effectiveness.
Use a purposeful sampling approach
Evaluations of B+ Programs Process evaluation (early in implementation) Use indicators developed by the program to measure program roll out Can validate the conclusions from routine monitoring Collect additional qualitative information including client perspectives on B+ Systems evaluations (early in implementation) Review program monitoring tools to assess whether or not they adequately monitor Identify gaps in the M&E tools/systems that would require modification. PMTC T effectiveness evaluation (later in implementation) How well does program meet the goal of reducing infant HIV infections.
Recommendations PMTCT programs must move beyond coverage to look at ART retention and final outcome using cohort outcomes analysis Combined review of B+ program data by ART and PMTCT program managers Need for enhanced monitoring during implementation Conduct process and systems evaluations in the early phases of roll out of B+
Acknowledgments Principal authors of IATT Framework: Michelle Adler (CDC), Rachel Blacher (CDC), Tegan Callahan (CDC), Rosalind Carter (IATT Secretariat), Nathan Shaffer (WHO) International Center for AIDS Care and Treatment Programs: Serena Brusamento, Caitlin Madevu- Matson, Fatima Tsiouris Mothers2Mothers: Alisha Meyers Reviewers: CDC: John Aberle-Grasse, Laura Broyles, Alex Cox, Isabella Danel, Margarett Davis, Mindy Hochgesang, Laura Porter, Daniel Shodell, Paul Young Elizabeth Glaser Paediatric AIDS Foundation: Rebecca Cathcart, Shabbir Ismail, Jack Menke IATT Secretariat: Jessica Rodrigues, Innocent Nuwagira MEASURE Evaluation: Upama Khatri Office of the Global AIDS Coordinator: Anna Gieselman, Katherine O Connor, Heather Watts UNICEF: Priscilla Idele United States Agency for International Development: Anouk Amzel, Karin Lane WHO: Chika Hayashi Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Center for Global Health Division of Global HIV, Maternal Child Branch
Thank You! For additional details refer to: IATT Monitoring & Evaluation Framework for Antiretroviral Therapy for Pregnant and Breastfeeding Women Living with HIV and Their Infants Center for Global Health Division of Global HIV, Maternal Child Branch