M&E needs for Option B+: highlights from the IATT B+ M&E Framework

James Houston– MD, MPHMedical Officer

Center for Global Health, Division of Global HIV,Maternal Child Health Branch

IATT WebinarJuly 29th, 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

PMTCT Cohorts

� Three different cohorts:� ART cohorts of patients initiating ART

� ANC cohorts of pregnant women at 1st 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 HIV-

infected 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

1) % of sites that participate in PT (proficiency testing)

Correct implementation of rapid testing algorithm and participation in PT program

2) % of sites that use a register to monitor quality

Stock out of critical commodities

3) % of sites that report at least one stock out

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 4) % of women whoare retained on ART at one month

Experience with B+ suggests a large % of lost to follow upoccurs between the ART initiation visit (visit 1) and the first follow up visit (visit 2).

5) % of women who are retained at 3, 6, or 9 months

Viral load suppression

7) % of ART patientswith an undetectable viral load at 12 months

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

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

Principal authors of IATT Framework: Michelle Adler (CDC), Rachel Blacher (CDC), Tegan Callahan (CDC), Rosalind Carter (IATT Secretariat), Nathan Shaffer (WHO)

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

International Center for AIDS Care and Treatment Programs: Serena Brusamento, Caitlin Madevu-Matson, Fatima Tsiouris

Mothers2Mothers: Alisha Meyers

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

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