PEPFAR

Using Data to Improve Quality, Efficiency and Coverage of VMMC

Services

Kelly CurranJhpiego

AIDS 2014 – Stepping Up The Pace

Jhpiego, an affiliate of Johns Hopkins University

• Working to improve maternal, reproductive and child health, HIV, TB and malaria services in 43 countries

• Implementing VMMC programs in 11 of 14 priority countries with funding from CDC, DOD, USAID and BMGF

Jhpiego-Supported VMMCsAs of June 30, 2014

TOTAL = 1,188,065~25% of all VMMCs supported by PEPFAR through 2013

Botswana = 23,240

Lesotho = 61,036

Swaziland = 19,465

South Africa = 29,036

Malawi = 35,675

Namibia = 24**Program began June 2014

Rwanda = 76,441

Ethiopia = 45,310

Kenya = 104,936

Zambia = 150,328

Mozambique = 257,299

Tanzania = 385,275

Botswana: How Expenditure Analysis

Drove a Change in Service Delivery

Jan 2012-=Sept 2013 (in PY3) and Oct 2012-Sept

2013 (PY4)

Oct 2013-June 2014 (in PY5)

0

100

200

300

400363

200

Fixed sites with large provider teams in a low-demand setting meant sites operated well under capacity with high unit costs

Smaller teams providing outreach services services in surgical tents in rural areas Increased uptake and lowered unit costs

Average unit Cost regionallyIs less than US $100; in highCost settings like Southern AfricaWe aim for $160

Unit Cost

Taking Services to Clients

Botswana: Innovating to Meet Clients’ Needs in a Low Population Density Setting

Introducing PrePex™ as an Alternative to Conventional SurgeryJu

n/Ju

l'12

Nov/D

ec'12

Mar

/Apr

'13

Jun/

Jul'1

3

Nov/D

ec'13

Apr/M

ay'14

0

1000

2000

3000

4000

5000

6000

Total MC

Campaign Performance

Rwanda: Using Program Data to Forecast Commodity Needs as PrePex™ Scales up

VMMCs done with Jhpiego support sincePrePexTM integration, February to June 2014

Percent of VMMC devices per size used in Jhipego VMMC-supported sites,

February to June 2014

Mozambique: Using Real Time, Web-based

Data to Increase Efficiency and Accountability

January February March April May June July August September October November December100

1,000

10,000

100,000

2010 2011 2012 2013 2014

VM

MC

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Mozambique: Online VMMC Information System Produces Real-time Program Data

Tracks: • Adverse events by provider

and facility to monitor client outcomes and identify supervision and/or refresher training needs

• Uptake by facility to identify need for additional demand creation activities and/or reallocation of clinical staff to sites which need additional capacity

• Commodity use to support forecasting and ensure accountability

Mozambique: Ensuring Quality by Continuously Tracking Adverse Events by Health Facility

Mozambique: Tracking VMMC Referrals from Home-based HTC

0

30,000

60,000

90,000

120,000

150,000 138,664

97,987

58,792

Tanzania: Using Geographic Information Systems to Finish the Catch-Up

• Successful and mature program that has nearly reached its original goals

• Most young men and adolescent boys in towns and large villages already reached

• To maintain the same productivity and ensure equity the program must be implemented in more sites per campaign than in previous years

Tanzania: Using Geographic Information Systems to Finish the

Catch-Up• The layered maps helped

the team to select 24 outreach sites for the campaign – most of which had a catchment population of 5,000 or more males aged 10-49.

• As a result of this enhanced targeting, the program was able to serve 25,816 males in rural communities in six weeks, as compared to 14,476 in the same time frame in the previous year.

12

Tanzania: Program Invested in Real-time Online Maps Connected Directly to the VMMC and Facility Databases with Information on Roads, Facilities, Population Served, Catchment Areas, Clinical Staff and Their Contact Info, Water and Electricity

VMMC clients found positive at MC site: 72 (100%)

VMMC clients who received a CD4 count during VMMC

services (all registered for ART clinic services): 45 (62.5%)

VMMC clients eligible for treatment: 40 (55.6%)

VMMC clients not eligible for treatment: 5 (7.0%)

VMMC clients who did not receive a CD4 count during VMMC

services and were asked to return later: 27 (37.5%)

VMMC clients who were traced: 11 (15.2%)

VMMC clients who were not traced: 16 (22.2%)

VMMC clients who received a CD4 count and were enrolled in care and treatment: 4 (5.5%)

VMMC clients who did not receive a CD4 count and

were not enrolled in care and treatment: 7 (9.7%)

Out of 446 clients who tested HIV positive in the hospital, 72 (16%) were tested at the VMMC site.

Lesotho: Tracking ART Uptake From VMMC

Mean CD4 count result

was 302 [195-685].

Lesotho: Documenting the Increased Uptake of HTC and ART among Men Tested and Linked from

VMMC

• A total of 1,906 clients were tested for HIV at VMMC clinic at Mafeteng hospital between February and December 2012

• 1,035 clients were tested for HIV in other services in the hospital during the same period

• Testing in the VMMC clinic represented 65% of all males tested at Mafeteng hospital

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0083614

• Thank you• Ke a leboga• Murakoze• Obrigada • Asante

sana• Ke a leboha

Kelly CurranDirector, HIV and Infectious DiseasesJhpiego, an affiliate of Johns Hopkins

Kelly.curran@jhpiego.org