Monitoring Evaluation In ITECH Focus Regions as of

Monitoring & Evaluation In I-TECH Focus Regions as of December 10, 2007 *Source: Preliminary data submitted by ITECH-supported sites to ITECH-Ethiopia in all slides unless otherwise specified.

ART Reported Sites as of December 10, 2007 (Hidar 30, 2000) Region COP’ 07 #Reported #Not reported Target Sites Amhara 17 17 0 Tigray 12 12 0 Afar 6 6 0 Total 35 35 0 *Aba Ala HC started ART and will report starting from Tahsas 00

Persons newly-initiated on ART Region COP ’ 07 # persons initiated on ART from April 9, 2007 – target Dec 10, 2007* % of annual target % of 3 rd Quarter target** Amhara 21, 715 7, 618 35 47 Afar 587 450 77 102 Tigray 7, 043 3, 079 44 58 Total 29, 345 11, 147 38 51 *Source: Preliminary data submitted by ITECH-supported sites and HAPCO, Ethiopia Mo. H, Monthly HIV and ART Updates. **The 3 rd quarter covers the period from Oct 9, 2007 – Jan 9, 2007; % of 3 rd quarter target calculated as #newly initiated/(. 75 x. COP’ 07 target)

Patients Accessing HIV Care & ART as of Dec 10, 2007 (Hidar 30, 2000) § Enrolled in HIV care = 52, 000 § Ever Started on ART = 33, 857 § Currently on ART = 24, 094 § Only 5. 2% of Currently on ART are Children = 1, 255

Persons who ever Started ART as of Dec 10, 2007 Region COP’ 07 #Ever Started % of 3 rd * % of annual _____Target ART quarter Target Amhara Tigray Afar Total * 3 rd 38, 982 13, 350 1, 068 53, 400 24, 457 8398 1002 33, 857 84 84 125 85 62 63 94 63 quarter: October 10, 2007 - Jan 9, 2008; % of 3 rd quarter target calculated as #ever started/(. 75 x. COP’ 07 target)

Number of persons currently receiving ART as of Dec 10, 2007 Region COP’ 0 7 Amhara 29, 989 # Currently on ART % of 3 rd % of Quarter* Cop’ 07 17, 258 77 58 Afar 1, 250 777 83 62 Tigray 10, 413 6, 059 78 58 Total 41, 652 24, 094 77 58 NB: Currently receiving ART data is based on regional reports. *3 rd quarter: October 10, 2007 - Jan 9, 2008; % of 3 rd quarter target calculated as #currently on ART/(. 75 x. COP’ 07 target)

Persons Enrolled Vs Ever Started ART in Amhara, Tigray and Afar Regions as of Dec 10, 2007 Persons Enrolled Vs Started ART NB: Some (35% to date) ever enrolled do not start ART due to the following reasons: Not eligible Eligible but not ready to start or Lost, Dead, Drop or Transferred out

CURRENT STATUS OF PATIENTS EVER STARTED IN ALL 3 REGIONS AS OF Dec 10, 2007 Ever Started Vs Currently on ART NB: 29% of Ever started patients are not currently on treatment. Reasons could be: Lost: Not seen at least for a month Drop: Not seen for more than 3 months Stop: by the clinician Dead .

Ever Started by Age and Sex in Amhara, Tigray and Afar Regions as of Dec 10, 2007 33, 857 Ever started NB: The new pediatric target is 1821 (6. 1% of all ART users)

Current ART Distribution by Sex in Amhara, Tigray and Afar Regions as of Dec 10, 2007 Of 24, 094 Currently on ART

Current ART Distribution by Age in Amhara, Tigray and Afar as end of Dec 10, 2007. Of 24, 094 Currently on ART .

Currently on ART by Regimen Distribution in Amhara, Tigray and Afar Regions as of Dec 10, 2007 2 nd line regimen 66% of users are on NVP with the rest having moved on to other regimens.

Ever Started Vs Currently on ART in Amhara Region as of Dec 10, 2007

Ever Started Vs Currently on ART in Afar Region as of Dec 10, 2007 Drop: Not seen for more than 3 months. Lost: Not seen at least for a month. Stop: by the Clinician advise. NB: In excess of those ever started by 68 people possibly due to transfer ins. .

Individual Hospital Data

# Ever Enrolled Vs Ever started ART, 4 busiest ITECH-supported hospitals, as of Dec 10, 2007 Discrepancy in ever enrolled and ever started: Dessie = 22% F/Hiwot= 23% Mekelle=24% Gonder= 31% May be due to not ready to start, Lost , Drop, and dead patients

Number of persons ever started vs currently on ART, 4 busiest ITECH-supported ART Hospitals as of Dec 10, 2007 Discrepancy in ever started and currently on ART: Dessie=34% , F/Hiwot 33%, Mekelle 34% , Gonder = 32% May be due to Stop, Lost , Drop, and dead patients

Current Status of Dessie Hospital as of Dec 10, 2007

Current Status of Felege Hiwot Hospital as of Dec 10, 2007

Current Status of Mekelle Hospital as of Dec 10, 2007

Current Status of Gondor Hospital as Dec 10, 2007

Current Status of Woldia Hospital as of Dec 10, 2007 ART Access

Current Status of Humera Hospital as of Dec 10, 2007

Current Status of D/Markos Hospital as of Dec 10, 2007

Current status of D/Tabor Hospital as of Dec 10, 2007

Current status of D/Birhan Hospital as of Dec 10, 2007

Current status of Axum Hospital as of Dec 10, 2007

Current status of Alamata Hospital as of Dec 10, 2007

Current Status of Maichew Hospital as of Dec 10, 2007

Current status of Dubti Hospital as of Dec 10, 2007

Current Status of Finote Selam Hospital as of Dec 10, 2007

Current Status of Motta Hospital as of Dec 10, 2007

Current status of Enat Hospital as of Dec 10, 2007

Current status of Metema Hospital as of Dec 10, 2007

Average work load in busiest Hospitals in previous month Everyday in Dessie, F/Hiwot, Mekelle and Gonder Hospitals on average: 83 existing ART patients seen by clinicians and nurses n 4 new ART patients seen by clinicians n

Summary of Findings n Facility reports received from all but 1 site; New site Ab Alla needs a data analyst n Progress on targets in the Second month of the 3 rd quarter: n n Inadequate Accounting for: n n n The 35% difference between ever enrolled and ever started The 29% difference between ever started and currently on ART Amhara region is not accounting for those LTFU Tigray region is not accounting for those LTFU for this month Afar region has the best tracking system as well as a lower LTFU ART Related: n n n 51% of newly initiated 85% of ever started 77% of currently on ART 34% of ART users have moved beyond NVP Pregnant women are disproportionately low in starting ART Workload n too high for the busiest hospitals

The Way forward n Hire data analyst for Ab Alla n Efforts need to be directed on those on Pre-ART to increase numbers initiated on ART including: n Better accounting for the status of those ever enrolled and not started on ART n Improve how transfer in and out are treated when aggregating facility-level data to the regional level data especially, Transfer ins and outs from/to another region. n Investigate why such a low% of pregnant women start ART n Consider staffing needs at the busiest hospitals especially the load on Clinical and M&E staff

Anteneh Seyoum Data Analyst, Addis