17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

EVALUATING OUTCOME INDICATORS USED TO ASSESS THE PERFORMANCE OF HIV PROGRAMMES OF TREATMENT AND CARE IN RESOURCE-LIMITED COUNTRIES

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0206

S. Hoskins ¹, K. Porter¹, A. Jahn², R. Malyuta³, S. Phiri², I. Weller⁴, on behalf of Evidence for Action (EfA), Outcome Indicators Group
¹Medical Research Council Clinical Trials Unit, HIV, London, United Kingdom, ²Lighthouse Trust, Lilongwe, Malawi, ³UNICEF, Odessa, Ukraine, ⁴University College London, London, United Kingdom

ISSUES: There are no standardised evidence-based outcome indicators to evaluate and compare performance of ARV programmes within resource-limited countries. Donors recommend different data and calculations to monitor programmes. The lack of standardisation means costly and time-consuming collection of multiple data by clinics, making it difficult to compare performance within and between programmes. Furthermore, the WHO’s ‘Early Warning Indicators’ (EWI) for HIV drug resistance (HIVDR) monitoring have not been evaluated in programmes. Identifying which outcome indicator(s) best predict long-term survival and the emergence of drug resistance would enable programme managers to respond to predictors of failure early.

DESCRIPTION: We compared indicators currently collected within ARV programmes in resource-limited countries. In January 2008 we compared monitoring and evaluation indicators recommended by Global Fund, PEPFAR, UNAIDS and WHO.

LESSONS LEARNED: Wide variations exist between recommendations: not all important indicators are collected by all funders (e.g. deaths attributable to HIV) whilst other requested indicators are not useful as few facilities record the data (e.g. quality of life). Although data are usually collated on percentage alive at 6,12 and 24 months after treatment initiation, it is unclear how persons lost to follow-up are defined or accounted for. Furthermore, no children-specific indicators are requested. Of the multitude of current indicators, we do not know which are the best proxy indicators to measure survival or evaluate the prevalence of drug resistance in the treated population.

NEXT STEPS: We now plan to conduct a study auditing existing patient and programme data collected by partners in Malawi, Uganda, India, Zambia and Ukraine to identify which indicators best correspond to patient survival and assess which EWIs are associated with HIVDR. This will provide evidence to recommend to governments and agencies standardised outcome measure(s) which best correlate with long-term patient survival and HIVDR and hence provide more robust tools for evaluating the performance of ARV programmes.

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2008-08-13
MOAB0206

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