Lessons learned from the TAP learning agenda: preliminary results

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Lessons learned from the TAP learning agenda
preliminary results

• Damien de Walque Harounan Kazianga (The World
  Bank)
• Laeticia Nikiema (IRSS, Burkina Faso)

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Overview

• TAP Learning Agenda a reminder
• Preliminary results from health facility survey
  in Burkina Faso
• To give a flavor of possible analyses
• Type of facilities offering ARV treatment
• Type of services offered
• Quality of service delivery, satisfaction, costs
  and waiting time
• What next?

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Question I Measuring the impact of treatment on
the welfare of patients and family members

• Lives saved and health outcomes
• Labor supply of patient and family members
• Schooling of children
• Other welfare indicators

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Other questions

• 2) Possible effects of ART on HIV transmission
  and prevention
• 3) Determinants of adherence to treatment
• 4) How to avoid the development and spread of
  resistance?
• 5) How are ART beneficiaries identified? How to
  encourage timely uptake?
• 6) How to assure the quality of HIV/AIDS service
  delivery?
• 7) How to encourage capacity building to
  reinforce the sustainability of ART delivery?

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Data collection (Longitudinally)

• Biomedical follow-up
• Health facility and association surveys
• Household surveys (HIV patients and general
  population)
• Surveys of employers and employees (Ghana)

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Framework for Learning agenda
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Health facility survey in Burkina Faso

• Work done in partnership with the Institut de
  Recherche en Sciences de la Santé (IRSS) in
  Burkina Faso.
• Data collected in summer of 2006.
• Analysis is under way.
• We are presenting some preliminary descriptive
  results.
• Results will be analyzed jointly with household
  survey of patients (currently collected)

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Sample
Only 37 of these health facilities offered ART
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Brief Description of the Health Facilities

• Distribution of staff by gender

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Brief Presentation of the Health Facilities

• Staff by function and type of health facility

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Health Facilities and HIV

• Voluntary testing37 Health facilities offered
  voluntary counseling and testing
• Most frequently reasons cited for seeking
  counseling and testing
• Voluntary 73
• Tests required by other health facilities in case
  of sickness (referral) 21.6
• Pregnancy 5.4

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PMTCT activitiesTesting of children born to
seropositive women.
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PMTCT TESTING AND HIV PREVALENCE
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• ARV prescription for PMTCT

Nevirapine seule Zidovidine seule ZidovidineLami
vudine
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Results from patients exit interview

• Patients randomly selected on the day of the
  visit to the facility
• Patients on ARV
• And patients coming for other type of health
  problems

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Results from patients exit interviewage and
gender distribution
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Distribution by type of facility
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Access to health services costs

• Expenses per visit excluding transportation costs

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Access to health services costs
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Access to health services waiting time

• Waiting time at health facilities

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Access to health services waiting time

• HIV related and non-HIV visits

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Access to health services waiting time

• HIV related visits by type of health facility

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SERVICE QUALITY AS MEASURED FROM PROVIDER
VIGNETTESMAXIMUM SCORE IS 20
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Users satisfaction

• Very satisfied 3. Not satisfied
• Satisfied 4. Dont know

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Satisfaction levels vary by gender and by type of
facility
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Next steps

• Merge with household survey data (currently
  collected)
• Will allow much richer analysis.
• Study impact on adherence, treatment outcomes of
• Impact of out-of-pocket expenses and
  transportation costs.
• Type of facility and service quality and
  patients satisfaction
• Other socio-economic variables

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TAP Learning Agenda Time table

• Baseline surveys (household facility surveys)
• - Burkina Faso - health facility collected
• - household collection ongoing
• - Ghana Data collection scheduled to start in
  February.
• - Mozambique Data collection scheduled to
  start in May-June.
• Follow-up surveys within 6-12 months after
  baseline.
• Also analysis of general population surveys on
  link between treatment and prevention (Ghana,
  Burkina Faso).