This report examines national and regional EWI prevalence estimates to compare performance over time within and across regions. In general, significant variability of clinic performance within countries was noted. EWI methods use colour-coded score cards (performance strata) to visualize clinic performance, which facilitate identification of gaps in service delivery. From a country perspective, understanding clinic-level variability of EWI results is critical to improving overall programme performance. Variability should be explored to characterize best practices to improve quality and facilitate their application in clinics not achieving global EWI targets.
Depending on the nature and extent of the problems identified, countries have responded to EWI results through various policy changes, both at the ART programme and clinic levels. Examples of documented actions include: strengthened recordkeeping systems; training of providers in optimal ARV prescribing practices; operational research on defaulter tracing to identify suitable approaches to early identification and re-engagement to care; increased resources for patient tracing given to clinics struggling with retention; implementation of SMS reminders to improve adherence; and changes in record-keeping systems to allow for the monitoring of clinic-level ARV drug supply.
This report has several limitations and results should be viewed in this context: with few exceptions, data reported by countries were not derived using representative clinic selection, and countries collecting and reporting EWI data do not represent all LMIC. Caution is therefore warranted when interpreting global, regional and national estimates and trends and, results should not be generalized beyond the clinics monitored. When too few data elements were reported, no statistics were applied to the descriptive analysis.