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Integration of electronic TB and HIV data collection in facilities

Integration of electronic TB and HIV data collection in facilities. Data management of HIV wellness patients. Background.

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Integration of electronic TB and HIV data collection in facilities

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  1. Integration of electronic TB and HIV data collection in facilities Data management of HIV wellness patients

  2. Background • At TB/HIV integration kick off meeting (7 March 2016) - which announced national roll out of TB module in TIER – Dr. Pillay formally sanctioned utilization of the HTS and pre-ART functionally in TIER • This undertaking has been: • To strengthen patient and data management • Use TIER.Net to improve data driven decision-making • To address leakage across pillars of diagnosed vs. initiation - critical to track whether individuals who tested positive have been initiated on ART and those who have been enrolled in HIV wellness (pre-ART) Comprehensive TIER Training for TB/HIV Integration

  3. Adult HIV Treatment Cascade Comprehensive TIER Training for TB/HIV Integration

  4. UTT vs pre-ART • With introduction of universal test and treat (UTT) strategy in Sep 2016 - all patients should be offered ART if diagnosed with HIV • However there are likely to be patients who elect to not start ART immediately • It is essential that facilities continue to manage and monitor people living with HIV who are not yet on ART • As such all patients who have been diagnosed with HIV - and are without an ART start date - must be captured in TIER using pre-ART functionality Comprehensive TIER Training for TB/HIV Integration

  5. Why is it necessary to digitize pre-ART data? • It is imperative that all HIV+ patients enrolled in HIV wellness are managed up to a point of initiation • Use of pre-ART module in TIER.Net– critical to this end • Capture of pre-ART patients will assist facilities to: • Understand facility burden • Assist with triaging HIV+ clients • Support patient monitoring for patients not ready or willing to start treatment immediately after diagnoses • Support linkage to care Comprehensive TIER Training for TB/HIV Integration

  6. Data source for capturing of pre-ART data in TIER? • From a public health perspective and Ideal Clinic/ICDM prescripts - effective clinical and data management compels institution of one patient, one folder, one folder number • Standardised HIV/ART clinical stationery designed to track each client diagnosed with HIV and enrolled in care • HIV/ART clinical stationery must be used as source for capture of pre-ART data in TIER • Clinical stationery accounts for all data required to populate the fields in pre-ART module in TIER • All folders must flow to data clerk daily (after every visit) for capture of pre-ART data in TIER Comprehensive TIER Training for TB/HIV Integration

  7. Data source for capturing of pre-ART data in TIER? (2) • As part of rationalization of registers initiative - provinces were directed to withdraw the pre-ART register • Therefore pre-ART register cannot and must not be used as a source for capture of pre-ART data into TIER • As such, pre-ART data will be prospectively captured. This means, patients newly diagnosed but not yet on ART will be captured in the pre-ART module Comprehensive TIER Training for TB/HIV Integration

  8. Back-capture of pre-ART data? There will be NO back capture of pre-ART data (as pre-ART register no longer exists) Rather select a day that pre-ART capture will commence and capture active HIV wellness patients Thus there will be prospective capture of pre-ART data from patients folders (from date facility decided to capture these data) All stakeholders within the facility must be aware of the decision Comprehensive TIER Training for TB/HIV Integration

  9. Folder flow for capture of pre-ART data 1 1 3 3 1 1 1 2 2 1 1 The flow covers all points that a data clerk can access folders for capturing 1 Location of folder collection by DC 2 Data capture 3 Filing 1

  10. Capture in TIER Comprehensive TIER Training for TB/HIV Integration

  11. Capture in TIER (2) Source: Demographic information and Treatment supporter Source: Date of diagnosis and longitudinal record Comprehensive TIER Training for TB/HIV Integration

  12. Capture in TIER (3) HIV positive window from HTS module Click on “pre-ART” button: Demographic info of patient - with HIV diagnosis date automatically filled Comprehensive TIER Training for TB/HIV Integration

  13. Capture in TIER (4) Source: Testing point Source: Staging Source: CD4 Count Comprehensive TIER Training for TB/HIV Integration

  14. Capture in TIER (5) Source: TB data Source: IPT data and treatment Planning Comprehensive TIER Training for TB/HIV Integration

  15. Capture in TIER (6) -Capture visit date -Referral from which service -Pregnancy status -Workup status Click under month of visit to be entered There will be a designated box for these files at each collection point, this differs per facility. Comprehensive TIER Training for TB/HIV Integration

  16. Capture in TIER (7) All blood results entered here- CD 4 count TB screening, IPT, Stage, Pregnancy screening and Next appointment date Comprehensive TIER Training for TB/HIV Integration

  17. Capture in TIER (8) Reminder: this is where DC retrieves results for capture into TIER.Net. If results are not filed- the clinician does not have the result and data clerk does not have a value to capture In turn, the programme cannot monitor impact of treatment Comprehensive TIER Training for TB/HIV Integration

  18. Waiting for ART list - Lists patients eligible for ART but not on treatment - Data clerk to generate report weekly and give to designated clinician who will contact patient and arrange follow-up appointment - Appointment to be documented in clinical stationery and given to clerk for capturing into TIER Place the waiting list for initiation here Comprehensive TIER Training for TB/HIV Integration

  19. What does the list encompass? Name of list Facility Name Date list generated Number of records 2 1 3 4 1.Name 2.Surname 3.Folder number 4.Age disaggregation for children Comprehensive TIER Training for TB/HIV Integration

  20. What does the list encompass? (2) TB Screening Pregnancy Screening CD4 count <200 # weeks patient has been eligible for treatment Comprehensive TIER Training for TB/HIV Integration

  21. ART monthly report Monthly report consists of: newly enrolled in HIV care (pre-ART) & remaining in HIV care (pre-ART) patients started on IPT Comprehensive TIER Training for TB/HIV Integration

  22. ART monthly report (2) • Report tracks: • # patients newly enrolled on ART and HIV care (pre-ART) • # patients remaining on ARTand HIV care (pre-ART) • # patients started on IPT • # pregnant women initiated on ART • ART monthly report should be pulled by data clerks by 7th working day of every month • Report must be saved on computer – and file named appropriately • Facility manager to verify and sign off on reports and file in respective section in lever arch file • Signed copy of report is submitted to sub-District office with DHIS MDS Comprehensive TIER Training for TB/HIV Integration

  23. Change management themes • A patient in pre-ART might not be issued a patient file in some facilities • As the clinical record is source for pre-ART (and ART) data captured in TIER – all HIV+ patients must have clinical stationery completed and inserted in patient folder • This is a necessary step and has to be reinforced at facilities • Clinicians should be orientated on correct documentation in HIV/ART clinical stationery for all HIV positive patients - those on ART and not-yet-on ART Comprehensive TIER Training for TB/HIV Integration

  24. Change management themes (2) • Digitising data from clinical record • Streamlined folder (which contains paediatric ART clinical stationery) flow in-facilities  IMPERATIVE • Clinicians need to be made aware that data completeness in clinical stationery - critical • All fields in the HIV clinical stationery must be completed • However, completeness remains critical • Client records must be stored on-site • Headlines for TKI when conduct clinical documentation training • Consider the workload: • Look at facility data to determine what facility process would be and what workload would be based on different situations

  25. Change management (3) • Ideal Clinic/ICSM – HPRS prescripts • One patient, one folder, one folder number • Every new patient must have a folder opened – even if patient only in facility for HIV test • Unique identifier - ID number (or other identification domains) where available PLUS HPRN/folder number MUST be tracked in all registers, clinical stationery, Road to Health book, laboratory forms as well as every other piece of clinical stationery

  26. Comprehensive TIER Training for TB/HIV Integration

  27. Comprehensive TIER Training for TB/HIV Integration

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