Implementing Integrated TB/HIV Data Management in Facilities

1. Change management processes to implement integrated TB and HIV data management in facilities, using TIER.Net Comprehensive training to support the national TB/HIV Information System (THIS) integration initiative

2. Next steps A look at implementation steps not yet covered in this training

3. Facility implementation National Provincial District Is facility ready? Can initial-capture start? Data accurate &complete? Training Go-live YES YES YES Perform initial-capture Ongoing maintenance Facility NO NO NO Fix data Fix identified issues Implement resolutions (TKI & facility)

4. FBA, and FBA Feedback Meeting & Final Report • FBA tool is a tool to collect data during assessment. • On memory stick, also as appendix in Implementation Guide. • FBA tool also has detailed instructions and guidance! • FBA findings must be written up in FBA Report, by TKI. • MsWord template for FBA Report is on memory stick. • FBA needs to be followed by on-site Stakeholder Approval & FBA Feedback meeting, to ratify decisions on remedial actions, allocate responsibilities, and set timeframes. • This cannot be done on the same day as the FBA. • The above must be written up in Final FBA Report. Simply edit / add to FBA Report to make it into the Final FBA Report. • Submit Final FBA Report to DIT → PIT → NIT.

5. FBA, and FBA Feedback Meeting & Final Report

6. FBA tool Tool to collect data during site assessment.

7. FBA report Template to compile report on assessment findings, and plans for remedial actions.

8. Facility implementation National Provincial District Is facility ready? Can initial-capture start? Data accurate &complete? Training Go-live YES YES YES Perform initial-capture Ongoing maintenance Facility NO NO NO Fix data Fix identified issues Implement resolutions (TKI & facility)

9. Data clerk training must include: • Discussion of in-facility data flow, storage of reports, and orientation to the in-facility change management processes(if not adequately done during Informational Meeting and FBA Feedback Meeting). • Overview of TIER.Net (new functionality). • Use the videosto show how to capture. • Use practical capturing exercises from the National training • Data clean-up. • Production of all reports and lists. • Basic interpretation of reports. • SOP roles and responsibilities.

10. Clinician training must include: • Discussion of in-facility data flow, storage of reports, and orientation to the in-facility change management processes(if not adequately done during Informational Meeting and FBA Feedback Meeting). • Inherent links between clinical stationery ↔ clinical patient management ↔ M&E system. • Importance of proper clinical record-keeping. • Basic overview of TIER.Net. • Demonstration of all reports and lists which support clinical management, including interpretation of reports/lists. • SOP roles and responsibilities.

11. Facility implementation National Provincial District Is facility ready? Can initial-capture start? Data accurate &complete? Training Go-live YES YES YES Perform initiial-capture Ongoing maintenance Facility NO NO NO Fix data Fix identified issues Implement resolutions (TKI & facility)

12. Final Checklist • To complete prior to enabling TIER.Net TB module at facility level. • Found as appendix in Implementation Guide. • Also standalone pdf document in memory stick. • All questions have to be answered YES in order to sign off on this check list.

13. Final Checklist – questions (summarised) • Is the facility a Phase 6 TIER.Net ART facility, a DCS TB service or a facility without ART services? • Has a stakeholder approval meeting with the suggested staff members been held? • Is a copy of the FBA and corrective actions signed off as completed and a digital copy sent to the DIT? • Have data capturers and facility managers had a demonstration of TIER.Net reports and guidance on interpretations? • Are all patient folders merged in one folder and kept in one registry? • In the paper TB register, are all patients with open episodes and no visits >3 months closed? • Have clinical record keeping and data capturing workshops been conducted?

14. Facility implementation National Provincial District Is facility ready? Can Initial-capture start? Data accurate &complete? Training Go-live YES YES YES Perform Initial-capture Ongoing maintenance Facility NO NO NO Fix data Fix identified issues Implement resolutions (TKI & facility)

15. Monitoring the TB/HIV Integration • The implementation of TIER is being monitored using the standardized Excel template “Phases of Implementation”. • This was introduced in 2012. • The “Phases of Implementation” template has now been replacedwith the “THIS Implementation Reporting Template”. • This template has been amended to include new categories for monitoring: • In-facility TB M&E system used • HTS • Pre-ART

16. THIS Implementation Monitoring The first tab contains the definitions for reporting. The second tab contains the facility list for reporting

17. THIS Implementation Monitoring • This template will assist districts, provinces and the NDOH to monitor the implementation against targets. • Enables managers to interrogate where additional support may be required or where lessons can be learned. • Submissions should be sent by the 20th of each month to Riona.Govender@health.gov.za • Monitoring will shift to quarterly after a yearfrom now (i.e. submissions by the 20th of January, April, July, October).

18. THIS Implementation Monitoring • Important Note: This sheet is updated by the NDOH each month as the number of service points increases, or where facilities’ names change or where facilities may be closed. • Reconciled data are sent back to provinces in an effort to correct or clarify any irregular submissions. • Always use the updated sheets. This contains the up-to-date facility list (per DHIS), the up-to-date naming convention, and all the phase updates for all provinces. It is essential this is used for future reporting. • Where old templates are used it results in challenges with irregular reporting and incorrect facility names contained in the sheet. • Using the up-to-date sheet prevents version control issues and inadvertent regression.

19. Tools and resources for implementation • Stationery • Software TIER.Net v1.10 – Help functionality • Implementation Guide: TIER.Net TB Module (includes FBA tool and Final Checklist) • FBA report template • TIER.Net User Guide* • Reports Manual* • Training materials • Self-­learning videos • Site Visit Task List* • Data Verification Tool before Go Live • Integrated HIV/TB M&E SOP* • Audit tool* • Installation Checklist* * Being finalised / updated.

20. TKI roles & responsibilities • Adequately prepare districts and facilities for rollout • Includes: informational buy-in meetings, facility assessments with remedial action, adjusting the flow of patients/folders/data as per Ideal Clinic and Implementation Guide, and training facility staff on record-keeping, data entry, and data use. • Implement • Includes: upgrading facilities to TIER v1.10. • Oversee the initial transition • Includes: onsite handholding during back-capturing of all active TB patients, data audit, sign-off, and retiring of paper TB registers.

21. TKI roles & responsibilities (continued) • Maintain the integrated TB/HIV information system • Includes: regular (and documented) site visits and quarterly audits, to assess adherence to SOPs, quality of record-keeping and data entry, and optimal use of TIER reports and lists for the benefit of clinical patient management. • Monitor • Includes: ensuring timely flow of monthly and quarterly data into ETR.Net and DHIS, reporting on rollout progress to the next level, and analysing data to improve clinical governance and programme management.

22. Questions

23. Plans for next steps by districts Districts to feed back on their ‘home work’

24. Next steps – plans from districts • Submitted via e-mail by Thursday evening? • Each district to present summary key points on Friday morning (strictly 2 minutes per district, verbal, no slides).

25. Feedback for this quarter (before 31 March)

26. Plans for next quarter (Apr-Jun)

27. Discussion and Q&A

28. Closing comments Did we achieve training goals? Evaluation of training. Awarding of certificates & signing of pledges.

29. Did we achieve objectives of the training? It is not just about the software! To capacitate PITs and DITs and TKIs on implementing the national initiative to integrate THIS. • Be fully conversant with the TB module in TIER.Net, • Understand the associated change management processes to integrate data management for HIV and TB within facilities, • Support facilities to drive the digitisation of TB data in an effective and sustained manner, • Drive the integration of TB and HIV Information Systems at (sub)district level and above.

30. Ice breaker - revisited Anonymous. But will ask for 5 volunteers to share with group. Find your paper from day 1, and express on the back how you feel now about TB / HIV Information Systems integration, • In one word, • Or, in one sentence, • Or, in a picture. Then stick it on the wall. 3 minutes

31. Help us improve these trainings Please write down your feedback on the following: • Training slides • Practical exercises • Venue (training room / food / accommodation) • Duration / set-up of agenda • Facilitators • Any other feedback • Do you feel capacitated to serve as TKI?

32. Participants’ commitment

33. I, the undersigned, [name] hereby confirm that: • I have participated in the 5-day TB / HIV Information Systems (THIS) Integration Training, including TIER.Net. • I have thus been capacitated to be a TIER Key Implementer (TKI). • I pledge to complete my training by watching the training videos from www.VULA.ac.za . • I commit myself to make adequate time available to fulfill my roles and responsibilities as a TKI. • I commit myself to adhering to the prescripts of this training, the Implementation Guide TIER.Net TB Module, the integrated HIV/TB M&E SOP, and other national TIER.Net-related SOPs, support documents, and tools. • I commit myself to capacitating, mentoring and monitoring facility personnel in the geographic area for which I am responsible, to likewise adhere to the abovementioned prescripts.

34. Awarding of certificates & signing of pledge Please come to the front when your name is called, to receive your certificate, and to sign your pledge. Thank you, for being engaged, attentive, and enthusiastic! With your involvement, together we will make TB / HIV integration a success!

35. Contact details of NIT members Nevilla Somnath – National TB Programme – RIMES – Nevilla.Somnath@health.gov.za Riona Govender – NDoHM&E – Riona.Govender@health.gov.za Catherine White – M&E Technical Support to NDoH - cwhite@clintonhealthaccess.org Barbara Franken – Project Manager for THIS integration - bfranken@clintonhealthaccess.org Ipeleng Mojaki – TIER Implementation Associate - imojaki@clintonhealthaccess.org Moeketsi Finger – TIER Implementation Associate - mfinger@clintonhealthaccess.org