TB/HIV Information Systems: Reporting from ETR.Net and TIER.Net to webDHIS

1. 1 TB/HIV Information Systems: Reporting from ETR.Net and TIER.Net to webDHIS

2. Welcome and introductions Facilitators: • Riona Govender – NDoH M&E (THIS NIT co-lead) • Zamangema Ngema – NDoH TB RIMES • Brent Williams - HISP • Moeketsi Finger – NDoH*(THIS NIT) • Ipeleng Mojaki – NDoH* (THIS NIT) • XolileNdzulu – NDoH HIS * Seconded from CHAI

3. Welcome and introductions Facilitators: • Barbara Franken – NDoH* (THIS NIT) • Hilda Motlanthe– NDoH TB RIMES • Sharon Maja – NDoH M&E • Bavuyile Norubela – HISP • XolileNdzulu – NDoH HIS * Seconded from CHAI

4. Welcome and introductions Facilitators: • Nevilla Somnath – NDoHTB RIMES (THIS NIT co-lead) • Tebogo Maomela – NDoH M&E • Charity Mashabane – NDoH TB RIMES • Ronelle Niit – HISP • XolileNdzulu – NDoH HIS

5. Acknowledgements • webDHIS developers: HISP • TIER.Net developers: UCT - Centre for Infectious Diseases Epidemiology and Research (CIDER) • Developers of ETR.Net:WAMTech • Clinton Health Access Initiative (CHAI)

6. Round of introductions • By show of hands: all districts represented? • District TB leads – is TB from every sub-district present? • District HIS/IM/M&E leads – is every sub-district present?

7. Agenda • TB/HIV Information Systems (THIS) Integration: background and national vision • TB: export / import process • HIV: export / import process • Demo, and practical work

8. Key house rules • Ask questions, as and when they arise. • Respect: no side conversations, no phones. • Computers closed – except during the practical exercise.

9. Tb / hiv information systems (THIS) integration QUICK Recap Background, benefits and national vision of data flow

10. 10 Rationale for TB / HIV integration • In context of high co-infection of TB and HIV, care is increasingly integrated. • However, data was largely managed separately: • HIV: 3-tiered ART M&E strategy. • TB: M&E system consisting of paper registers and ETR.Net. • Problem: Fragmented data systems compromise patient management, and duplicate effort and resources to manage these systems.

11. 3-tiered ART M&E system • In 2011 South Africa adopted the 3-Tiered ART M&E Strategy, consisting of: • 1sttier - paper ART register, or • 2nd tier - TIER.Net, a non-networked electronic monitoring system, which digitizes HIV patients at facility level, or • 3rd tier – smARTer, networked Electronic Medical Record. • Each tier produces the same core set of data. • TIER.Net is entrenched nationally: ~ 3,600 facilities (94% of ART sites) are digitising ART data in TIER.Net.

12. 12 Timeline of TB / HIV integration • 2013: WHO-led evaluation of HIV, TB and PMTCT programmes recommended integration of information systems. Reinforced by systems review in 2014. • January 2015: NDoH decision to proceed with integrating TB and HIV data management in facilities. • Expansion of TIER.Net to capture TB data. • March 2016: Strategy launched to inform stakeholders of TB/HIV Information Systems (THIS)integration initiative. • January–March 2017: Comprehensive THIS trainings. • May 2017: National release of TIER.Net v1.10.5

13. 13 Benefits of THIS integration • Let’s hear from the audience

14. 14 Benefits of THIS integration Integrated data management supports integrated patient management- In-facility digitisation of TB data puts ownership of TB data back into the hands of facility staff - direct access to patient management reports. Integrated data flow- TB and HIV data will follow same flow, within facilities, as well as in reporting/exporting data to (sub)district – this improves completeness and timeliness of reporting to webDHIS. Rationalisedsupport – streamlined monitoring, maintenance, IT equipment, training, system upgrades, etc. Focus of today

15. Integration headline re data flow • TB treatment data will now follow DHMIS prescripts (previously only data for screening and presumptive TB followed DHMIS). • Standardisation of: • The flow of TB and HIV data into webDHIS. • Timeframes of reporting monthly and quarterly data. • Responsibility for review and verification of data in webDHIS.

16. Integrated M&E SOP (being finalised) Provides standard procedures for accurately, completely, and timeously: • Collecting and managing routine HIV/ART and TB data, • Reviewing and using data for enhanced clinical patient care at facilities, • Improved reporting of information to webDHIS, • Enhanced flow and usage by sub-district, district, province and national levels.

17. Interim data flow (during transition period) Patient-level data Aggregate data Electronic HIV & TB facilities Paper TB facilities National 25th: national data signed off by DG webDHIS Integrated National TIER.Net HIV/TB Patient Database 20th: provincial data signed off by HOD ETR.Net Province webDHIS Integrated Provincial TIER.Net HIV/TB Patient Database ETR.Net 15th: district data signed off by District Manager (Sub)District Export quarterly DS-TB outcome data 10th: sub-district data signed off by sub-district manager Export quarterly ART cohort data* Export quarterly DS-TB outcome data webDHIS ETR.Net TIER.Net 5th: monthly data signed off by Facility Manager and reported to webDHIS** Dispatch quarterly Facility TB Register TB Register TIER.Net TB data from patient folder TIER.Net TIER.Net TB data from patient folder HIV & TB data from patient folder HIV & TB data from patient folder HIV & TB data from patient folder HIV Testing data from HTS Register Presumptive TB data from TB Case Identification Register

18. 18 Expected data flow (from 1 April 2018 onwards) Patient-level data Aggregate data Electronic HIV & TB facilities National 25th: national data signed off by DG webDHIS Integrated National TIER.Net HIV/TB Patient Database 20th: provincial data signed off by HOD Province webDHIS Integrated Provincial TIER.Net HIV/TB Patient Database 15th: district data signed off by District Manager (Sub)District 10th: sub-district data signed off by sub-district manager Export quarterly ART cohort & DS-TB outcome data webDHIS TIER.Net 5th: monthly data signed off by Facility Manager and reported to webDHIS Dispatch quarterly Facility TIER.Net TIER.Net TIER.Net HIV & TB data from patient folder HIV & TB data from patient folder HIV & TB data from patient folder

19. What is an export? • TIER.Net allows for data exchange (export/import) with other applications. • An export is a file template used to transfer data out of an electronic programme. • An export file can then be imported into another programme. • DES = official Data Exchange Standard for transfer of raw data between electronic software programs (e.g. between TIER.Net, ETR.Net, and webDHIS)

20. Example: exports from TIER.Net Facility • Dispatch – complete data set, used to move data between levels. • Excel export- LIMITED set of data, for analysis beyond standard reports, if need be. • DHIS ART Export - XML file with ONLY ART cohort data held in TIER.Net, used for importing data into webDHIS. • Export to ETR- XML file with ONLY TB cohort data held in TIER.Net, used for importing data into ETR.Net. • DES export- XML file with almostALL data held in TIER.Net, used for complex analyses in relational data tables. Sub- district Research only

21. Questions?