Implementation of the New Recording and Reporting System

1. Implementation of the New Recording and Reporting System Kayla Laserson, ScD Centers for Disease Control and Prevention On behalf of the Expert Group on the Revision of the TB Recording and Reporting Forms and Registers October 2006

2. Aim of the revisions Process and time schedule Results of the WHO survey and CDC evaluations Results of STAG-TB endorsement Sample changes on essential forms Next steps Outline

3. To ensure quality patient care, information-sharing with patients, and transfer of information between health facilities To aid staff in providing adequate services to individual patients To allow managers at different levels in the NTP to monitor programme performance in a standardized and internationally comparable way To provide the basis for programmatic and policy development To provide epidemiologic surveillance Aims of the WHO RR System

4. Aims of the Revision • Align the RR data collection forms to the Stop TB (STB)Strategy • 6 components and 20 sub-components • References used: • "Management of tuberculosis: Training for district TB coordinators”, WHO/HTM/TB/2005.347a-m and "Management of tuberculosis: training for Health Facility Staff”, WHO/CDS/TB/2003.314a-k • Reference for definitions and TB indicators are from the "Compendium of indicators for monitoring and evaluating national tuberculosis programs”, WHO/HTM/TB/2004.344 and "A guide to monitoring and evaluation for collaborative TB/HIV activities” WHO/HTM/TB/2004.342, WHO/HIV/2004.09

5. Revision Process • Expert group formed • Core: KNCV, IUATLD, CDC, WHO • Selected NTPs, 6 WHO regions, WHO Secretariat-GDF • DEWG, TB/HIV WG, MDRWG • 4 sub-groups: TB/poverty, pediatric, PPM, DX algorithm • The Expert Group developed the revised forms and registers with 3 parts to be considered as complementary for the purpose of country adaptation • Part I: Essential TB data • Part II: Essential TB data in settings using routine culture • Part III: Additional TB data, primarily to be used for e-RR

6. Revision Process • Build on country needs captured through field testing and exchange • Largest possible consensus • WHO, KNCV, CDC, IUATLD, and STAG-TB endorsement

7. Timeline of Revision • Forms development : 6 months (April-Oct 2005) • 4 meetings: April, May, Sept, Oct 2005 • Field testing version (WHO/STB web) • Field test: 8 months: (Nov 2005 - June 2006) • WHO questionnaire • CDC/WHO evaluation in 3 countries • WHO, KNCV and IUATLD country visits • Meeting June 2006 • Suggested revisionsfrom above field tests/evaluations discussed and incorporated • Final RR core group meeting August 2006 • WHO, KNCV, STAG-TB endorsement Oct 2006

8. WHO Field Testing Survey • ¾ countries (74/105) revised TB RR forms • 50% (37/74): started revision in 2005 • 66% (49/74): addition of TB/HIV indicators main impetus for revision • 33% (32/96): have e-RR • High acceptance of the draft WHO revised RR forms • Demand for simplification • Urgent need to complete the revision

9. To evaluate the usability and acceptability, with particular emphasis on the added HIV variables To determine the basic requirements for implementation of these forms by NTPs To provide input to STOP TB and partners for further revision of the forms and manual Case studies from El Salvador, Nigeria, and Haiti CDC/WHO Evaluation of New Forms

10. Consider alternative formats for certain sections of the forms Extensive training needed, both on current and new variables Ensure translation into country-specific language and terminology Each country should: Pilot their version of these forms prior to nationwide implementation Develop implementation plan that includes training, distribution of forms, and evaluation of new R&R system Recommendations for Implementation of Modified Forms based on CDC/WHO Evaluation

11. Revised forms and registers endorsed by KNCV, WHO Revised forms submitted to STAG-TB members The STAG-TB sub-group members composed of 4 persons (P Fujiwara, M Borgdorff, S Egwaga, A Elsony); endorsed the revised TB forms and registers All STAG-TB members received documents Recommendations WHO should develop guidelines, training modules and provide TA WHO should assess the revised forms after one year and involve experts in general health system information Agency and STAG-TB Endorsement

12. Sample Changes on Essential Forms

13. Form 3:Tuberculosis Treatment Card

14. Form 5: Basic Management Unit (BMU) TB Register (right side)

15. Form 6: Quarterly Report on TB Case Registration in BMU

16. Form 7: Quarterly Report on TB Treatment Outcomes and TB/HIV Activities in BMU

17. Form 7: Quarterly Report on TB Treatment Outcomes and TB/HIV Activities in BMU using Routine Culture

18. Register of TB suspects, with HIV test results Register of TB contacts Quarterly report on TB treatment outcomes to include separation of smear-negative & smear not done TB treatment outcomes of HIV+ TB patients Number of TB patients HIV tested/positive in both quarterly registration and outcome forms Register of referred TBcases Quarterly report on sputum smear conversion Additional Data Forms for Countries Using e-RR

19. Launch of new forms 30-31 Oct 2006 Dissemination Post on Web Circulate to all NTP managers and stakeholders through email and WHO regional offices Guidelines and training materials will be also published in the WHO publications currently under development Implementation Forms, guidelines and training materials will be adopted and adapted at country level based on the generic document Implementation will be undertaken together with the other new components of the Stop TB Strategy globally by the DEWG and at country level by NTPs Most of the revision will require training Monitoring of the implementation of these revised forms and registers will require a repeat survey, to be conducted by WHO at the end of 2007 e-RR Promote the development and use of standardized e-RR Monitor e-RR implementation at country level Develop guidelines on data quality control (e-RR and paper) Next Steps

20. Pierre Yves Norval (WHO/STB, coordinator RR); Einar Heldal (WHO Consultant), René L’Herminez (KNCV TB Foundation), Arnaud Trébucq (IUATLD), Michael Rich (WHO Consultant); Jeong Ym Bai (Ministry of Health South Korea), Mao Tan Eang (Ministry of Health, Kingdom of Cambodia), Rober Gie (Stop TB Paediatrioc sub-group), Vahur Hollo (Ministry of Health, Estonia), Chris Seebregts (Medical Research Council, South Africa); Mirtha Del Granado, Sergio Arias (Regional Office for the Americas), Samiha Bagdadhi, Ridha Djebeniani (Regional Office for the Eastern Mediterranean), Philippe Glaziou, Pieter van Maaren (Regional Office for the Western Pacific), Suvanand Sahu (Regional Office for South-East Asia), Jerod Scholten (Regional Office for Europe), Oumou Bah-Sow (Regional Office for Africa), Robert Matiru, Fabienne Jouberton (Stop TB Partnership, Global Drug Facility); Mohamed Aziz, Léopold Blanc, Daniel Bleed, Karin Bergström, Knut Lönnroth, Malgosia Grzemska, Mehran Hosseini, Pierre-Yves Norval (Coordinator of the Expert Group on Recording and Reporting), Paul Nunn, Alasdair Reid, Brian Williams (Stop TB Department, WHO); Christopher Tantillo, Philippe Veltsos (Information Technology and Telecommunication, WHO); In addition to review by the STAG-TB, the following people reviewed the forms and provided valuable comments: Avijit Choudhury, William Coggin, Amal Galal, Wieslaw Jakuboviak, John Mansoer, Anna Nakanwagi-Mukwaya, Patricia Shirey, Kelly Stinson, Jay Varma, Douglas Fraser Wares; 105 countries who responded to WHO field test survey; CDC/WHO Evaluation: Kelly Stinson, Lisa Nelson, Patrick Nadol, Lori Armstrong, Eric Pevzner, Bess Miller, Charles Wells, Abe Miranda (CDC); Victor Mejia, Jacob Creswell, Edgar Monterroso (CDC-GAP Central America); Julio Garay, Marta de Abrego, Roxana Castro, Mario Soto, Clinic, SIBASI, and hospital staff (El Salvador); Lisa Onyemobi, Chijioke Osakwe, Philip Bassey, Clinic and hospital staff (Nigeria); Capceau Pierre, Harry Geffrard,Max-Henry Legorme, Preval A. Pierre (Haiti). Acknowledgements