Feasibility of Establishing HIV Case-Based Surveillance to Measure Progress Along the Health Sector Cascade: Situational Assessments in Tanzania, South Africa, and Kenya

Abstract

BackgroundTo track the HIV epidemic and responses to it, the World Health Organization recommends 10 global indicators to collect information along the HIV care cascade. Patient diagnosis and medical record data, harnessed through case-based surveillance (CBS), can be used to measure 8 of these. While many high burden countries have well-established systems for monitoring patients on HIV treatment, few have formally adopted CBS.ObjectiveIn response to the need for improved strategic HIV information and to facilitate the development of CBS in resource-limited countries, we aimed to conduct situational assessments of existing data collection systems in Tanzania, South Africa, and Kenya.MethodsWe developed a standardized protocol and a modularized data collection tool to be adapted for the particular focus of the assessments within each country. The three countries were selected based on their stage of readiness for CBS. The assessment included three parts: a desk review of relevant materials on HIV surveillance and program monitoring, stakeholder meetings, and site visits.ResultsIn all three countries, routine HIV program monitoring is conducted, and information on new HIV diagnoses and persons accessing HIV care and treatment services is collected. Key findings from the assessments included substantial stakeholder support for the development of CBS, significant challenges in linking data within and between systems, data quality, the ability to obtain data from multiple sources, and information technology infrastructure. Viral load testing capacity varied by country, and vital registry data were not routinely linked to health systems to update medical records.ConclusionsOur findings support the development of CBS systems to systematically capture routinely collected health data to measure and monitor HIV epidemics and guide responses. Although there were wide variations in the systems examined, some of the current program and patient monitoring systems can be adapted to function effectively for CBS, especially if supported by an improved patient registration system with shared unique health identifiers.

Data Centre Profile: The Provincial Health Data Centre of the Western Cape Province, South Africa

“…This contrasts with many data linkage exercises conducted for the purposes of estimating key program metrics, but which do not benefit from iterative improvements which derive from direct operational use of tools, and which are unable to directly impact the care of individual patients. All the requirements of case-based surveillance, proposed for example by some global agencies as a panacea for information gaps in the HIV response in high-burden settings [20], can frequently be met from appropriate consolidated data environments such as the PHDC, which simultaneously also directly support clinical care. This is due to linked data on case-detection, laboratory assessments, treatment access and outcomes being available from the single consolidated source in a timely manner, as described above for advanced HIV [17], obviating the need for a parallel disease-specific case-based surveillance system.…”

A pragmatic approach to monitor and evaluate implementation and impact of differentiated ART delivery for global and national stakeholders

“… enhanced monitoring at all or a sample of sites—this process involves active collection of routine data on a more frequent schedule and/or collection of additional data both to trigger timely identification of implementation or outcome challenges that need corrective action and to monitor change in such processes and outcomes incorporation of key questions into other large‐scale surveys (e.g. Demographic Health Surveys, or Population‐based HIV Impact Assessments) that align with monitoring indicators cohort monitoring case‐based reporting , or other targeted studies …”

Consolidating strategic information to monitor progress against the UNAIDS 90-90-90 targets: evaluating the operational feasibility of an electronic HIV testing register in Cape Town, South Africa

“…Health information systems can signi cantly support the health system at large, however health information systems are not universal across country contexts [3,14]. In South Africa, TIER.Net is an HIV health information system which electronically captures longitudinal individual-level information on patients on antiretroviral treatment (ART) [3,6]. However, HIV testing information is not captured on this system in many facilities, particularly information on those testing negative.…”