DIGITISATION OF HIV TESTING DATA

1. DIGITISATION OF HIV TESTING DATA Integration of electronic TB and HIV data collection in facilities

2. Background: Adult HIV Treatment Cascade

3. Children 5-14 years HIV Treatment Cascade Leakage for children living with HIV diagnosis more acute

4. Children under 5yrs HIV treatment cascade

5. Background (4) • Need to ensure that a greater number of PLHIV are diagnosed and that those who know their status are initiated on treatment • Current systems track number of tests conducted • Do not track whether discrete individuals have been tested and diagnosed with HIV • To address leakage across pillars 1 and 2 as well as diagnosed vs initiation pillars - critical to track whether individuals have been tested (retested for pregnant women, high risk individuals) • Digitising HIV testing data in TIER at facility level will enable clinicians to track who in patient population is living with HIV • Support clinical management of these patients (by at least ensuring ART initiation for those tested positive)

6. What HIV testing data will be digitised? • Digitisation of HIV testing data – complex undertaking • Facilities must at a minimum focus on capture of: • In-facility testing data • All HIV positive tests from all in-facility service points • Including birth and 10 week PCRs, 18 month rapid testing • HIV status of all presumptive and confirmed TB cases • Both patients tested positive/negative for HIV • Significant proportion of patient population co-infected with TB & HIV • For those facilities able to manage additional workload: • Capture of all HIV positive and negative tests conducted in-facility • Capture of community-based testing data – not to be undertaken at this stage

7. National HIV testing services guidelines Shift in paradigm regarding HIV counseling and testing HIV testing services encompass full range of services that should be provided with HIV testing (including linkage to HIV prevention, treatment & care as well as other clinical service)

8. Sources for digitising HIV testing data • HTS register • Replaces HCT register • Reflects shifting paradigm and move to HTS move towards comprehensive screening • Register is currently being rolled out in provinces • Plan to phase out HTS and TB identification register – to be replaced by insert in patient folder • HTS Register vs. PHC Tick Register • Some provinces (including those utilising e-tick register) – tracking of HIV testing through PHC Tick register and HCT register  duplicative • Position taken by National HIV Prevention Directorate: HTS register is source for reporting • HIV testing data cannot be digitised in TIER from PHC Tick register • Critical information required for digitising is missing

9. Sources for digitising HIV testing data (2) • What patient population likely to be captured in HTS register? • HIV testing amongst patients aged 15yrs and older • Patients 12yrs and older able to consent to testing for themselves – screening likely to be conducted by counsellor • What about children under 12 years? Or children under 5 years?

10. Source for digitising PCR and 18 months rapid testing data, under 5s HIV test data • Counsellors do not administer PCR tests at birth, 10 weeks or rapid tests at 18 months • Nurses conduct these tests - PICT • Test results documented in Road to Health booklet (not HTS register) and tracked in PHC tick register • RTH booklet - patient retained record • Do facilities make duplicates of this record? Are duplicate records inserted in patient folder?

11. Source for digitising PCR and 18 months rapid testing data, under 5’s (2) • In principle all facilities ought to capture alltesting of HIV-exposed infants • To facilitate patient recall (of those tested negative) for PCR testing at 10 weeks, 18 months • As no data source for capture of all PCR and rapid tests • Facilities must focus on digitising all positive PCR, rapid test and HIV tests • Data source  paediatric ART clinical stationery

12. Back-capture of HIV testing data? • Facilities should undertake prospective capture of HIV testing data • UTT commenced nationally 1 September 2016 • Option to back-capture HIV testing data to account for UTT • Strategy to help ensure all patients who have tested positive are initiated on treatment • Will be applicable to those first 5% of facilities implementing TB digitisation in TIER • If these facilities undertake back-capturing to coincide with start of UTT in facility – only a couple of months have lapsed and capture exercise will not be too onerous on clerks • Do not recommend further back-capturing of HIV testing data – serious ask for administrative staff • TKIs to provide guidance to individual facilities

13. New HTS register

14. Critical fields in HTS register Folder number /HPRN– critical field SA ID number (or other recognised identification domains) – where available- important

15. Demographic info in HTS Register vs capture in TIER Col C Col B Col E Col D Col G&H Data not available from register Patient folder/HRPS

16. Capture of HIV test and results data After capturing demographic information of patient and saving data Click on “New” for capturing HIV test and results data

17. HIV test and results data in HTS Register vs TIER capture Col I Col K & L Col P Col R Col S Col A Col Z + Y Col X

18. Exercise: HTS register capture Each participant to receive a copy of a pre-populated HTS register Capture patients # 2-8 from the register (Emaphupheni clinic) into the module (excluding Frank van der Walt who has already been captured)

19. HTS Report

20. HTS Report (2) • Current version is an aggregate report - counts all patients who received HIV counseling and testing for a stipulated period • Reports provides monthly breakdown of data which tracks: • Total # tests • # first ever HIV tests • # reactive/positive, non-reactive/negative, invalid/discordant rapid test, PCR and Elisa tests • # tests by 19-59 months, 5-14 years &15 years and older disaggregations • # positive tests by 19-59 months, 5-14 years &15 years and older disaggregations • Gender disaggregation against these age disaggregations • % HIV positive screened for TB

21. HTS Report (3) • In order to utilise HTS report for reporting to DHIS • Every HIV test conducted ought to be digitised (regardless of test result) • Includes all retests (quarterly retesting high risk individuals, antenatal attendees who test negative) • All tests conducted = denominator values for HIV testing indicators • APP target 10 million tests conducted – critical consideration

22. Change management themes • Digitising data from clinical record PLUS register • Streamlined folder (which contains paediatric ART clinical stationery) and register flow in-facilities  IMPERATIVE • Counsellors and nurses need to be made aware that data completeness in clinical stationery and registers alike - critical • All fields in the HTS register and paeds ART clinical stationery must be completed • HTS register an interim measure (move to an eventual insert in the patient folder) • However, completeness remains critical • Headlines for TKI when conduct clinical documentation training

23. Register flow from service point to data station 1 1 1 1 1 1 2 2 Register flow for HIV clients Flow covers all points that a data capturer can access the registers for capturing. 1 Location of register collection by data clerk 2 Location of data capture 1

24. Change management (2) • Register management critical • DHMIS policy – inventory of registers mandatory • Registers must be numbered • All registers to be captured daily and returned to appropriate counsellor/nurse • For data capturer/admin clerk – place marker for point of last capture – useful • Could use a little coloured sticker/ mark with DC initials and date

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 HTS register, paeds clinical stationery, Road to Health book as well as every other piece of clinical stationery • Significant change – HIV testing services