Comprehensive Training to support the National Integrated TBHIV
Comprehensive Training to support the National Integrated TB/HIV Information System Implementation Weak adherence to NDOH guidance
Weak adherence to TB-related guidance from NDOH - Incorrect practices re initial capture of DS-TB cases - “TIER. Net leads to declining DS-TB Case findings” - “TIER. Net leads to declining cure rates
Weak adherence to TB-related guidance from NDOH - Incorrect practices re initial capture of DS-TB cases - “TIER. Net leads to declining DS-TB Case findings” - “TIER. Net leads to declining cure rates
Longstanding guidance on initial capture of DS-TB • Implementation Guide: TIER. Net TB Module (May 2016) • Page 15 – 16 • Section 7. 7 Initial capture (from TB register) before going live 4
Longstanding guidance on initial capture of DS-TB (2) • Guidance provided in Comprehensive THIS Training 2017: 5
Non-adherence to NDOH guidance: Initial capture of DS-TB • Implications of “back capture” of DS-TB data in TIER. Net – Records captured in TIER. Net – Paper registers potentially captured in ETR. Net – Resulting in duplicate records in ETR. Net • There should be no “back capture” of DS-TB data – Including TKIs/TB managers providing dates for facilities to “back capture” 6
Weak adherence to TB-related guidance from NDOH - Incorrect practices re initial capture of DS-TB cases - “TIER. Net leads to declining DS-TB Case findings” - “TIER. Net leads to declining cure rates
“TIER. Net leads to declining DS-TB Case findings” (1) • What would cause TB case findings to decline? – Are all symptomatic cases recorded in TB Ident Reg? – Are all symptomatic/presumptive cases captured in TIER. Net? – Are TB Id Reg and blue cards flowing to AC for daily capture? – Are line lists generated on time, actioned and signed off? o TB identification results outstanding list o Waiting for TB treatment list
“TIER. Net leads to declining DS-TB Case findings” (2) • TIER. Net does not reduce TB cases/numbers • DS-TB Treatment Initiation Report produces information captured from TB identification register • PRESCRIPTION: ENSURE DAILY FLOW OF TB IDENTIFICATION REGISTER & BLUE CARDS FOR DAILY CAPTURE TO AC
“TIER. Net leads to declining DS-TB Case findings” (3) • Potential factors contributing to purported declining TB cases – folders and registers not flowing to ACs – inconsistent flow of folders and registers to ACs – folders and registers not flowing to ACs on a daily basis CRITICAL THAT THE TB IDENTIFICATION REGISTER IS COMPLETED CORRECTLY AND FULLY AND FLOWS TO THE AC DAILY
Weak adherence to TB-related guidance from NDOH - Incorrect practices re initial capture of DS-TB cases - “TIER. Net leads to declining DS-TB Case findings” - “TIER. Net leads to declining cure rates
“TIER. Net leads to declining cure rates” 1
“TIER. Net leads to declining cure rates” (2) • Algorithm in TIER. Net is based on latest, stricter NDOH definition of ‘cure’ • Algorithm in ETR. Net is based on outdated, more lenient, definition of ‘cure’ • Clinicians must apply the latest, stricter definition ETR. Net Smear positive pre-treatment, smear negative at the end of treatment, and on one previous occasion at least 30 -days apart 1 TIER. Net Smear positive pre-treatment, negative at the end of treatment, and negative at smear conversion (2 or 3 months)
Weak adherence to guidance from NDOH Weak compliance with ART M&E prescriptions
Weak compliance with ART M&E prescriptions • Very weak adherence to ART M&E SOP – Compromises quality of data in TIER. Net – NIT abundantly clear on prescriptions in ART M&E SOP and soon-to-be-discussed Integrated TB/HIV Data Management SOP • Invokes questions regarding the accuracy and validity of data 1 5
Weak compliance with ART M&E prescriptions (2) • Monthly ART Report was designed to be pulled at close of the reporting month – For example, takes into account that patients do not always present on their scheduled ‘next appointment date’ • NIT guidance on TRAP processes was that Monthly ART Report was not designed for weekly reporting • Regardless, directive was given to report TROA on weekly basis this will result in inaccurate data 1 6
Weak adherence to lab results management guidance from NDOH Lab results management Bulk capturing of normal lab results
Longstanding guidance on bulk capturing of normal lab results • Clear prescriptions made during comprehensive trainings and in an SOP – Disseminated Nov ‘ 17 to all PITs/TKIs – Also posted to VULA – Now available on portal www. tbhivinfosys. org. za 1 8
Weak leveraging of bulk capture functionality • Bulk capturing functionality was designed to drive efficiency (speeds up capturing) • Not universally utilised in facilities – Missed opportunity to alleviate the AC work load 1 9
Operational take-aways for leveraging bulk capturing functionality • Clinicians MUST document test in clinical stationery (affix sticker) – Good Clinical Practice • Tests MUST BE captured – Non-capturing of tests limits usefulness of bulk capturing • Critical prescriptions - all laboratory results must be triaged by a clinician on same day that results arrive 2 0
Capturing of HIV and TB tests after a visit • Enter Lab reference number from sticker attached in patient folder • Do NOT click Result returned until results are back (results box is greyed out until then) 2
Bulk capturing of returned (normal) results • Once results have been returned, and triaged by a clinician, all NORMAL and INITIALLED results can be captured in bulk • Under Tools click ‘Tests Awaiting Results’ (renamed from ‘pending tests’)
Bulk capturing of returned (normal) results (2) • Search by folder number, or by lab reference number • Or, click on headings to sort any column • Double-click to open the patient record
Test results capturing window (1) • Bulk capture is ‘short cut’ to test results capturing window • Tick ‘Result returned’ to activate box for ‘Test result’
Test results capturing window (2) For VLs, button for LDL autopopulates test result with 124
Test results capturing window (3) • For CD 4 select the correct radio button: - Absolute for adults - Percentage for children
Common error: capturing test result in box for lab reference number
Thank you NIT_Support@health. gov. za www. tbhivinfosys. org. za
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