Comprehensive Trainings to support the National Integrated TBHIV
Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation TB/HIV introduction and overview
What We Will Cover • • • How HIV & TB is monitored in South Africa What is Data Management? Overview of Clinical Stationery Review of TB/HIV information system How the systems can improve service delivery and improve quality
Why do we need data? Drive evidence based decision making for TB/HIV
Examples of monitoring?
Why Do We Need to Monitor? • Inform the HIV/TB programme about the needs of the programme • To assess clinical practice & design appropriate interventions • To plan for future services & resource allocation • Are we having an impact on preventing HIV and TB and improving the quality of life for those living with HIV and TB? “To imp rov measure e care, one mu st it. ” (Tier ney et. a l 2002: 79 2)
HOW IS THE TB/HIV PROGRAMME MANAGED IN SOUTH AFRICA?
ROADMAP National Strategic Plan – 2017 2022 NSP, 2017 – 2022
HIV/TB Programme elements • Monthly (HIV & TB): – – – Number of tests done, number positive Number presumptive cases Number initiated/started on treatment Retention Adults/Children • Quarterly (HIV & TB): – – Viral load suppression (of VL done) TB&HIV co-infection Conversion Those completed treatment, cured, relapsed, lost to follow
Terms HIV TB • Symptomatic • Tested for HIV • DS-TB, DR-TB, MDR, XDR • Eligible for ART • TB Case Finding ? • Initiated on ART ? s • rm Bacteriologically positive e • Transfer In on ART T r • TB treatment start e • Remaining on ART Oth • Conversion ? ? • Restart ART • TB treatment completion • Lost to Follow up • TB treatment success • Viral Load Suppression • Lost to follow up
HIV & TB CLINICAL STATIONERY
Tools to monitor the HIV/TB Programme • Screening tools • Standardized Clinical Stationery – HIV clinical stationery – TB Blue Card • Paper Registers: – TB ID registers – HTS Register • Reports and Line Lists • Routing Health Information System – web. DHIS
Benefits of Standardized Clinical Stationery • Longitudinal view of patient record allowing for continuity • Provides ease of review resulting in better patient management • Facilitates capturing of data • Legal record • “If it isn’t documented, it isn’t done”
Patient Held Cards
Clinical HIV Stationery All patients (on ARV, Work Up patients, wellness patients) should have this stationery completed in their folder.
One column = one clinical visit Patient Visit Continuation sheet
Visit Summary • History, examination and management plan • Investigations • Medications • Dates 123456789
TB/HIV INFORMATION SYSTEM
TB/HIV information system Paper Registers TIER. Net
What is TIER. Net? • TIER. Net is an offline, data system for TB/HIV • Supports good clinical governance – Contains line lists – alerts! – Contains reports • Enhances service delivery management – Service burden – Outcomes linked to service – Staff workload reports • Used to report routine health information for TB/HIV to next levels of health via web. DHIS
In-facility data flow for HIV/TB patient management Patient Routine data used to inform the HIV/TB programme Standardized data elements captured into web. DHIS Patient visit documented in the TB/HIV clinical stationery Data from pt folder captured into TB/HIV information system Monthly and quarterly reports generated, reviewed, interrogated and signed off by managers Line lists and reports generated and actioned
How does data move? Clinician documents clinical findings in stationery Dispatch file generated for submission to next level of health Next level of health interrogates data and provides feedback AC captures routine information into the TB/HIV information system Routine reports are generated for submission to next level of health Next level of health approves data submitted Reports and line lists are generated OM/FM and clinicians interrogate and provide interventions Next level of health captures or Imports data into web. DHIS
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HOW THE TB/HIV INFORMATION SYSTEM CAN SUPPORT PATIENT CARE
Line lists and reports to support clinical governance Monthly & Quarterly reports Linkage to Care (waiting list) Patient Appointment Lists Missed Appointment Lists TB Sputum Conversion & Discharge reports • Overdue Test Reports (Sputum, VL’s) • Facility Management Reports • Patient Summary • • •
Reports & Line Lists Reflect Patient and clinical activities Patient tells clinician of reason for the visit Folder arrives at AC with completed stationery AC captures all information into TIER. Net Clinician discusses findings, care and treatment plan with patient Pharmacist documents medication that has been dispensed Reports and line lists are generated Clinician documents findings on clinical stationery, including documenting blood results Clinicians documents that bloods that have been drawn Management actions findings
Thank you!
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