PEPFAR

Option B+ Weekly SMS reporting; data Use to improve service delivery

Zikulah Namukwaya, MD, MPHMU-JHU Care /Mulago Hospital

AIDS 2014 – Stepping Up The Pace

Background

• Dec 2012 Option B+ Rollout Evaluation Recommendation No.3: “Need For Systems to Aggregate and Report Summary of Progress Frequently”

• Develop a real time monitoring system to inform ongoing rollout and the implementation of Option B+

• A monitoring system and online dashboard considered central in the PMTCT programme until B+ is well established

• A team comprised of members from MOH, CDC, USAID and other stakeholders recommended nine indicators to be used for weekly reporting

• IPs were asked to train at least one health worker for each facility supported in weekly reporting

Emergency Operations Centre (EOC)

• MOH recently established an Emergency Operations Centre, and MOH declared eMTCT a public health emergency

• It was agreed to channel efforts concerning eMTCT through the EOC, specifically:– Receive and disseminate real time data on eMTCT programme implementation– Monitor progress and track against targets– Carry out real-time monitoring, and remove bottlenecks as much and as soon as

possible– Ask Implementing Partners(IPs) to present and interpret their data on a rotating

schedule

• The eMTCT team meets weekly at the EOC to discuss progress

The online dashboard

• MOH, Districts, USG, HDPs and IPs have access to real-time online dashboard

• Dashboards provide detailed access to reports, and datasets that may be downloaded and further analysed– Proportion of women tested

and initiated– Stock-outs– EID data

The weekly reporting systema. No. of 1st ANC visits

b. No. of women having HIV test during 1st ANC Visit

c. No. of women testing positive for HIV

d. No. of women with known HIV+ status during 1st ANC visit

e. No. of women initiating Option B+ (ART) during 1st ANC visit

f. No of women already on ART treatment by 1st ANC visit

g. No. of women who missed any ANC appointment

h. Availability of test kits

i. Availability of HIV ARVs

‣ Each week, a health worker from a facility providing Option B+ sends a report with nine indicators via SMS through their phone

‣ Data are collected, collated and analyzed every week, and a report is distributed to stakeholders

‣ Data are also available real time through a web-based dashboard accessible to stakeholders

• New ANC Attendance (Indicator 1)– Daily summaries are compiled in

time, from which weekly summaries are made

– Total Number tested • Difference indicates increased

access to HIV testing services• More accurate projection of the

logistics needed– Total HIV positives

• Identification of New positives/ Number smaller that previous numbers

– Total ANC 1 known positives• Increasing numbers as seen from our

previous reports

Option B + SMS Indicators     

Mulago NATIONAL REFFERAL HOSPITAL PMTCT Program 2014W25     Data element Value

Wkly: Total No ANC 1st Visit 586Wkly: Total No ANC Tested 499Wkly: Total NoTested HIV + 17Wkly:Total ANC known HIV + 31Wkly: Total Intitiating Option B+ 26

Wkly: Total ANC on ART before 21Wkly: Total missed appointment 28Wkly: HIV kits available 1Wkly: ARVs available 1

Weekly reporting

0

32,500

65,000

97,500

130,000

0%

20%

40%

60%

80%

100%

Number of ANC1 visits and women tested and proportion of facilities

reporting

• Reporting started initially below 30%, and is now consistently above 85%

• 1677 facilities registered for Option B+

Proportion testing _Mulago Hospital

• Average testing is 85% among new ANC. 15% report with documented HIV results (<3mo for HIV neg)

2014W15

2014W16

2014W17

2014W18

2014W19

2014W20

2014W21

2014W22

2014W23

2014W24

2014W25

2014W26

0

100

200

300

400

500

600

700

800

0.010.020.030.040.050.060.070.080.090.0100.0

ANC 1st Visist ANC tested % testing

New

AN

C att

enda

nce

Prop

ortio

n H

IV te

sting

Reporting– Clean reports at end of month due to on-going

cleaning and checks (Earlier submission)– Data Accountability; Easy to summarize weekly

reports and see discrepancies

Mulago NATIONAL REFFERAL HOSPITAL PMTCT Program - Option B+ Weekly Report - Jan to Jun 2014

Name

Actual Reports

Expected Reports Percent

Reports On Time

Percent On Time

Mulago NATIONAL REFFERAL HOSPITAL PMTCT Program 25 26 96.2 25 96.2

Reducing stock-outs• Weekly reporting can

identify stock-outs at individual facilities each week

• Through collaborative efforts, the major causes for these stock-outs were identified, and most were resolved

• EOC monitors the stock levels on a weekly basis

0

75

150

225

300 Number of facilities reporting stock-outs in test kits or ARVs

Logistics• HIV kits and ARVs availability

– 100% for Mulago (26 weeks in the 6-months)– Reflection of timely reporting and follow up of our

supplies with NMS

Option B + SMS Indicators

Mulago NATIONAL REFFERAL HOSPITAL PMTCT Program Jan to Jun 2014

Data element ValueWkly: HIV kits available 26Wkly: ARVs available 26

EID data also included in the weekly report

• EID data provided by the Central Public Health Laboratory has been included in the weekly report since March 2014

• Facilities with high MTCT rates can be identified immediately, so that action can be taken

March 2014

April 2014

May 2014 June 20140

2250

4500

6750

9000

0%

2%

4%

5%

7%

Client Follow up• At the end of each clinic day, the health worker identifies clients who

have missed their appointments by identifying all those without a tick ()– For clients with phone contact, the health worker will call immediately and

document the response in the appointment Book– For clients without phone contact / failure to contact through phone,

a list is forwarded to the Health visitor for follow up• Using the Referral form for locator Information

Summary

• There is more involvement by staff in reporting, DHOs and implementers embraced the system

• It provided an opportunity to receive updates from sites in real-time without district staff having to physically go there

• We have observed improvement in data capture, (timely and more accurate)

• Client follow up is immediate (phone call same day) or weekly for home visits

• More accurate documentation of HIV testing (New Vs repeats..)

• Gaps are identified early and staff are taking more responsibility

• Translating weekly reports to monthly/quarterly reports has improved general reporting

Partners in Weekly Reporting

MAKERERE UNIVERSITY

Ministry of Health