Reducing uLTFU and Increasing
the PLHIV who Return to CareFacility based strategiesDr Diana Mokoena, APACE Program Manager: Jhb
The Problem: Poor NET_NEW
Number of patients remaining on ART not
proportional to number started on ART.
Therefore programme growth is poor.
320000
325000
330000
335000
340000
345000
350000
355000
360000
-6000
-4000
-2000
0
2000
4000
6000
8000
10000
12000
Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18
TX_Net_New trend Johannesburg District. Apr - Dec 2018
New on ART Increase in TROA TROA
STAFF PATIENTS MANAGEMENT SYSTEMS
Data MANAGEMENT POLICY/SOPs IT, EQUIPMENTS
Lack of motivation
Limited knowledge
of tier.net
Lack of tracers
lack of data
managemt skills
Non involved
Poor/no
supervisionMobile population
self trasnfers
burden of disease
fear of giving
correct information
Fil flow procedures
not followed
CCMDD not
managed
OPMs are checked
out
Tier.net not up to
date
poor record
keeping, filling
Lack of adherence
to filing SOP
No knowledge
poor recording
All key quality
indicators(Red)
Too many registers
and not updated
Reports not
generated or used
DHMIS policy not
adhered to
Lack of adherence
to tier.net SOP
No tracing
resources e.g.
uLTFU &
UNSTABLE TROA
Problem
Statement
No IT trouble shoot
support
Data quality not
priortised
uLTFU & unstable TROA
Underlying Cause for Poor Data Quality/ 28 Days “uLTF”
Acknowledgement: Dr Mawela, AquaH for the slide
Two pronged approach to increasing TX_Net_New
• Telephonic, electronic & household tracing
• Facility Point of Contact person (Jabu) to navigate returning patients
Tracing & relinking to
care those who are lost
• Patient navigators/Linkage Officers (Jabu)
• Decanting stable patients
• Linking new patients to adherence support programs
Preventing new (&existing)
patients from getting lost
Anova’s Stepwise approach to return to care
Generate TIER.Net list
• Facility based data capturer
Confirm visit missed through file audit
Share list with Anova office based data capturer for Nerve Centre tracing
Feedback outcomes to facility based data capturer
Telephonic tracing by facility based Linkage Officer
Referral to WBOTs for household tracing
Early tracing has higher return rates! Majority of patients found to be active with uncaptured visits or active in multiple facilities
40% of patients on uLTFU list found to still be active in care
Costing for SWAT data mop up:• Additional admin staff to
pull files for audit• Data capturer to generate
list & update outcomes (existing/additional)
• Desktop/laptop for capturing of outcomes
• Daily supervisor
NB! No additional staff needed for maintenance/continuous updates
62772
27494
847910998
257
7682
989
6874
0
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70000
Baseline: endDec 2018
# of files drawn # of files thatcould not be
found
No of files withvisits captured
(Adherenceclub, CCMDD,backlog etc. )
Outcomechanged
Died
Outcomechanged
TFO
Outcomechanged
LTF
Referred fortracing
Nu
mb
er o
f p
eop
le
uLTFU facility tracing outcomes: Jhb DistrictDec 2018 - Jan 2019
Anova’s Stepwise approach to return to care
Generate TIER.Net list
• Facility based data capturer
Confirm visit missed through file audit
• Up to 40% found to be uncaptured visit
Share list with Anova office based data capturer for Nerve Centre tracing
Feedback outcomes to facility based data capturer
Telephonic tracing by facility based Linkage Officer
Referral to WBOTs for household tracing
Nerve Centre Tracing
Costing for Electronic Tracing:• High spec PC/ cloud
server• Resources for TIER
dispatch collection• Min. 1X Skilled data
staff: proficient in advance Excel, SQL etc.
Structured Query Language (SQL) Script run to Identify silent transfers across COJ
Monthly dispatches loaded into
Central Database
Tier.net update:
eg, assign Trans-out
(Using a combination of name sound, Age, Gender, DoB, Address, Next of Kin, ID number etc)
32% of Transfer out (TFO) patients from secondary hospital confirmed to still
be in care within the district
1442
4537
Outcomes of 5979 patients transferred out from Helen Joseph Hospital
May-Nov 2018
Active on TIER Not found
99% still in Jhb clinics
Anova’s Stepwise approach to return to care
Generate TIER.Net list
• Facility based data capturer
Confirm visit missed through file audit
• Up to 40% found to be uncaptured visit
Share list with Anova office based data capturer for Nerve Centre tracing
Feedback outcomes to facility based data capturer
Telephonic tracing by facility based Linkage Officer
Referral to WBOTs for household tracing
Telephonic Tracing returns over 20% of PLHIV to care in 35 clinics
Costing for Facility based Telephonic Tracing:• Cellphone• Airtime• Tool to record tracing
outcomes• Linkage Officer/Tracer
(existing Anova staff)• Coordinator to
review/analyse tracing outcomes and give guidance (existing Anova staff)
208
780 634
3383
5005
83 216 54
6851038
110 141 60 113424
9 14 10 15 480
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6000
Oct-18 Nov-18 Dec-18 Jan-19 Total
Jhb Subdistrict A, B & C: Telephonic Tracing Activities:
Oct 2018 – Jan 2019
#patients called # reported back to facility
#Referred to WBOT #Reported back after WBOT tracing
Anova’s Stepwise approach to return to care
Generate TIER.Net list
• Facility based data capturer
Confirm visit missed through file audit
• Up to 40% found to be uncaptured visit
Share list with Anova office based data capturer for Nerve Centre tracing
Feedback outcomes to facility based data capturer
Telephonic tracing by facility based Linkage Officer
Referral to WBOTs for household tracing
Feb Blitz: 394 PLHIV in Soweto relinked to care through Household
Tracing by CHWs
1033
569
394
828 8 17 4 13 23
464
0 0
464
0
200
400
600
800
1000
1200
Household Tracing Outcomes: Jhb Subdistrict D February 2019Costing for household tracing:• Team Leader for
CHWs/Community tracers (new staff)
• CHWs/Community tracers (existing DOH)
• Tool to record tracing outcomes
Progress with reducing uLTFU and relinking PLHIV to Care
12288
26570
5047
28950
8235
25771
8247
23783
64318156
0
5000
10000
15000
20000
25000
30000
35000
Waiting for ART (u)LTFU
JHB District data quality/ TRAP indicators
Oct-18 Nov-18 Dec-18 Jan-19 Feb-19
Conclusions & Recommendations
• Returning patients to care has to be a multi-pronged approach.
– Data “clean-up”, active tracing using multiple approaches, intentional about keeping in patients in
care in the first place
– No ONE method will reach & relink everyone
• Investment in resources that support electronic tracing & centralized tracing centres is worthwhile and
a valuable support for facility & community based tracing efforts
– District/cluster level servers
– Networking of facilities
– Skilled staff for data analysis
– Call centres etc.