Page 258 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Transition to an in-facility electronic Tuberculosis

register: Lessons from a South African pilot project

Authors: Background: South Africa has one of the highest incidences of Tuberculosis (TB) globally. High
Hanlie Myburgh 1 co-morbid HIV prevalence complicates TB management and treatment outcomes. Growing
Remco P.H. Peters 2
Theunis Hurter 2 evidence suggests that integrating the TB and HIV programmes will improve the overall
Cornelius J. Grobbelaar 2 results.
Graeme Hoddinott 1
Objectives: To describe how TB programme staff at various levels of the South African health
Affiliations: system responded to the transition from a paper-based to an electronic register of TB data
1 Desmond Tutu TB Centre, integrated with HIV programme data.
Department of Paediatrics
and Child Health, Faculty of Method: Three primary health service facilities in the Cape Winelands district, Western Cape
Medicine and Health province, South Africa served as pilot sites for implementation. Semi-structured interviews
Sciences, Stellenbosch
University, Cape Town, were conducted with 21 TB programme staff purposively selected at facility, sub-district,
South Africa district and provincial levels of the health system, based on their involvement in implementing
electronic TB data. An objective-driven thematic frame was used to analyse the data.
2 Anova Health Institute,
Johannesburg, South Africa Results: Fears about the transition included reductions in data quality, changes to the status
quo and a lack of computer literacy. Participants acknowledged benefits of reduced workloads,
Corresponding author: speed of accessing patient-level data and click-of-a-button reporting. Three factors influenced
Hanlie Myburgh,
[email protected] the ease of adopting the new system: firstly, implementation challenged the vertical position of
the TB programme, TB data and staff’s conventional roles and responsibilities; secondly,
Dates: perceptions of the paper-based register as functional and reliable made the transition to
Received: 26 Aug. 2019 electronic seem unnecessary; and thirdly, lack of a process of change management challenged
Accepted: 30 Sept. 2019
Published: 16 Jan. 2020 staff’s ability to internalise the proposed change.
Conclusion: A process of change management is critical to facilitate the efficiency and
How to cite this article:
Myburgh H, Peters RPH, effectiveness with which the electronic in-facility TB register is implemented.
Hurter T, Grobbelaar CJ,
Hoddinott G. Transition to an Keywords: TB programme; systems integration; monitoring and evaluation; roles and
in-facility electronic responsibilities; HIV.
Tuberculosis register: Lessons
from a South African pilot
project. S Afr J HIV Med. Introduction
2020;21(1), a1025. https://
doi.org/10.4102/sajhivmed. South Africa has one of the highest burdens of Tuberculosis (TB) globally. In 2017, the estimated
1,2
v21i1.1025
incidence of drug-susceptible TB (DS-TB) was 567 per 100 000 persons, and there were
3,4
Copyright: approximately 78 000 deaths from TB-related causes. The close relationship between TB and
© 2020. The Authors. HIV (> 60% of TB patients are also living with HIV) further complicates TB management and
Licensee: AOSIS. This work treatment outcomes. 2,5,6 Growing evidence suggests that integrating the TB and HIV programmes
is licensed under the
Creative Commons will improve overall outcomes and reduce mortality. 1,6,7,8
Attribution License.
Background
In South Africa, TB and HIV programmes and health information systems are implemented as
vertical and siloed systems and have largely retained this separation. 1,2,5 Since 1995, the National
TB Programme has been supported by a central standardised recording system to monitor TB case
rates and treatment outcomes. This system comprises paper-based registers at facility level.
An Electronic TB Register (ETR.Net) for DS-TB at sub-district, district, provincial and national
levels was added in 2005. 1,9,10,11 In 2014, the National Department of Health of South Africa took a
decision to integrate the TB and HIV information systems at facility level into a single non-networked
12
Read online: electronic system called TIER.Net. Since 2010, TIER.Net has been serving as the primary monitoring
Read online:
13
Scan this QR platform for the national antiretroviral treatment (ART) programme and was incrementally
Scan this QR
code with your
code with your
smart phone or
smart phone or expanded to include HIV testing and pre-ART data modules. TIER.Net is used to capture
mobile device
mobile device patient-level HIV information at facility level and is integrated with the district health information
to read online.
to read online.
system (DHIS) for reporting various programme data from sub-district to national levels. In contrast,
http://www.sajhivmed.org.za 250 Open Access