Page 259 - HIVMED_v21_i1.indb

Page 2 of 7 Original Research

HIV programme TB programme Integrated TB and HIV programme data

Na onal Na onal Integrated HIV/TB
database
DHIS ETR

Province TIER DHIS ETR Province HIV and TB TIER
reports

(sub) Distrcit TIER DHIS ETR (sub) Distrcit WebDHIS TIER

Facility HIV data Paper TB TB data Facility TB and HIV data Facility computer
register
TIER
from pa ent
folder
folder
folder from pa ent from pa ent with TIER.Net
Before implementa on* A­er implementa on*
Source: Adapted from Department of Health. Implementation Guide: TIER.Net TB Module [homepage on the Internet]. Republic of South Africa; c2016 [cited 2019 Jun 5]. Available from: https://
www.tbhivinfosys.org.za/download/support-files/2021c177939202ea8d65cad89395ad4e.pdf
*, TB and HIV data flow at the time the study was conducted.
FIGURE 1: The data flow of TB and HIV programme data before and after the implementation of the TB module in TIER.Net. Prior to implementation, the TB and HIV
12
programme comprised two separate systems (TIER, ETR), each maintained on separate hardware with its own support structure; co-infected patients were tracked
separately. The TB system emphasises data reporting with the use of paper registers, and facility level staff depend on sub-district TB coordinators for programme
feedback; the HIV system (TIER.Net) combines immediate, real-time access to individual and aggregated HIV data for patient management and programme reporting, and
is integrated with the DHIS. After implementation, TB and HIV programme data flow up through TIER.Net and are consolidated into one database. TB and HIV programme
data are available at all levels of the health system for querying and reporting (national through to facilities) and is integrated with the WebDHIS system.
TB programme data remained separate from other health Methods
programmes, where TB nurses capture patient information
into facility level paper-based TB registers (Figure 1). Pages Study design and setting
from the paper-based registers are sent to the sub-district The Department of Health identified three primary health
administrative level where they are captured into ETR.Net. TB service facilities in the Cape Winelands district in the Western
coordinators validate the captured data and refer queries back Cape Province, South Africa, to serve as pilot sites for
to the facilities. They also provide quarterly feedback to implementing electronic TB data at facility level. The sites
facilities and TB managers, and submit a dispatch of the data were each located in different sub-districts and differed with
to the district level, from where it is sent to province, and respect to TB caseload, TB staff component and programmatic
finally to national level to generate annual reports. With the services offered. This qualitative evaluation was conducted
integration of TB and HIV programme data, a specially independently from the implementation process.
developed TB module for TIER.Net would supplant the
paper-based TB register at facility level. In theory, this would
allow TB programme staff at facility level immediate and easy Sampling and data collection
access to individual and aggregated TB data. The introduction Data were collected between July and September 2016, one
of the TB module is also the first step in decentralising TB year after implementation had started. Participants were
programme data. Specifically, introduction of the TB module purposively selected as key informants at facility, sub-district,
would shift the programme from one that performs district and provincial levels of the provincial health system
surveillance only to one that uses real-time data for patient based on their involvement in the implementation process of
management and is integrated with the DHIS used for overall the TB module in TIER.Net in a decision-making, managerial
health programme reporting.
and/or implementation capacity. Participants included:
In this qualitative study, we retrospectively describe how TB • managers at facility, sub-district, district and provincial
programme staff working at various levels of the South African levels of the health system (n = 12) who were involved in
health system responded to the transition from a paper-based the TB programme and health information in a managerial
to an electronic TB data system at facility level prior to its and decision-making capacity
widespread adoption and implementation. We consider the • administrative staff at facility level (n = 2) who were
need to prioritise change management in health services responsible for electronically capturing health information
implementation and the unique challenges posed by the for various health programmes, including the TB
history of the TB programme for data and service integration. programme

http://www.sajhivmed.org.za 251 Open Access