Mokgadi Morokolo, Prince Dulaze & Joshua...
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Mokgadi Morokolo, Prince Dulaze & Joshua Murphy
Transcript of Mokgadi Morokolo, Prince Dulaze & Joshua...
Mokgadi Morokolo, Prince Dulaze & Joshua Murphy
The best way to
improve Data Quality
is to USE the data!
Rentia Voormolen
ESI / Cast of Thousands
Outline
• Overview of DFA Indicators
– The Why, What & How
• Leverage points for Quality Improvement
– What helps us achieve targets
– What hinders
• Data review
– Name and Fame/shame…
– Your viewpoints
Definitions: Indicator & Rate
• Indicator: Quantitative or qualitative
variable that provides simple and reliable
measurement of one aspect of
performance, achievement or change in a
program or project (Source: ESI)
• Rate: A type of ratio that indicates how 2
measures are related.
• A rate is a type of indicator
Data For Action Indicators (+4)
• ANC Client 1st HIV test rate (M)
• (1) ANC 1st Visit <20 weeks (M)
• (2) ANC client CD4 test rate (M)
• (3) ANC initiated on AZT during antenatal care rate (M)
• (4) ANC initiated on HAART rate (M)
• (5) ANC clients 32 weeks or later retesting rate (M)
• Baby PCR Test around 6 weeks Uptake Rate (B)
• (6) Baby PCR test around 6 weeks positive rate (B)
• (7) Postnatal care mother visits within 6 days rate (M-B)
• Baby HIV Antibody Test at 18 months Uptake Rate (B)
• Baby HIV antibody test positive at 18 months rate (B)
DFA Data
Johannesburg Metro Municipality
– City of Joburg
Some Key Info
Population ~3.8 million
ANC HIV prevalence 29.6%
Sub-district 7
Facilities ~124
Indicators: focus on Mothers
Indicator System Factor Individual Factor
ANC Client 1st test rate Yes Yes
ANC 1st Visit <20 weeks Yes Yes
ANC client CD4 test rate Yes
ANC initiated on AZT during antenatal care rate
Yes Yes
ANC initiated on HAART rate
Yes Yes
ANC clients 32 weeks or later retesting rate
Yes Yes
Indicators: focus on Babies Indicator System Factor Individual Factor
Baby PCR Test around 6 weeks Uptake Rate Yes Yes
Baby PCR test around 6 weeks positive rate ? ?
Postnatal care mother visits within 6 days rate Yes Yes
Baby HIV Antibody Test at 18 months Uptake Rate
Yes Yes
Baby HIV antibody test positive at 18 months rate
? ?
Why Each Indicator is Important
• Numerator/Denominator
• Clinical Relevance – Individual (health of mother & baby)
• Programmatic Relevance – Public health – prevention aspect at population level
– Evaluating our performance
– Planning • Finance
• Human Resources
• Target
• What are the factors that prevent us from reaching these targets?
• What can help us achieve these targets?
ANC Client 1st HIV test rate
• Numerator: Antenatal client HIV 1st test
• Denominator: Antenatal client eligible for HIV
1st test (Calculated)
o Antenatal clients with unknown HIV status are
eligible for first HIV tests
o All antenatal first visits MINUS first visit clients
on HAART MINUS first visit clients known HIV
positive but NOT on HAART
o Include clients who tested negative in
previous HIV tests.
ANC Client 1st HIV test rate
Clinical Relevance Tested mothers can seek treatment. Mothers can
know their status.
Prevention of transmission to child
Programmatic
Relevance
If people don’t get tested, then you can’t properly
enter them into the PMTCT programme.
Early detection and initiation of treatment
Target (Johannesburg 2012:/2013: 96.5%)
What is stopping us
from this target? Client, staff attitudes?
Data quality?
What could help us to
achieve this target?
Continuous staff training
Patient education on benefits of knowing ones
status
Community outreach programmes
ANC 1st Visit <20 weeks
• Numerator: Number of 1st visits before 20
weeks
• Denominator: Total number of ANC 1st
visits
ANC 1st Visit <20 weeks
Clinical Relevance Good for a healthy pregnancy, good for early HIV
detection/diagnosis
Programmatic
Relevance Good for PMTCT
Target National Target 2012-2013: 60%
What is stopping us
from achieving this
target
Client, staff attitudes?
Client knowledge?
Data quality?
What could help us
to achieve this
target?
Continuous staff training
Patient education on benefits of knowing ones
status
Community outreach programmes
ANC client CD4 test rate
• Numerator: Antenatal client CD4 1st test
• Denominator: ANC eligible CD4 1st CALC
o Antenatal clients who tested positive for first
HIV tests
o Plus clients re-tested positive at 32 weeks or
later
o Plus first visit clients known HIV positive but
NOT on HAART.
ANC client CD4 test rate
Clinical Relevance Determine ART eligibility, predictor of positive
response to ART
Programmatic
Relevance Lowering the transmission rate
Decrease infant and mother mortality rate
Target National Target 2012-2013: 85%
What is stopping us
from achieving this
target
Data quality and validation
Lab results turn-around time
What could help us to
achieve this target? Continuous staff training/ constant monitoring
ANC initiated on AZT during
antenatal care rate
• Numerator: Antenatal client INITIATED on AZT
• Denominator: ANC HIV pos tot CALC
o All antenatal clients (NOT ON HAART) who
tested positive for first HIV tests
o PLUS clients re-tested positive at 32 weeks or
later.
ANC initiated on AZT during antenatal care
rate
Clinical Relevance Reduce chances of transmission during
pregnancy
Programmatic
Relevance Lowering the transmission rate
Decrease infant and mother mortality rate
Target National Target 2012-2013: 90%
What is stopping us
from achieving this
target
Recording
Shortage of haematics(iron tablets)
What could help us to
achieve this target? Continuous staff training/ constant monitoring
Stock control
ANC initiated on HAART rate
• Numerator: Antenatal client initiated on HAART
• Denominator: HIV positive antenatal client
with a CD4 count under the specified
threshold and/or a WHO staging of 4.
ANC initiated on HAART rate
Clinical Relevance Pregnant patients could be started on treatment
earlier
Programmatic
Relevance
Reduction of opportunistic infection (TB)
Decrease maternal mortality rate
Decreases the number of stage 4 illnesses
Target National Target 2012-2013: 95%
What is stopping us
from achieving this
target
Relocation – highly mobile society
Disclosure
What could help us to
achieve this target? Fast-tracking all pregnant women into ART
Future data management system(Tier 3)
ANC clients 32 weeks or later
retesting rate
• Numerator: Antenatal client HIV re-test at
32 weeks or later
• Denominator: ANC HIV 1st neg test
CALC
o All antenatal clients who were tested for HIV
for the first time
oMINUS those that tested positive at their first
test.
ANC clients 32 weeks or later retesting rate
Clinical Relevance Sero-conversion
High infectivity rate
Programmatic
Relevance Confirming and maintaining the negativity status
of the mother
Target National Target 2012-2013: 85%
What is stopping us
from achieving this
target
Patient relocations and re-test at different
facilities
Recording
What could help us to
achieve this target? Importance of recording
“if its not recorded, its not done”
Baby PCR Test around 6
weeks Uptake Rate
• Numerator: Baby PCR test around 6
weeks
o It was agreed to count PCR tests done
between 4 and 12 weeks under PCR test
around 6 weeks.
oDo NOT include repeat tests
• Denominator: Live birth to HIV positive
woman
Baby PCR Test around 6 weeks Uptake Rate
Clinical Relevance Early initiation of HAART
Programmatic
Relevance Transmission rate between mother and child
Maintaining the negativity status of the child
Target National Target 2012-2013: 100%
(Johannesburg 2012/13: 95%)
What is stopping us
from achieving this
target
Recording (Road to health) – NVP given to the
baby
Relocation
Disclosure
What could help us to
achieve this target?
Patient education
Encourage disclosure
Importance of recording good quality data
Baby PCR test around 6 weeks
positive rate
• Numerator: Baby PCR test positive around 6 weeks
• Denominator: : Baby PCR 6 wk. test
o Babies born to HIV positive women must be PCR tested when they get their first vaccinations 6 weeks after birth. Because sick babies may be tested before 6 weeks and some may receive their first vaccinations after 6 weeks, it was agreed to count PCR tests done between 4 and 12 weeks under PCR test around 6 weeks.
o Do NOT include repeat tests.
Baby PCR test around 6 weeks positive rate
Clinical Relevance Importance of knowing babies’ status
Early initiation of HAART
Programmatic
Relevance Indicator of PMTCT success
Target National Target 2012-2013: < 3,5%
What is stopping us
from achieving this
target
In many cases, we are achieving this.
What could help us to
achieve this target?
To continue we must ensure the PMTCT
programme is delivered to the highest quality
possible
Baby HIV Antibody Test at 18
months Uptake Rate
• Numerator: Baby HIV antibody test positive at
18 months
• Denominator: : Baby PCR neg 6 wk. CALC
o All babies who were PCR tested for the first
time around 6 weeks
o MINUS those that tested positive at their first
PCR test.
Baby HIV Antibody Test at 18 months Uptake
Rate
Clinical Relevance Infection during breastfeeding
Postnatal Sero-conversion
Programmatic
Relevance
Postnatal transmission rate
Research topic – positivity rate during
breastfeeding
Target National Target 2012-2013: 85%
What is stopping us
from achieving this
target
Limited knowledge & awareness of importance
Disclosure
Celebrating early (NVP)
What could help us to
achieve this target?
Encouraging disclosure
Continuous education on infant feeding
Postnatal continuation of HAART
Baby HIV antibody test
positive at 18 months rate
• Numerator: Baby HIV antibody test
positive at 18 months
• Denominator: Baby HIV antibody test at
18 months
o Baby born to HIV positive woman who was
tested for HIV antibodies (rapid or ELISA) 18
months after birth. This should include babies
who previously tested PCR negative as well
as those not PCR tested.
Baby HIV antibody test positive at 18 months
rate
Clinical Relevance Importance of knowing babies’ status
Programmatic
Relevance Indicator of PMTCT success
Target National Target 2012-2013: <5%
What is stopping us
from achieving this
target
Mix feeding
Relocation (mobile population)
Other issues?
What could help us to
achieve this target? Continuous education of clients
Caution & Suggestions
• Note NDOH – Action Framework, PMTCT Cascade – PMTCT Dashboard
• Data should be interpreted with caution
• Based on routinely collected data in DHIS
• Not to be replicated without appropriate permissions
• Information to be delivered at facility, sub-district level
The best way to improve Data Quality is to USE the data!
DFA Data
Dashboard Example (Tableau)
Name and Fame (1st Test, Early Booking)
• ANC Client 1st HIV test rate
Sub-district D A,B,G: approaching targets
Reached target: Chiawelo (D) Q2 Jun-Aug, Windsor (E) in
September
• ANC 1st Visit <20 weeks
Bosmont clinic (high on average), Zola increasing
Name and Shame (1st Test, Early Booking)
• ANC Client 1st HIV test rate
Sub-district D&F low, C&E scattered
• ANC 1st Visit <20 weeks
Across the district, too low
Name and Fame (Prophylaxis, ART)
• (3) ANC initiated on AZT during antenatal care rate
Sub-district F&G close to targets
Alex CHC reached targets
• (4) ANC initiated on HAART rate
Sub-district B looks better
Lillian Ngoyi
Name and Shame (Prophylaxis, ART)
• (3) ANC initiated on AZT during antenatal care rate
Sub-districts A,B & C high variation
• (4) ANC initiated on HAART rate
Sub-districts A, C, E & G high variation
Name and Fame (PCR, 18 Month HIV AB test)
• (6) Baby PCR test around 6 weeks positive rate
District – below 3.5% for the most part, close to <2%
(2016 NSP targets)
Sub-district D 2% or below since May 2012
Name and Fame/Shame
(18 Month HIV AB test)
• Baby HIV Antibody Test at 18 months Uptake Rate
Below targets
• Baby HIV antibody test positive at 18 months rate
CAR
• Challenge
• ACTION (intervention)
• Desired result
• Examples:
– Challenge: poor data quality
– Action: data feedback to address (Completeness, Timeliness, Accuracy)
– Desired results: Complete data without variation
QI Leverage points
• System Factors
– Facility managers, Nurses, Data capturers
– Lab
– Appointment systems
• Individual factors
– Awareness, knowledge, attitude of clients &
staff
Immeasurables
• Our outcomes and impact can be
described through DHIS, but what about
those that are less readily measured?
• Client education, knowledge & attitude
• Staff attitudes
– Improving values and attitudes – of staff,
managers and patients (6 Priority Areas)
• How is the service sold?
