reducing ultfu and increasing the plhiv who return to care · advance excel, sql etc. structured...

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

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257

7682

989

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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





• Up to 40% found to be uncaptured visit





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

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

1000

2000

3000

4000

5000

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

Feb Blitz: 394 PLHIV in Soweto relinked to care through Household

Tracing by CHWs

1033

569

394

828 8 17 4 13 23

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0 0

464

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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.

https://www.google.co.za/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiXhoiFk4HeAhVJVhoKHaKJAnAQjRx6BAgBEAU&url=https://jerusalemchamber.com/2017/08/07/chapter-3-qa/&psig=AOvVaw3HGnpSe4hundsZQ2vidmfX&ust=1539442114124661

https://www.google.co.za/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwiXhoiFk4HeAhVJVhoKHaKJAnAQjRx6BAgBEAU&url=https://jerusalemchamber.com/2017/08/07/chapter-3-qa/&psig=AOvVaw3HGnpSe4hundsZQ2vidmfX&ust=1539442114124661

reducing ultfu and increasing the plhiv who return to care · advance excel, sql etc. structured...

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