TRACE INITIATIVE: Data Use

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BACKGROUND

Data Use is at the Center of M&E Improve coverage, reach and intensity of services Improve program planning and resource allocation Improve transparency and accountability Improve quality of data Make decisions based on evidence Shape policy decisions and improve advocacy efforts DATA USE

Data Use from an Informatics Perspective

Data Use for HIV Recency How to use MER indicator HTS_recent: Surveillance Determination of the percentage of recent infection among newly diagnosed PLHIV will enable countries to identify geographic areas and subpopulations with ongoing transmission and monitor epidemic trends over time  Programmatic response Identification of areas and subpopulations with ongoing transmission will allow countries to fine-tune their programmatic response by targeting education, prevention, and testing resources to increase case finding and interrupt transmission. Proxy incidence While tests for recent infection among newly diagnosed PLHIV are not currently being used to estimate population-level incidence, a proxy measure of annual incidence among HTS clients may be calculated and serve as a standardized indicator for monitoring epidemiological impact of programs over time. Implementation The denominator may be used to monitor the rollout and coverage of testing for recent infection.

DATA USE TOOLS

Data Dashboards Programmatic tool to display current, validated, and verified results By various actors: From facility level to national level for resource and activity allocations, assessing overall impact of resources/activities  Generated routinely using aggregate data Over time: Longitudinal progress Over Geographic location: Hotspots Over Transmission Networks: Populations Reviewed by program response team to inform prevention efforts and response to transmission clusters

DHIS2 Tracker: Data visualization dashboard DHIS2 Dashboards support single-software-system solution

REDCap: Sample RShiny dashboard

Performance and Progress Monitoring Tools A performance and progress monitoring tool is an information management tool that visually tracks, analyzes and displays Key performance indicators and metrics: How the study is progressing Data points to monitor a process: Issues that may need to be investigated This data is not validated and 'messy' Will be used to track inconsistencies that may be the result of many errors from various levels Linkage errors at the above site level  Incomplete records at the facility level Lab samples not received at various points Points to data that may serve as a trigger for further analysis (CQI)

Linkage with CQI Continuous Quality Improvement (CQI) indicators will be collected and should be used to assess the quality of the provision of recency testing CQI is a philosophy that encourages team members to continuously ask: How are we doing? Can we do it better? Can we do it more efficiently? Can we be more effective? Can we do it faster? Can we do it in a more timely way?

IMPORTANCE

How It All Comes Together Data Collection  Performance and Progress Monitoring Tools (pinpoint possible errors) CQI Tools (Remediation of said errors) Verified and Validated data Data Dashboards (Programmatic use to control the epidemic)

Epidemiological Trends Data can be used to look at HIV recency infection by demographic variables, HIV risk indicators, or geography

Example Analyses for HIV Recency Testing

% Recent by Assay and RITA

% Recent by Facility and Quarter

Index Testing Yield Example HIV yield among partners by index case recency status, Central America, January-August 2018, Guatemala, Nicaragua, and Honduras

Recent Cases by Location Source: Data collected by the Ministries of Health in Guatemala, Honduras, and Nicaragua and presented at the 2018 PEPFAR Annual Meeting by Northbrook S et al.

Recent and Long-Term Cases by Location Source: A pragmatic approach to HIV hotspot mapping in a developing country available at http://proceedings.esri.com/library/userconf/proc17/papers/1688_462.pdf

SaTScan Analysis Source: Data collected by Nicaragua Ministry of Health and presented at the 2018 PEPFAR Annual Meeting by Northbrook S et al.

Cluster Investigation HIV Transmission Cluster A group of HIV-infected persons (diagnosed or undiagnosed) who are connected by HIV transmission Represent recent and ongoing transmission in a population Identifying transmission clusters can help Identify risk networks that are concerning and key characteristics of these underlying risk networks Improve outcomes associated these groups and interrupt transmission Increase knowledge of transmission dynamics to help create new targeted interventions

Responding to Potential Clusters HIV Investigation Establish an alert system to rapidly describe person, place, and time Review programmatic data IP performance Site-level testing Utilize index partner testing to target risk network Ensure accessibility of HIV services in area Monitor changes over time

DISSEMINATION & USE

Data Dissemination Purpose: To inform the national HIV response and guide public health prevention and control measures Data will be shared widely with in-country stakeholders Dissemination of results will be in the form of reports and peer-reviewed publications. What will be shared: Aggregate surveillance data describing where and among whom recent infections are occurring among newly diagnosed PLHIV

Integrated Cycle for Program Planning 1. Assessment 2. Strategic Planning 3. Design 4. Implementation/ Monitoring 5. Evaluation 6. Reporting/ Sharing Findings

Barriers to Using Data for Program Decision-Making Availability of data Quality of available data Relevance to the population of interest Relevance of data to planning tasks at hand Manner in which data are presented Organizational problems that affect the decision making process

Using Data to Make Program Decisions Easily Step 1 Identify the problem or question you want answered Step 2 What M&E data is needed to answer the question? Step 3 Analyze / examine the data Step 4 Develop a program improvement plan

Questions? Comments?

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