Webinar IPC Roadmap Development and IPC Roadmap Implementation TB CARE II 23 September 2019

Designing and Implementing IPC Roadmaps Introduction Designing and Implementing IPC Roadmaps

Introduction and Purpose To discuss the use of IPC roadmaps for institutionalizing data collection and use To discuss IPC roadmaps in the context of reporting on NAP progress To understand the specific, operationalized measurements of IPC interventions and hear experiences from country teams on how they measure IPC interventions at national and sub-national levels.

Developing an Implementation Roadmap IPC Roadmap Developing an Implementation Roadmap

IPC Roadmap: Core Components Core components for developing and implementing an IPC roadmap include the following: New or Existing: is the indicator already in use? Data Source: what data systems are used to collect data for this indicator? Responsible Parties: who (at each level) is responsible for data collection, aggregation, analysis and presentation? Frequency: How frequently is this indicator reported? Timeline: for new indicators, when will the indicator be in use and reported?

Core Components: New or Existing? Is the indicator currently in use in the country? To what extent? Is the indicator included in guidance document? Are data available for this indicator? If the indicator is new in the country, is it being collected elsewhere?

Core Components: Data Source What data systems are in place for collecting this indicator? At what level is the indicator collected (i.e. facility, laboratory)? At what level is the indicator aggregated and summarized? What is the general data flow (i.e. collected at the facility, summarized and validated at district level, summarized and validated at provincial level, summarized and validated at national level)

Core Components: Responsible Parties Who is responsible for data collection, aggregation, validation and presentation? At all levels (i.e., facility, district, provincial, national) Is there a champion for the given indicator or intervention who understands the indicator and data collection methods?

Core Components: Frequency How frequently are data aggregated and presented? For example: collected at the facility level and then aggregated monthly, with summary results presented in a quarterly report

Core Components: Timeline For implementing new indicators in a given country context, what steps must be taken to establish data systems, responsible parties and other factors, and what is the projected start date for data collection and subsequent reporting?

IPC Roadmap: Levels of Implementation Most indicators are facility level indicators (with aggregation to various higher levels for reporting purposes) National level indicators could include the following Incidence of TB infection among health care workers National TB infection control guideline scorecard

Operationalizing the Roadmap IPC Roadmap Operationalizing the Roadmap

IPC Roadmap: Reporting Progress on NAP Milestones Assess current indicators in the country Which IPC indicators are currently in place? For new indicators, follow the “essential elements” to define a plan for implementing Define a baseline for new indicators Use a set of IPC indicators to report progress toward NAP milestones in a standardized, comparable manner (or as comparable as possible)

Country Example South Africa

Existing IPC Practices South Africa Existing IPC Practices

Existing practices for TB infection control Existing tools, checklists, SOPs, and scope of use Screening Tool - TB symptomatic screen for all patients and HCW Risk Assessment Tool – for clinics and hospitals, conducted annually IPC Evaluation checklist – conducted monthly, used to monitor implementation of IPC plans Ideal Clinic Dashboard – used to assess compliance to IPC at facility level, used monthly Other tools in use Household risk assessment tool – being piloted, used every 6 months Risk assessment tools for Correctional facilities (prisons) and police cells

Roadmap/Pathway to Adapting and Adopting Best IPC Practices   New or Existing Frequency Timeline Selected indicators Does the indicator already exist? Are you collecting data on this/these indicators? If yes, what is the data collection approach? How you collect data on/for this indicator(s) How frequently is this indicator be reported? If this is a new indicator, what is the timeline for rolling out this indicator? Comments Managerial Controls National TB infection control guideline scorecard Yes - Ideal clinic and National Core Standards (Hospital QA) By completing a self and peer-assessment spreadsheet.  Quarterly These are for clinics and CHCs but not for Hopsital Proportion of health care facilities (small, medium, larger) with an updated (past 10 years) IPC Plan/SOP that includes TB IPC measures Online checklist Quarterly  New for hospitals - full implementation April 2019  Proportion of health care facilities in the district/state with an active infection control committee responsible for implementing the written infection control plan that includes airborne infection control Proportion of health care workers trained in infection prevention and control. Proportion of tertiary health care facilities in the district/state that have been subjected to facility risk assessment for airborne infection control

Roadmap/Pathway to Adapting and Adopting Best IPC Practices   New or Existing Frequency Timeline Selected indicators Does the indicator already exist? Are you collecting data on this/these indicators? If yes, what is the data collection approach? How you collect data on/for this indicator(s) How frequently is this indicator be reported? If this is a new indicator, what is the timeline for rolling out this indicator? Comments Administrative Controls Proportion of facilities w/ > 90% of hospitalized patients screened for active TB Yes. The tick register / hospital register At each entry point as part of the regular triage. Monthly Environmental Controls Proportion of facilities w/ airborne infection control risk assessment Yes- Ideal clinic and National Core Standards (Hospital QA) Online checklist Respiratory Hygiene Proportion of facilities with surgical masks available for patients identified with a cough To check stock out of surgical masks and n95 New system. Report stock outs Apr-19 Explore inclusion in the Stock management information system HCW Surveillance Proportion of HCWs screened for active TB disease Self reporting. Depending on the policy approval New system Proportion of HCWs screened for TB infection Proportion of facilities w/ adequate score on HCW screening program evaluation OUTCOME/IMPACT: Risk of TB (disease) among health care workers relative to the general population, adjusted for age and sex In Patient Waiting Time

South Africa Example: FAST

FAST & U-LAM administrative process indicators FAST & U-LAM administrative process indicators . To evaluate the proportion of patients in care who are screened for TB and put on treatment . To evaluate time from sample submission to diagnosis to treatment . Cascade Data reported monthly FAST Data Elements Number of patients screened for TB Number presumptive Number tested by GeneXpert Number tested positive by Gene Xpert Number diagnosed with DS TB Number diagnosed with RR TB Number started on DS TB treatment Number DS TB initial lost to follow-up Number DS TB died before treatment started Number RR TB started on treatment Number RR TB lost to follow up before treatment started Number RR TB died before treatment started Number tested by other Clinical Diagnostic Tests Number tested positive by other Clinical Diagnostic Time from sample submission to diagnosis Time from diagnosis to treatment U-LAM Data Elements Number of HIV positive patients with low CD4 count ( less than or equal to 100 cells/ul Number of HIV positive patients who are seriously ill and regardless of low CD4 count Number of clients LAM tested Number tested LAM positive Number initiated on TB treatment Initial death Loss to follow Number done Xpert/MTB Rif Number diagnosed RR positive Number of RR positive on MDRTB treatment

Example: Health Care Worker Surveillance South Africa Example: Health Care Worker Surveillance

Screening of LTBI among HCWs Study conducted to determine the prevalence of LTBI and progression to active TB using QuantiFERON-Plus (QFT-Plus) in three hospitals 1) Pelonomi Regional hospital, Free State 2) Zithulele District hospital, Eastern Cape and 3) Pretoria West District Hospital, Gauteng Phase one (recruitment and enrolment of 272 participants) at Pretoria West District Hospital has been completed. Preliminary findings show that 121 (44.5%) were LTBI positive and 129 (54.8%) negative.

Healthcare worker surveillance There is a draft national policy on Occupational TB and HIV services for healthcare workers IPC guidance documents do not include surveillance for healthcare workers Provinces have guidelines that include TB medical surveillance and indicators, this is not standardized across provinces Number of health care workers diagnosed with TB (DS/ MDR/ XDR-TB) Systems used to collect the data vary – OHASSYS, DHIS, ETR Data not flowing to national level but can be obtained from the provinces Data not reported to the WHO currently

Legal and Policy Framework Constitution of the Republic of South Africa (Act No. 108 of 1996) The National Health Act (No. 61 of 2003) Occupational Health and Safety Act (No. 85 of 1993), and Regulations for Hazardous Biological Substances, 2001 Roles of employer and employees Record keeping of risk assessment, monitoring activities, medical surveillance (the last being subject to confidentiality) for a period of 40 years Compensation for Occupational Diseases and Injuries Act (No. 130 of 1993) TB schedule 5 Biological Hazard Compensable disease

Healthcare worker surveillance future plans Approval of policy Development of guidelines Training of Occupational Health Practitioners Develop M and E framework Roll out the OHASYS (Occupational health Information system) Only for health care workers Confidential Quarterly and Annual reports will be provided by the Occupational Health Unit for all medical conditions

IPC Roadmap Conclusions

Questions

USAID TB CARE II In partnership with: The TB CARE II project is funded by the United States Agency for International Development (USAID) under Cooperative Agreement number AID-OAA-A-10-00021 and is managed by the prime recipient, URC. In partnership with: