Option B+ Weekly SMS reporting; data Use to improve service delivery Zikulah Namukwaya, MD, MPH MU-JHU Care /Mulago Hospital AIDS 2014 – Stepping Up The Pace

Background Dec 2012 Option B+ Rollout Evaluation Recommendation No.3: “Need For Systems to Aggregate and Report Summary of Progress Frequently” Develop a real time monitoring system to inform ongoing rollout and the implementation of Option B+ A monitoring system and online dashboard considered central in the PMTCT programme until B+ is well established A team comprised of members from MOH, CDC, USAID and other stakeholders recommended nine indicators to be used for weekly reporting IPs were asked to train at least one health worker for each facility supported in weekly reporting

Emergency Operations Centre (EOC) MOH recently established an Emergency Operations Centre, and MOH declared eMTCT a public health emergency It was agreed to channel efforts concerning eMTCT through the EOC, specifically: – Receive and disseminate real time data on eMTCT programme implementation – Monitor progress and track against targets – Carry out real-time monitoring, and remove bottlenecks as much and as soon as possible – Ask Implementing Partners(IPs) to present and interpret their data on a rotating schedule The eMTCT team meets weekly at the EOC to discuss progress

The online dashboard MOH, Districts, USG, HDPs and IPs have access to real- time online dashboard Dashboards provide detailed access to reports, and datasets that may be downloaded and further analysed – Proportion of women tested and initiated – Stock-outs – EID data

The weekly reporting system a.No. of 1st ANC visits b.No. of women having HIV test during 1st ANC Visit c.No. of women testing positive for HIV d.No. of women with known HIV+ status during 1st ANC visit e.No. of women initiating Option B+ (ART) during 1st ANC visit f.No of women already on ART treatment by 1st ANC visit g.No. of women who missed any ANC appointment h.Availability of test kits i.Availability of HIV ARVs a.No. of 1st ANC visits b.No. of women having HIV test during 1st ANC Visit c.No. of women testing positive for HIV d.No. of women with known HIV+ status during 1st ANC visit e.No. of women initiating Option B+ (ART) during 1st ANC visit f.No of women already on ART treatment by 1st ANC visit g.No. of women who missed any ANC appointment h.Availability of test kits i.Availability of HIV ARVs ‣ Each week, a health worker from a facility providing Option B+ sends a report with nine indicators via SMS through their phone ‣ Data are collected, collated and analyzed every week, and a report is distributed to stakeholders ‣ Data are also available real time through a web-based dashboard accessible to stakeholders

New ANC Attendance (Indicator 1) – Daily summaries are compiled in time, from which weekly summaries are made – Total Number tested Difference indicates increased access to HIV testing services More accurate projection of the logistics needed – Total HIV positives Identification of New positives/ Number smaller that previous numbers – Total ANC 1 known positives Increasing numbers as seen from our previous reports Option B + SMS Indicators Mulago NATIONAL REFFERAL HOSPITAL PMTCT Program 2014W25 Data elementValue Wkly: Total No ANC 1st Visit586 Wkly: Total No ANC Tested499 Wkly: Total NoTested HIV +17 Wkly:Total ANC known HIV +31 Wkly: Total Intitiating Option B+26 Wkly: Total ANC on ART before21 Wkly: Total missed appointment28 Wkly: HIV kits available1 Wkly: ARVs available1

Weekly reporting Reporting started initially below 30%, and is now consistently above 85% 1677 facilities registered for Option B+

Proportion testing _Mulago Hospital Average testing is 85% among new ANC. 15% report with documented HIV results (<3mo for HIV neg)

Reporting – Clean reports at end of month due to on-going cleaning and checks (Earlier submission) – Data Accountability; Easy to summarize weekly reports and see discrepancies

Reducing stock-outs Weekly reporting can identify stock-outs at individual facilities each week Through collaborative efforts, the major causes for these stock-outs were identified, and most were resolved EOC monitors the stock levels on a weekly basis

Logistics HIV kits and ARVs availability – 100% for Mulago (26 weeks in the 6-months) – Reflection of timely reporting and follow up of our supplies with NMS

EID data also included in the weekly report EID data provided by the Central Public Health Laboratory has been included in the weekly report since March 2014 Facilities with high MTCT rates can be identified immediately, so that action can be taken

Client Follow up At the end of each clinic day, the health worker identifies clients who have missed their appointments by identifying all those without a tick (  ) – For clients with phone contact, the health worker will call immediately and document the response in the appointment Book – For clients without phone contact / failure to contact through phone, a list is forwarded to the Health visitor for follow up Using the Referral form for locator Information

Summary There is more involvement by staff in reporting, DHOs and implementers embraced the system It provided an opportunity to receive updates from sites in real-time without district staff having to physically go there We have observed improvement in data capture, (timely and more accurate) Client follow up is immediate (phone call same day) or weekly for home visits More accurate documentation of HIV testing (New Vs repeats..) Gaps are identified early and staff are taking more responsibility Translating weekly reports to monthly/quarterly reports has improved general reporting

Partners in Weekly Reporting MAKERERE UNIVERSITY Ministry of Health