ADDIS ABABA CITY ADMINISTRATION HEALTH BUREAU

Regional Refresher Orientation Workshop On HIV Case Based Surveillance And Recency Testing
For Data Clerks And Sub City Team

BIN Hotel, Ethiopia

May 2022
 Introduction to HIV Epidemiology

HIV CBS and Response

Outline Health Information System

REDCap, Data Flow and Data Quality

Data Analysis

Challenges and Ways Forward

 Introduction
• The SDG and WHO GHSS recommend case surveillance as a part of a comprehensive
HIV SI system

• HIV Case based surveillance is designed to help countries to:

provide high quality, timely, and reliable data disaggregated by ppl characteristics across
the d/t level of health care system.

Concentrate SI resources where they yield the greater impact.

Make the best use of the existing data to increase understanding of the HIV epidemic
and the determinants for its spread.
 Global HIV Epidemic (2019)

38.0 MILLION
Estimated PLHIV globally, with ~1.7 million new
infections having occurred in 2019.

23% decline
In annual new infections between 2010 and 2019.

60% decline
In AIDS-related deaths from 2004 to 2019 due to
widespread ART coverage.
 GLOBAL HIV UPDATE, YEAR-END 2020

10/21/2022 5
 The HIV epidemic remains one of
the major public health challenges in
Ethiopia, causing significant
morbidity and mortality since the
EPIDEMIOL mid-1980s
OGY CONT…
The national adult HIV prevalence is
0.9 percent and currently there are
more than 426,000 HIV cases on
treatment (EDHS2016)
 3.5
3.3
3

TRENDS OF 2.5

HIV 2

PREVALEN 1.5

CE IN 1
1.4
1.5

ETHIOPIA 0.5
0.9

(EDHS) 0
2000 2005 2011 2016
Year
 Regions PLHIV all ages Year 2019 PLHIV all ages Year 2020

Addis Ababa 115679 114101

Afar 13306 13136
ETHIOPIA Amhara 208001 207934
HIV Benis Gumz 6786 6817
ESTIMATE
USING Dire Dawa 11556 11531

SPECTRUM Gambela 13896 13998

VERSION# Harari 5521 5577

5.82 YEAR Oromiya 166590 166221

2019 , 2020 SNNP 64738 64333

Somali 6301 6161

Tigray 56863 57044

Overall 669237 666853

Population Pyramid For The Year 2020, PLHIV And General
Population
All age group Children PLHIV: Age between 10-19 Age between 15-24 Age 50+
PLHIV: 622236 44138 (7%) PLHIV: 47233 PLHIV: 72561 PLHIV: 142418
(8%) (8%) (23%)
General Population by age and sex PLHIV age distribution

10/21/2022
Gap To Three 95’s, Using Latest Spectrum Estimate
 90–90–90 Goals (2019)
81% [68–95%]
of people living with HIV knew their HIV status.

82% [66–97%]
were accessing treatment among people who knew their status,.

88% [71–100%]
were virally suppressed among people accessing treatment,
11
Gap To
Three
95’s,
Using
Latest
Spectrum
Estimate
…
Gap To Three 95’s, Using Latest Spectrum Estimate…
Trend of AIDS Death VS New Infections to Show the
Epidemic Situation
 There is a clear indication that Ethiopia is at a
verge of HIV Epidemic control.

Routine assessment of the direction of the HIV

epidemic through ongoing surveillance of newly
diagnosed PLHIV remains essential.
Summary
HIV CBS provides ongoing individual,
sub-national and national data to
prevent, detect, and respond to the HIV
epidemic
HIV CASE
REPORTING
AND CASE-
BASED
SURVEILLANC
E

10/21/2022 16
 What is HIV Case-based Surveillance (CBS)?
Systematic reporting of newly diagnosed HIV cases to a public health
authority and subsequent reporting of their “sentinel events”

Primary objective is to provide individual-level de-duplicated data on a

national cohort of diagnosed PLHIV to monitor epidemic trends, determinants
of infection, and program impact on the epidemic

HIV diagnosis Sentinel events

 • To characterize HIV cases by demographic
characteristics (e.g., age, sex, geographic
distribution), and clinical characteristics at the time of
diagnosis.
• To monitor epidemiological trends in newly identified
HIV cases.
• To monitor trends of clinical status and linkage to
Objectives of services at the point of diagnosis.
implementin
g HIV CBS • To identify and monitor major risk factors for HIV
transmission in Ethiopia.
• To describe the proportion of HIV recent infection by
place, person, and time.
• To accurately profile the HIV epidemic over time
• To Generate evidence to guide the response at
individual and cluster level
Populatio • All individuals, regardless of
n Under gender or age, who are newly
Surveilla diagnosed with HIV for the first

nce time.
• For the HIV recency testing
information, the population under
 Information generated from
HIV/CBS coupled with recency
testing
Helps to uncover the risk factors for
Response infections
Indicates an ongoing transmission risk
Guide potential focus area for response
Guide targeted prevention strategies
Evaluate response
 A response can be classified
in to

1. Site level Response

Response strategies
Cont.

2. Above site level steps

 Framework for site Level Response
Newly Identified HIV positive
client
Linked to Surveillance Program
• CRF Completed)
• Tested for RTRI
• Case classification

Case 1: Newly Case 2: Newly

diagnosed Case 3: All other Newly
diagnosed
diagnosed children,
individuals age ≥15 individuals age ≥13
years with years with risk
adolescents or adults Strengthening Routine
except case 1 & 2
probable recent factors/group Site
Service Level Response
offered
infection. for all diagnosis
HIV Positive Include PHEM
Optimize Linkage
cases as per FP to MDT for
national
Enhanced Optimize Rapid ART initiation standards like continuous
Response Optimized Partner Elicitation & Testing comprehensive performance
care & treatment
Optimized HIV Prevention Measures
including ICT.
review
Optimized Service for Known Positive partners

Monitoring: individual level response tracking and reporting 22

Key Steps of The Cluster Assessment and Response
Process
  Is a new technology working based
on antibody binding
HIV-1 capacity/maturity to HIV-1 antigens
RECE
NCY  Is not a diagnostic test kit like Stat pack,
Abon & SD Bio line
TESTI
NG  Is designed to detect only recent and
long-term infections of HIV-1 but not
HIV-2
  Recent Infection = HIV-1 infection within
the last 12 months
 Long-term Infection = HIV-1 infection
HIV-1 more than 12 months ago
RECE  Estimates incidence
- Degree of new HIV transmission
NCY - Key information for response activities:
CONT. Planning
…  impact assessment
resource allocation and
prevention purposes
 Data Flow Within The Facility
Service Delivery Point • Verify CRF completion status during HIV retesting
• Complete CRF for those not completed
PITC (All VCT PMTCT/ART • Complete response related information
OPDs)

If new HIV positive identified:

PHEM Focal Person
a. Perform recency Testing
b. Complete CRF
c. Submit the completed CRF o Receive the completed
N.B CRF Data clerk
o The PHEM Focal Person together with o Check the overall
ART/PMTCT Focal will complete the remaining information completeness • Receive a completed CRF
information and consistency from PHEM focal person
o Approve the completed • Enter data to REDCap with in
CRF one working day
• Provide to data clerk • Submit back to PHEM focal
Community Outreach/HTS only Testing Sites
• Archive in a secured room person for archival on the
and locked file cabinet same day
  If new HIV positive Identified in outreach/HTS only HF, the HF
facilitates Escorted referral and linkage to it own SDPs/HF
ART/PMTCT provider
o Perform recency test
o Complete CRF
o Submit the completed CRF to PHEM focal person
N:B All information obtained with in 15 days should
  be reported
26
 Data flow from Health facility to higher level
• Access HIV Case report data

EPHI
from HF through REDCap
• Review and Provide feedback
• Analyze and Use the RHB
surveillance data • Access data through REDCap
Central REDCap based on their level of privilege
• Review and Provide feedback
Server • Analyze and
surveillance data
Use the
WrHO

ZHD

HF

• Enter the Completed CRF into REDCap

• Archive CRF
• Use surveillance data

27
 Data Quality Dimensions
Accuracy
• The data quality dimensions
Confidentiality
specified below should be Precision
applied across the CBS data
management process to Integrity
DQ Dimensions Reliability
determine how well the
HIV CBR data represents
Timeliness
the fact. Completeness

• It is important to note that

the cause of data quality 28
 Data Quality Dimensions: Accuracy/Validity
Data quality Standard
Degree to which a data element value
submitted to the CBS system falls within
Completeness ≥ 90%
the range of possible or expected values.
Examples of non-valid data might include:
Timeliness ≥ 85%
o Males recorded as pregnant

o PLHIV diagnosed in 1958

Validity ≥ 95%
o PLHIV with negative CD4 values

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 • HIS is one of the six building blocks of health systems
and refers to any system that captures, stores, manages or
HEALTH transmits information related to the health of individuals
INFORMATI or the activities of organizations, which will improve
health care management decisions at all levels of the
ON SYSTEM health system
 A functional and effective national HIS is critical for
production, analysis and use of strategic information for better
control of the HIV epidemic and to monitor program
interventions
HEALTH  As part of the health sector’s response to HIV, the national
INFORMATI HIS should ensure accessibility of high-quality information
ON SYSTEM along the cascade of HIV services to all stakeholders at
 The right place
 The right time and
 With the right format for use
  To meet the growing information needs of the health sector in
general and HIV programs in particular, several revisions of
indicators, data recording and reporting formats have been
created and implemented in health facilities
HIS CONT…
 To automate the HIV CBS system in Ethiopia, EPHI selected
REDCap system, a web application for building and managing
online surveys and databases, among other tools.
 Electronic HIV case surveillance data entry tool
REDCAP
 • Redcap is a mature, secure
web-based application for
building and managing online
surveys and databases
• Has two methods
REDCAP • The online method from your web
browser using the online designer;
CONT. • The offline method by constructing a
'data dictionary' template file in
Microsoft excel, which can be later
uploaded into redcap
 REDCAP STORY

Currently over 3,107 active

institutional partners over 128
countries
Created in 2004 at Vanderbilt
University
602,000 projects currently in
production or development-build
status
816,000 active users
6024 articles
Free for use

10/21/2022 35
 REDCap is preferred in that it is
a web-based system for
collecting, storing, securing,
managing and reusing research
data
WHY
REDCAP?

Designed to hold Stable

regulated and
Secured
protected data
including clinical Long term
storage
10/21/2022
results 36
 Distribution all important materials

Completion Case Report Form in SDPs and Data clerks enter to

REDCap

ACTIVITI
Conduct MDT and PMT meeting with integration of other HIV
programs

ES DONE Data use to improve prevention and control of HIV transmission

ON HIV Refresher and basic Training were provided for different teams
CBS
Continues mentorship and site level support

Improved data quality use for decision making and minimized miss
opportunity

Increased individual responsibility and commitment at health facility

level
Data Analysis from
October01/2021 to
March 31/2022
 NUMBER OF
HIV
POSITIVE
CASES
REPORTED
BY AGE &
SEX IN OCT
2021- MARCH
2022
 NUMBER
OF HIV
POSITIVE
CASES
REPORTED
BY POINT
OF
TESTING
FROM OCT
2021-
MARCH
2022
NUMBER OF HIV +VE CASES BY WHO STAGING AND
RTRI RESULT FROM OCT 2021- MARCH 2022
WHO Staging Among Recent Cases WHO Staging Among Long Term Cases
C B S P E R F O R M A N C E ( R A P I D T E S T F O R R E C E N T I N F E C T I O N ( RT R I ) , A A , F Y 2 2 ,
SOURCE: REDCAP
ART INITIATION AND ICT CASCADE OF NEWLY IDENTIFIED CASES
AND BASED ON THEIR RTRI RESULT FY22, SOURCE: REDCAP
REPORT COMPLETENESS
OF HIV NEW CASES IN AA
(REDCAP VS DHIS 2) BY
QUARTER
  REDCap data entry
 Secure the data with appropriate security
measures
ROLES &
 Submit the reported CRF ASAP to PHEM
RESPONSIBI Officer or SFP for archival
LITIES OF  Regular communication with PHEM
DATA Officer or SFP
CLERKS  Conducting data quality activities and
taking corrective actions
 Data generation and preparation of redcap
report when needed

10/21/2022 45
CHALLENGES AND
GAPS

• Interruption of internet connectivity and weak internet strength at

some CBS sites
• Data quality checks are not conducted regularly
• No strong and regular communication with the facility SFP pertaining
to data quality gaps and actions to be taken at majority of CBS sites
• No documented CRF tracking format at some facilities
CHALLENGES AND
GAPS CONT.

• Data quality dimensions like timeliness, form completeness and consistency did
not meet the standards at some facilities
• Insufficiency of the dongle internet charge for data entry of one month period
• Lack of interoperable options between smartcare and redcap has created
workload
 PROPOSED ACTION
ITEMS

• Facility management and other stakeholders need to be engaged in line

with strengthening the internet connectivity
• Data clerks need to conduct data quality checks at least once in a week
• Data clerks need to have regular and strong communication with the SFP
 PROPOSED
ACTION
ITEMS

• Data quality dimensions should be monitored against the set standards or requirements
• The amount of GB or insufficiency of data will be communicated to the concerned body for better
data entry, data quality assurance and for better program performance
• Inline with interoperability, there is a good start, but the issue will also be communicated to the
concerned bodies for timely functionality of the system
 AAHB

All health
staff EPHI
Acknowledg involved
ment

CDC ICAP
THANK YOU

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