Using Data to Improve HIV Cascade Outcomes

Speeches Shim

ABOUT THE AUTHORS: Emily Harris is a Health Science Specialist in the Office of HIV/AIDS. Jenifer Chapman is Project Director for Data.FI.

A new year brings the opportunity for reflection. We consider where we started, and where we’re going. We celebrate our wins, unpack our losses, and resolve to do better through systematic quality improvement. This new year finds us reflecting upon our work helping countries to strengthen and sustain access to critical, high-quality data to accelerate HIV and COVID-19 epidemic control.

In 2019, Data.FI ― a PEPFAR-supported, USAID-managed global consortium ― developed an Epidemic Control Room (ECR) model in Nigeria, sparked by the need to improve the use of high-frequency data and build on PEPFAR successes in actionable data reviews, such as root cause analyses. Data.FI’s ECRs (i.e., “situation rooms”) are technology-enabled data analytics and visualization platforms that integrate and triangulate data from multiple sources to facilitate stakeholder-led action planning. The project’s approach to collaborative data review includes processes for identifying critical information needs; asking the right questions to better interpret data; developing standard visualizations to facilitate problem identification; analyzing root causes of performance issues; and strengthening multidirectional feedback mechanisms among various levels of the health system. This improves transparency and enables continuous feedback and learning for ongoing program adaptation.

Data.FI organized a training of trainers workshop on the new functionalities and use of upgraded OVC and DREAMS databases in Cote d’Ivoire. Participants came from social centers, the National OVC Program, and a PEPFAR implementing partner.
Data.FI organized a training of trainers workshop on the new functionalities and use of upgraded OVC and DREAMS databases in Cote d’Ivoire. Participants came from social centers, the National OVC Program, and a PEPFAR implementing partner.
Photo Credit: Data.FI/Cote d’Ivoire

In Nigeria, Data.FI’s ECRs have had a measurable impact on PEPFAR partner performance across the clinical cascade. In Akwa Ibom State, the intervention has contributed to improved HIV testing yield, prevention, continuity of treatment, and viral load testing:

  • Prevention: The average percentage of initiation of pre-exposure prophylaxis (PrEP) increased from 13 percent to 112 percent of the annual target.
  • Continuity of Treatment: Our analyses revealed that 44 facilities had program losses, with a total of 11,564 persons assumed to have interruption in treatment. Post ECR intervention, 84 percent (9,703) of clients were tracked back to care.
  • Viral Load (VL) Testing: Post ECR intervention, the average percentage of eligible patients with documented VL testing results increased from 44 percent to 70 percent.

With the onset of COVID-19, Data.FI used its existing routines and relationships to quickly adapt the ECR approach in response to the emerging health security threat. The project rapidly set up emergency operation centers (EOCs) across eight Nigerian states, in close collaboration with the Reaching Impact, Saturation and Epidemic Control (RISE) project. In total, Data.FI supported 155 data review meetings across these states in six months, tracking cases and population behaviors for stakeholder decision making.

 Data.FI’s senior technical advisor mentors data managers from the Malawi Ministry of Health and other local partners on data cleaning, reporting, and data use at a district hospital in northern Malawi.
Data.FI’s senior technical advisor mentors data managers from the Malawi Ministry of Health and other local partners on data cleaning, reporting, and data use at a district hospital in northern Malawi.
Photo Credit: Data.FI/Malawi

These successful practices from Nigeria were scaled to six neighboring West African countries (Burkina Faso, Ghana, Liberia, Mali, Senegal, and Togo), where Data.FI revamped existing data review meetings, making them shorter, more participatory, and focused on priority indicators. These review meetings led a wide range of improvements in program performance in 2020, including:

  • Index Testing: In Liberia, the contribution of index testing to overall testing in a priority district increased from an average of four percent in the eight weeks prior to intervention to an average of 30 percent in the eight weeks post-intervention.
  • Key Populations: In Senegal, stakeholders identified very low testing (and test positivity) rates among men who have sex with men (MSM) in one district. In the five weeks post-intervention, 130 MSM were tested (with an 8.5 percent test positivity rate) compared to only 36 (and a test positivity rate of zero), in the preceding seven weeks.

In 2021, Data.FI will continue to innovate, integrating new data sources and advanced analytics into ECR meetings. The project will also develop an approach for assessing value-based care indicators in data review meetings. This rapid trajectory of growth over the last two years demonstrates how a commitment to institutionalizing practices, and to pivoting interventions to align with existing data systems and key priorities, helps build impactful and scalable interventions. Data.FI’s evolving ECR approach helps to ensure that no one in need of HIV services is left behind ― a resolution we share year after year.

Last updated: January 27, 2021

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