Abstract: PSI/Central Asia implements the USAID Dialogue on HIV and TB Project to improve TB treatment adherence among people living with HIV (PLWH) through comprehensive case management and social support. We use a management information system (MIS) to evaluate the effectiveness of adherence support. The MIS tracks referrals to TB testing and new cases detected through the use of vouchers. Clients are assigned a unique identifier, and social workers track client activities, including treatment completion and reasons for default. Unlike past systems that just tracked number of visits or people reached, this MIS enables follow-up of individual clients over time and identification of treatment defaults. After one year, MIS data showed 43.8% of defaulters (48) lost contact with the project in the last month – highlighting the need for improved PLWH retention strategies. The project is reviewing PLWH records and meeting with clients to identify steps to improve retention.
The USAID Dialogue on HIV and TB Project is the only program in Central Asia integrating HIV and TB prevention and control among people living with HIV (PLWH). In this region, the typical clinical treatment for patients co-infected with HIV and TB has involved separate services for each disease, leading to low levels of follow-up from case detection and consequently low treatment adherence. The program therefore has created multidisciplinary teams of medical staff and social workers for more comprehensive care including education, service referrals, and treatment adherence social support. The project MIS was designed to track project activities.
Historically, many HIV/TB programs in low and middle-income countries have collected only the number of clients reached or participating in an activity. This project is unique because clients are followed using unique identifier codes (UIC), and tracked through the referral, case detection, and treatment process. The project MIS is structured in Microsoft Access software so data is collected on each client from actual referral voucher redemption through to new TB case detection and TB treatment adherence results. It also records self-reported knowledge and behaviors, such as HIV transmission routes, treatment adherence, and risky sexual behavior. The program collects data on the frequency of contacts, when TB treatment is completed, and reasons for default.
The goal of the project is to routinely and efficiently use data to inform progress and programmatic decisions. Quantitative surveys in Central Asian countries are cost prohibitive for routine data collection. This comprehensive MIS enables the project to track changes over time in key indicators more efficiently and evaluate adherence rates for evidence of effectiveness. Using this tool, project staff are further able to use results to make key program management decisions. For example, the MIS helps in evaluation of medical staff and social workers in the multidisciplinary teams for further improvement of treatment and care services for PLWH.
For TB programming, data analyzed from the MIS demonstrated that a key weakness of the project is low client retention. Because the current MIS doesn’t provide enough detail to understand why clients are losing contact with the project, the project team will focus on developing a strategy to enable the MIS to better assess factors accounting for why clients leave or lose contact with the program, apart from migration and mortality.
Another programming concern highlighted by the MIS evaluation is the quality of service provided by multidisciplinary teams due to increasing work load as the project evolves. More analysis is needed to determine conditions for the most successful results, such as tracking results by social worker, including number of clients, average number of contacts, automatic reminders for follow up contacts, etc. While there is room for the MIS to grow and improve, the features of the MIS are innovative for the region with plans by state institutions to adapt the MIS as an M&E tool.
- Populations Served
- People Living with HIV
- Health Areas
- HIV and Sexually Transmitted Infections
- Marketing Products and Services
- Resource Types
- Central Asia
- HIV Prevention, Integrated Service Delivery, Screening, Diagnosis, and Treatment, TB and HIV Integration, TB Treatment