Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation Change management processes to implement TIER at the.

Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation
Change management processes to implement TIER at the facility to use TIER for the integrated TB and HIV data management

Outline of next two days
Training session excludes DR-TB due to recent programmatic changes (short course regimen) & changes to EDRWeb that still require interoperability with TIER.Net Guiding principles Change management headlines Data management Preparatory steps for going live Framed in the context of tracking the DS-TB treatment cascade – line lists & reports TB identification & testing Laboratory diagnosis & treatment initiation Retention in care Importing TB information into ETR.Net National vision is Integration; support of clinical governance Where possible in all ppt, make reference to ideal clinic principles (ICSM)

Background The National TB Programme maintained a simple yet robust TB recording & reporting system since late 1990s Consisted of data collection tools, paper-based registers & electronic registers (ETR.Net & EDRWeb) Key issues with the TB recording & reporting systems Patients managed in vertical data management systems Systems do not support the tracking of patients longitudinally with repeated TB episodes Systems do not support the tracking and management of patients with co-morbidities Ownership of data removed from health facilities as information is captured away from health facilities TB data does not flow into DHIS

Background cont.. TIER.Net: patient information management system that supports the capture of TB data at health facilities Patient information captured directly from patient folders - retirement of paper registers Extensive reporting functionality that supports retention of patients across the treatment cascades includes line lists that alert clinicians of leakages in care from one pillar to the next (e.g. laboratory results outstanding list, patients not yet on treatment list) Management reports at various levels - support patient management & drive improved data quality TB data from TIER.Net imports to webDHIS at sub district level Alignment to DHIS includes review of TB reporting timelines TIER.Net maintains interoperable functionality with ETR.Net/EDRWeb/DHIS/HPRS - The source for data is the patient folder

Guiding Principles for integration
One patient one folder (several diseases) 1 patient, 1 folder, 1 folder number Integrated clinical stationery: the TB treatment record (blue card) & ART clinical stationery will be filed together Active TB case: blue card remains on top of ART folder Inactive TB case: blue card placed at bottom of ART folder Patient held cards do not change Re-organisation of filing room to accommodate integrated folders - merge all TB and HIV patient records and hold them in one filing room Placing ownership of TB data back in the hands of facilities Initial capture of active TB episodes takes 3 to 4 days; not months In interim if not possible to have 1 filing room keep the HIV/ART in the TB room until the end of TB episode. TB and ART to be captured jointly

Change management headlines
Anything new is uncomfortable but aligning TB/HIV integration with strategy towards the long term vision of a single networked EMR Can expect performance indicators to decline temporarily for one or 2 quarters before seeing improvements Report any concerns immediately to NIT (National/provincial teams on standby to help) Changing roles and responsibilities – sub/district TB DCs and Coordinators not becoming obsolete, but free up time and tools to monitor quality of clinical services, drive improvements and improve clinical care of patients Replacement of paper register with electronic register at facility level Capturing directly from TB blue card into TIER.Net Line lists & reports can be printed real time - to improve patient and facility management - Drop in cure rates due to algorithms being stricter in the electronic systems

Data management inextricably linked to clinical governance
Quality of source data complete and correct clinical documentation - critically important for patient care and TB/HIV monitoring Ongoing clinical trainings necessary as part of this process Successful capture dependent on: Good clinical record keeping Dedicated time for capturing No lab results are to be captured without the clinician actioning and signing Reporting algorithms aligned across TIER.Net & ETR.Net

Preparing for initial capture of active TB episodes
Close off all episodes of TB patients who have not had a visit for >3 months in the paper register – assign LTF outcome Decide with TB Nurse if paper TB register sufficiently completed and up to date to be used as source for capture If no major gaps - capture can happen using TB register Any page with an active patient - requires whole page to be captured (active and inactive) If register not completed well – pull all TB blue cards to ascertain if all patients are in register and update patients and/or missing information TKI to help during this process Estimated that 120 blue cards per day can be captured into TIER if 2 people are working side by side from 1pm to 4pm

Preparing for initial capture of active TB episodes – Facilities capturing in ETR
Backup TB data from ETR.Net onto an external device Create a dispatch file & submit to the (sub) district office STOP capturing TB registers in ETR.Net & uninstall ETR.Net from the computer From the paper register, close off all episodes of TB patients who have not had a visit for >3 months – assign LTF outcome Decide with TB Nurse if paper TB register sufficiently completed & up to date to be used as source for capture If no major gaps - capture can happen using TB register Any page with an active patient - requires whole page to be captured (active and inactive) If register not completed well – pull all TB blue cards to ascertain if all patients are in register and update patients and/or missing information TKI to help during this process All above steps must be done on the same day

Data verification Is the captured data accurate and complete?
Complete data verification guide (page 31 of the Implementation Guide) Number of active patients in register or blue cards should equal number in TIER TB Module Have elements (see data verification guide) in a few sample patients been captured accurately? This should occur on same day as last day of this process Should be quick and seamless Done by TKI together with clinicians, FM and DC Now paper TB register can be retired – put away in FM’s office - Take note of the last recorded TB registration number, sequence to be continued in TIER

Data Verification Guide

Ongoing support During the first month, the TKI should visit the facility on a weekly basis to perform the following: Complete a Facility Site Visit Task List form Supervise data capture and answer any questions that may arise Speak to the FM to ensure patient management reports are being generated & used Use audit tool to assess completion of stationery and capturing into TIER.Net After the first month of intensive support, the TKI should visit the facilty quarterly to ensure the data is flowing to the (sub) district during the reporting periods, and all the above steps are maintained

Highlights of previous section
Programme management tool (vertical) vs patient management information system Critical success factors – change management, clinical governance & guiding principles Central role of TKIs in preparing facilities for roll out 2-3 years to reach national vision TB/HIV integration improves clinical care and patient management - saves time for both clinicians and patients All information required for patient management available real time Coordinators will have more time for mentoring at facility which will improve patient care

DS-TB Cascade: TB identification & testing
Anticipate the questions about multiple TB cascades

Discussion: TB Screening and Identification
What steps need to happen in a facility for TB screening & identification? (For new case, patient on ART) When does screening happen? Where in the facility does TB screening happen? Who in the facility conducts TB screening? Where is the TB screening information recorded? Who and where is sputum collected from positive screened cases? What tools are utilised for recording patient information? Where in the facility are these tools located/kept? Who records in them? No guidance of how often one person can be screened Although the cascade does not reflect TB screening, TB patients journey in a facility starts with TB screening Assists to understand what the TKIs have been identifying as they do the FBAs Integration does not mean multiplying sputum rooms

TB Screening & Identification: Patient & Register flow
3. Consultation sputum specimen collected for Gene Xpert testing complete a laboratory request form record patient details in TB Identification Register Record return dates for TB test results in the patient’s carry card 2. Vitals screening for TB Filling in (tick) the PHC Tick Register 2 3 3 3 1 4 1. Registration - Collection of or opening new file at main registry - 4. Data capturing All TB Case Identification Registers will be collected by the DC from consulting rooms DC to capture presumptive TB cases tested for the day and update results of already captured cases DC returns all the registers to the respective consulting room after capturing Reaffirmation on the national guidance All patients to have a folder; use of HPRN where HPRS implemented Each consultation room must have a TB identification register; all this registers must be numbered and a registry of registers compiled to aid DCs laboratory request form: recording all details correctly, completely & legibly; including Patient’s ID number and contact number, clinician’s name & contact details Use the ‘Remarks’ column in the TB Identification register to record the patient folder number 3

TB screening and Identification flow
Symptomatic client arrives at the facility Client presents at reception If known, collects folder and goes to consultation If new, reception to allocate folder number and open folder, and refer to screening Client screened using TB symptom screen, and recorded in PHC tick register and clinic file If screened positive, refer to sputum room/clinician Bacteriological (GXP) test conducted If GXP positive and Rif sensitive, smear taken and patient started on treatment If GXP positive and Rif resistant, start DR treatment according to latest guidelines If screened negative, patient counselled on HIV and TB

Integrated Clinical Stationery
TIER grounded in the ICSM - Ideal Clinic prescript one patient, one folder, one folder number (irrespective of module used) Prior to introduction of the standardised ART clinical stationery – large number of facilities had no facility-retained records The folder number in ART clinical stationery thus informed the filing system in the facility Need to avoid framing discussions as being about “TIER number” – all facilities must have a system for numbering folders (which contains all clinical stationery)

Integrated Clinical Stationery(2)
In TIER - single folder number establishes the link between the modules for an individual patient and links the patient through the cascade of care TIER.Net searches on, and links on, this folder number (among other parameters) Thus folder number is essential for: patient linkage linkage of laboratory results linkage between different systems patient filing

Folder number in TB/HIV clinical stationery
DCs are trained to capture the folder number from the front of HIV/ART clinical stationery The TB Blue card does not have space for folder number/HPRN The folder number/HPRN will have to be copied from the clinic folder onto the blue card

Recording TB Identification information
DCs capture TB Id information directly from this register into TIER on a daily basis Lab requests to be captured into TIER Only clients screened positive are recorded in this register with date and type of bacteriological test sent to the lab According to the burden, one or more registers will need to be available Facilities to devise means to ensure all information entered into this register and captured into TIER - Add screenshot of register without the the words “AND FOLLOW-UP REGISTER”

Capturing Case Identification data in TIER.Net Patient Lookup
Search database for patient always check to see if patient already exists to avoid entering the same patient twice (use folder #, surname) - Demo using the ‘brown’ folder

Capturing Case Identification data in TIER Patient Demographics
Create a new patient record

Capturing Case Identification data in TIER Patient Demographics
Source for: Surname, Name Source for: DOB and Gender Ensure correct sub-module Include the screenshot of the tests from the register, then show capturing of the tests screenshot, then show were they are populated Case Id register does not cater for folder numbers currently; use the ‘Remarks’ column in the interim Source for: Contact details

Capturing HIV status from Case Id register
Source for: HCT details Case Id register does not cater for any of the variables needed for HCT capturing currently. In the interim, a row was added in the HIV status column to enable capture of HIV test date Use the HTS register in the facility to obtain these information

Guidance for capturing HIV status
HIV Negative HIV Positive If tested in this facility, check for proof in the HTS register If tested in another facility, ask for proof of test If no proof of HIV test, retest the patient for HIV (page 67 of the consolidated guidelines) On ART: copy test date from ART clinical stationery located in the patient folder Not on ART: - If HIV test done on same days as TB screening, capture same date - If HIV test not done on same day, ask patient for proof of test If no proof of HIV test, probe for estimated time (year) of test

Line lists & reports for TB Identification & testing
TB case identification results outstanding list TB Identification Report

Discussion: Laboratory Results management
Who receives & sorts laboratory results on a daily basis in the facility? Who reviews and signs laboratory results in the facility? Who is responsible for following up of outstanding results? Who records results in the Case Identification Register, including rifampicin-resistant (RR results)? When (at what point in time) are the results recorded in the Case Id Register? How are patients’ results filed? Who ensures that all positive GXP cases have a second sputum specimen collected? Who initiates patients on treatment?

Management of normal laboratory results
FM to identify dedicated person responsible for receiving lab results daily Clinician must review all results Normal results separated out from abnormal results Triaging of results Management of Normal results Each normal lab result must be signed off by clinician (initial and date) Signed off lab results submitted to DC for capture DC will “bulk” capture results in TIER using Pending Tests functionality Results can only be captured against tests already in TIER (from TB ID register, TB blue card or ART clinical stationery) DC signs captured lab results DC files each result in respective patient file

Management of normal laboratory results (2)
Clinician will have ticked in ART clinical stationery - tests requested at respective visit Clinician will have indicated in TB ID register and TB blue card – tests requested at previous visit During patient consultation visit: Clinician must look for new results inside the patient folder Transcribe any new lab results in clinical stationery (ART clinical stationery or TB ID register or blue card) from lab result form or SMS printer or telephonic/electronic medium If result was received from SMS printer- record “SMS” next to result If results were received via phone or looked up on the NHLS TrakCare - indicate “telephonic/electronic” in visit summary section Ensure daily flow of TB ID register and patient folders to the DC for capture into TIER

Management of abnormal laboratory results
FM to identify dedicated person responsible for receiving lab results daily Clinician reviews results Normal results separated out from abnormal results Management of abnormal laboratory results Clinician must take the following actions: Recall patients with abnormal lab results to the facility Document the action of recall (i.e. telephone call or WBOT visit) as well as date of next visit/appointment in patient folder Clinician signs off result (initial and date) For initial TB diagnostic test: Clinician records initial diagnostic test (GXP) result in the TB ID register DC inserts the result into patient folder and the folder is returned to registry for refiling Triaging of lab results

Management of abnormal laboratory results (2)
For all other abnormal lab results: DC inserts lab result in patient folder and returns folder to registry for refiling At next consultation visit, Clinician must look for new results inside the patient folder Transcribe the new abnormal lab results in clinical stationery (ART clinical stationery or TB ID register or blue card) from lab result form or SMS printer or telephonic/electronic medium If result was received from SMS printer- record “SMS” next to result If results were received via phone or looked up on the NHLS TrakCare - indicate “telephonic/electronic” in visit summary section Ensure daily flow of patient folders to the Data clerk for capture into TIER

Bulk NHLS Capture Tool (Pending Tests)
Designed to capture all outstanding results of requested HIV and TB tests

Click on the patient row to enter the result or Search for a particular Folder Number or Lab reference number

For CD4 or VL test results For TB test results

Searching for existing patient in TIER
Click on Search from the patient list to search for an existing patient Click the Search button once you have entered the search string

Searching for existing patient in TIER
Double click the patient to open the record Section for capturing the Case Identification tests

Capturing Sputum tests in TIER
Click on New to capture the Sputum tests and results

TB Case identification results outstanding list
N.B: The record will no longer appear on this list if Patient has been traced and assigned an outcome (initial LTF, Died) DC ticks “Result Not Available” in the “Case Identification” when result has been lost or specimen leaked/contaminated - Add a screenshot of where to find the report/list in TIER

TB identification results outstanding list
This lists identifies those tests which have been taken but no result has been entered (7 days for smears/GXP and 42 days for TB cultures) Purpose of the list To alert clinicians of outstanding laboratory results NB: clerks to stay on top of sorting, capturing and filing results in a timely manner to ease workload and to potentially not endanger patients’ lives These are management list; meant to help with the patient management at facility level

How to use the TB identification results outstanding list
When to generate the list DC to generate the list every Friday Steps to be taken DC to verify outstanding laboratory results See Table of Reports in TB\HIV M&E SoP (page 5) DC to give the list to the person responsible (identified by the Facility Manager) for further action The client must be recalled to the facility to re-test if test not found or contaminated -

Capturing Sputum tests results in TIER
Click on Edit to capture the Sputum tests results

Capturing GXP results Source for: GXP sensitivity results

Waiting list for TB treatment
Patients who have not yet initiated TB treatment will appear on this list for 60 days or until a TB episode is created & linked to this test A bacteriologically positive TB result does not automatically open the TB treatment episode, this needs to be manually captured - Facilitator to say now the results have been captured and we now need to ensure patient starts on treatment

Waiting list for TB treatment
A list of patients with bacteriologically positive TB results that have not been started on TB treatment yet Purpose of the list To help clinicians identify patients who have not yet started treatment (reasons?) Useful to reduce time between TB identification and treatment; facilitates the timeous tracing/recall of the TB patient to initiate treatment Indication of the facility’s working relationship with its community support structures (CHWs, CCGs &/or WBOTs) - Not started within 7 days (guideline – within 2 days, but this account for results of test taken on a Friday, etc.)

How to use the Waiting list for TB treatment
When to generate the list DC to generate the list weekly Steps to be taken DC to give to the responsible clinician (identified by the Facility Manager) for patient recall Clinician to document recall information, including appointment DC to capture appointment into TIER - Not started within 7 days (guideline – within 2 days, but this account for results of test taken on a Friday, etc.)

TB Identification Report
# of presumptive TB cases # produced a sputum sample # positive results, further disaggregated by test type # positive started on TB treatment or reason for attrition (initial LTF or death) DHIS indicators calculated according to latest NIDS ILTF is >28 days (as -60 to +28 is the baseline window for bacteriological tests) N.B: the most recent completed month may not have all results back from previous month We know this screen shot not clear , but you will have the occasion of seeing it yourself later on your computer

TB Identification Report
Aggregate report of all presumptive TB cases with bacteriological tests carried out in a month including contacts tested for TB Purpose of the report To monitor sputa sent to the lab, for evaluating case detection and determining the prevalence of presumptive TB cases at facilities

How to use the TB Identification Report
When to generate the report DC to generate on the 7th working day of every month Steps to be taken DC to submit the report to FM DC to present at monthly clinical or facility meetings FM to verify and sign off on reports and file in the respective section in the lever arch file in the registry A copy is submitted to the SD office by the 10th of each month - DC presenting builds sense of teams

Monthly DHIS Indicators according to NIDS 2017
Smear TAT (<48h) TB bacteriological positive >=5 years Treatment start >=5 years Child contacts < 5 years started on IPT - Slide for TB coordinators

User Roles in TIER.Net Normal user The normal user is the person who will be capturing the data at the facility Administrator Role should be given to the Operational or Facility Manager, or anyone in a management role other than the implementer Unable to delete the Implementer user name and password Not able to export patient identifiers via excel or the DES export Implementer There should only be one implementer user name and password per installation This role has been created ONLY for those who implement TIER.Net at facility or sub-district, district and provincial level Can change passwords and can create exports with patient identifiers included The implementer can also perform all the roles of the user and administrator

TB Identification Exercise 1
Capture the 1st two cases (J. Something & J. Dikotsi) from the Case Identification register (up to column ‘Date Sputum collected’) Generate ‘TB case Id results outstanding list’ Update 1st two cases with lab results (up to column Sputum turnaround time’) Regenerate the ‘TB case Id results outstanding list’ What do you observe? Capture the 3rd case (B. Maseko) from the case identification register Demo J. Something NB. Show all the test types, highlight capturing of child will be ‘clinical’ Explain the capturing of a child using the Mantoux section Generate ‘Case Id results outstanding list’ Update J. Something lab results Regenerate the case Id outstanding list Participants now to do exercise up to Case 3 (B. Maseko)

TB patient journey starts with screening All symptomatic TB cases to be recorded in the TB Id Reg and captured in TIER Proper management of results is key to TB management TIER management functionality will help to reduce time from diagnosis to treatment Line lists Monthly report Flow of monthly data elements into DHIS

DS- TB cascade: Laboratory Diagnosis & Treatment Initiation

Discussion: Treatment Initiation
Who opens a blue card for TB patients? Who records/updates information in the blue card? Who attaches laboratory results to the blue card? Who ensures that patient information in the blue card is recorded correctly & completely? - Demographics part sometimes open by data clerk

Started on DS-TB Treatment
3. Consultation Open a TB treatment record (blue folder) for patients who have started on TB treatment Attach all laboratory results to the TB treatment record Ensure that information is recorded correctly, completely and timeously 2. Vitals - 2 3 3 3 5 1 1.Registration - Collection of file at main registry - 4 4. Data capturing The data capturer must collect all blue cards from the clinician for daily capturing/updating in TIER.Net on the same day TB files must be merged with the HIV files and filed in the main registry (not stored separately in the “TB room”) 5. Filling Room After capturing from the blue cards, the records are filed in the filing room 3

Folder number in TIER At the point of capture DC retrieves the demographic details from the patient folder and captures the information into TIER.Net (where there is no HRPS) The folder number will then pull through in all other modules in TIER

TB registration number
TIER auto generates TB registration numbers chronologically, this number can be changed based on last manually allocated number Note: last registration number in paper register TB registration number for tracking data into ETR TB registration number not used for any other purpose Not for filing Not for tracking patient in TIER (done through folder number) Due to the use of folder numbers, the TB registration has limited functionality (purpose)

TB treatment initiation flow
Depending on the setup The DC may fill demographics (front top half of blue card) and then refer to the clinician to fill in clinical portion of card The clinician will fill all portions of the blue card Lab results usually filed by DC after triaging and signing by clinician DC must collect all files from the clinician for daily capturing/updating in TIER on the same day After capturing in TIER, the files must be returned to filing room

Capturing TB Registration details in TIER
Source for: Patient Demographics – ID Number/DoB, Age, Gender and Contact details

Capturing TB Registration details in TIER cont…
Source for: Registration Number, Registration Date and Registration Type Note: registration date is not on the blue card but in TIER. Registration date corresponds to the day of registration at this facility - Registration date and Treatment start date different only fro transfers and move patients

Source for: ICD Code, Patient Category, Disease Classification and Site of Disease

Source for: Regimen and Treatment start date

DS-TB Treatment Initiation Report
Clients are only counted once Bacteriological coverage calculation only includes TB cases ≥ 4 years of age

DS-TB Treatment Initiation Report
Number of clients initiated in a quarter or a month by test type and by TB classification Purpose of the report Informs FMs and clinicians of numbers of patients initiated on TB treatment per quarter Differentiates between disease classification (PTB and EPTB) and patient categories (new and relapses) Provides information on TB diagnosis (numbers diagnosed by GXP, smear and culture) Provides information on bacteriological coverage

How to use DS-TB Treatment Initiation Report
When to generate the report DC to generate on 7th working day of Jan, Apr, Jul, Oct Steps to be taken DC to submit report to FM DC to present information on TB diagnostics during clinical or Facility Meetings FM to verify and sign off on all reports A dispatch (or manual paper registers if not using TIER) to be sent to the sub district office by the 10th of each new quarter A copy of the signed report (by the Facility Manager) to be kept in the respective section of the lever arch file in the registry

Line lists & reports for TB treatment
Waiting list for TB treatment TB Treatment Initiation Report

Timeous initiation of patients on treatment reduces transmission of disease & mortality Complete & accurate recording in the blue card supports patient management Daily capturing & updating information form the blue card into TIER also improve patient management These result in improved data quality management

DS- TB cascade: Successfully treated

Discussion: Treatment Success
Who updates information in the blue folder? Who attaches laboratory results to the blue folder? Who ensures that patient information in the blue folder is recorded correctly & completely?

TB treatment success flow
The clinician will continue to update the blue card with new clinical information Lab results usually filed by DC after triaging & signing by clinician DC must collect all files from the clinician for daily capturing/updating in TIER on the same day After capturing in TIER, the files must be returned to filing room

Capturing treatment continuation information in TIER (page 3 of Blue card)
Source for: number and types of drugs given Source for: Treatment visits - Use the legend to read the calender? Use of legend

Monitoring of Response to TB Treatment
All patients diagnosed with GXP must have a baseline smear result and followed up accordingly Sputum examination at 7 weeks: 42 to 70 days Sputum examination at 11 weeks: 71 to 100 days to determine smear conversion (a sign of good clinical progress) to guide the health care worker to change the patient to continuation phase of treatment or to extend the intensive phase Sputum examination at 23 weeks: 150 days To determine the final outcome of treatment for the patient.

Line lists & reports for Treatment Success
DS-TB conversion sputa required DS-TB Smear Conversion Report DS-TB cases requiring action (non conversion)

DS-TB conversion sputa required list
If a test has been requested within the time period, but with no results, the date of the request appears in the column “Test Requested? If a test was positive at 2 months, “Pos” will appear in the last column. Record will still appear on list if test was done too early Recall patient for another test Record will fall off the list if test was done too late If a test is done on day 40 the record will still appear on the list (too early) Once past 70 days from TB start date (or 100 days if positive sputum between 42 and 70 days) the record will no longer appear on the list (too late)

DS-TB conversion sputa required list
All bacteriologically positive clients with no conversion result on regimens 1 or 3 between days after treatment start (or up to 100 days if 2 month result is positive) Purpose of the list To alert clinicians of patients with outstanding smear conversion results Sputum specimen may not have been collected from the patient Specimen may have been collected but not tested Specimen may have been tested but results not received Result may have been received but not recorded in the blue folder

How to use DS-TB conversion sputa required list
When to generate the list DC to generate weekly Steps to be taken DC to submit list to clinician & to FM Depending on the reason for no conversion result (see previous slide), clinician to take appropriate action Recall the patient for another specimen Ensure that the specimen is tested & the result recorded in the blue folder & subsequently captured in TIER

DS-TB Cases Requiring Action (non-conversion) list
The list will exclude all cases where there has been an outcome (LTF, RIP or TFO) before 98 days and all DR TB and EPTB cases ‘Action Required’ column at the end is to be used in the facility to note action taken for follow up ‘Smear/Culture positive at 2 Months’ required action = check for treatment compliance, reassess patient clinically and Conduct LPA (or culture and DST, if LPA is not Available) ‘Smear/Culture positive at 3 Months’ required action = if RR-TB or MDR-TB is confirmed, stop treatment and refer patient to the MDR-TB treatment initiation site for assessment and treatment initiation. Register the patient as “RR-TB or MDR-TB”

DS-TB Cases Requiring Action (non-conversion) list
List of all PTB cases with a positive bacteriological diagnosis (smear, culture or GXP) and still have a positive smear or culture result at month 2 or 3 after starting TB treatment Purpose of the list To alert clinicians of patients who did not convert at 2 or 3 months of treatment To help clinicians determine the cause (reason/s) of non conversion To help clinicians to make appropriate clinical decisions

How to use DS-TB Cases Requiring Action (non-conversion) list
When to generate the list DC to generate monthly Steps to be taken DC to submit report to the clinician & FM Recall patient to determine reason/s for non conversion poor adherence treatment support DR-TB

DS-TB Smear Conversion Report
All regimens included; PTB with smear at -60 to +28 days around treatment start date Negative smear result between 42 – 70 days Positive smear between 42 and 70 days No conversion result between 42 – 70 days Negative smear between 42 and 98 days Positive smear between 42 and 98 days No conversion result between 42 and 98 days H/I/J. Died, transferred out or lost to follow up before 98 days

DS-TB Sputum Conversion Report
PTB cases reported and proportions of those with smear conversion results at 2 & 3 months, & the proportion who died, TFO or defaulted prior to sputum conversion Purpose of the report Aggregated data that informs clinicians of patients’ progress on treatment up to 2 & 3 months Give reassurance to reports algorithm Explain the outcomes are based on the algorithm but they smears have to be in the “window”

How to use DS-TB Sputum Conversion Report
When to generate the report DC to generate on last Friday of the Month Steps to be taken DC to generate report & give to clinician Clinician to provide clinical guidance regarding documentation at next clinical management meeting

Appointment List Replaces TB diary Serves several purposes
Identify patients booked for the day/week (pull files in advance) For small facilities can be used to identify missed appointments real time -focus on early missed appointment and unconfirmed List; Pts will also be ‘caught’ for other reasons through out the month -

Early Missed Appointment List
The lists are calculated from today’s date in relation to the last visit date The duration since last visit is calculated taking into account the date of last visit and the number of days of medication given

Early Missed Appointment List
List of patients who missed their appointments between 1 and 2 weeks Purpose of the list To alert clinicians of patients who missed their appointments To facilitate the process of recalling patients To prevent treatment default

How to use Early Missed Appointment List
When to generate the list DC to generate every 2 -3 days Steps to be taken DC to pull patient file to verify non-attendance, and capture any patient visits missing in TIER but recorded in the clinical stationery FM to delegate person to phone patients to schedule return appointment If patient is not reached, tracing visit should be organized Result of each intervention to be documented in the blue card

Late Missed Appointment List
List of patients who missed their appointments between 2 and 3 weeks Purpose of the list To alert clinicians of patients who missed their appointments To facilitate the process of recalling patients To prevent treatment default

How to use Late Missed Appointment List
When to generate the list DC to generate weekly Steps to be taken DC to pull patient folder to verify non-attendance Clinician to submit a copy to the facility designated CBS supervisor for tracing the patient Result of each home visit to be documented on report Report to be returned to clerk for capture of final outcomes Report should be signed by clerk and filed in the respective section in the lever arch file in the registry

Unconfirmed Lost to Follow-up List
List of patients who missed their appointments for 2 months or more Purpose of the list To alert clinicians of patients who missed their appointments To facilitate the process of recalling patients To prevent treatment default

How to use Unconfirmed Lost to Follow-up List
When to generate the list DC to generate on 1st Friday of every month Steps to be taken DC to pull patient folder to verify non-attendance DC to capture LTF outcome in TIER DC to pull another report to verify LTF outcomes all captured and report is cleared of patients

Line lists & reports for Treatment Success
DS-TB discharge sputa required DS-TB Outcome Report TB Missed appointment and unconfirmed LTF TB Outstanding Outcomes Patient Appointment List

DS-TB Discharge Sputa Required List
If a test has been requested within the time period, but with no results, the date of the request appears in the column “Test Requested?

DS-TB Discharge Sputa Required List
All bacteriologically positive cases with no discharge results on regimens 1 or 3 between from 150 days after treatment start Purpose of the list To alert clinicians of patients with outstanding discharge smear results Sputum specimen may not have been collected from the patient Specimen may have been collected but not tested Specimen may have been tested but results not received Result may have been received but not recorded in the blue folder

How to use DS-TB Discharge Sputa Required List
When to generate the list DC to generate 1 week prior to monthly clinical meeting Steps to be taken DC to ensure all lab results are captured & filed in patient blue cards & give list to the clinician Clinician to discuss reports in monthly clinical meeting Document the action plan for the respective report Report to be filed in the respective section in the lever arch file in the registry

TB Outstanding Outcomes List
Expected lengths of treatment are calculated as follows: For regimens 1 and 3 (excepting TB bones/joints and miliary): > 6 months For regimens 1 and 3 miliary or bones/joints TB : > 9 months

TB Outstanding Outcomes List
List of patients who have been on TB treatment for longer than the expected duration & do not have an outcome Purpose of the list To alert clinicians of patients who have been on TB treatment for longer duration & to facilitate appropriate clinical action

How to use TB Outstanding Outcomes List
When to generate the list 1 week prior to clinical management meeting Steps to be taken DC to generate report & give to clinician for discussion at clinical meeting Clinician who last saw patient will record outcome in blue card Blue cards to be submitted to DC to capture the outcomes into TIER The clinician making the corrections to sign off on the list DC to sign off and file in the respective section in the lever arch file in the filing room

DS-TB Outcome Report Not doing things like in the past where we wait for things to break and then try to fix Only “Newly Registered” are counted in this report Adults: >= 9 years of age Children: < 9 years of age

DS-TB Outcome Report – TB/HIV collaboration

DS-TB Outcome Report DS-TB Outcome Report
Aggregate outcomes of all DS-TB patients, according to type of TB at diagnosis by quarter Purpose of the report Informs clinicians of all patients’ outcomes Outcomes are reported 12 months after treatment initiation

How to use DS-TB Outcome Report
When to generate the report DC to generate on 7th working day of Jan, Apr, Jul, Oct Steps to be taken: DC to generate & submit to FM If the facility has a monthly clinical meeting, the clerk should present the outcomes of these reports in this forum FM to verify and sign off on all reports A dispatch to be sent to SD office by the 10th of each new quarter A copy of the signed reports to be kept in the respective section in the lever arch file in the filing room

Lists and reports guide clinicians and DCs towards improved patient management Correct timing of sputum collection key to monitoring patients’ response to treatment

TB Treatment Initiation Exercise 2
Generate ‘Waiting for TB treatment list’ What do you observe?

TB registration: Exercise
Capture the Case identification and treatment details for David Maseko & Maria. Mahlangu using the case Id register and the blue card Using the Dummy database; generate DS-TB Discharge Sputa Required list Open patient “test5285” Ossie Mahurin and enter a negative sputum on today’s date (give 14 days of treatment ) Regenerate the DS-TB Discharge Sputa Required list What do you observe?

TB Outcome: Exercise Generate TB Outcomes report Q1 2015
Count how many cured ? Open patient “test5646” Trisha Walller Enter a negative sputa on the date (24 Aug 2015) highlighted by the pink square in the TB Rx calendar (give 14 days of treatment). Change the outcome from “completed” to “cured” Now generate TB Outcomes report again, and count how many are cured ?

Reports

How to Export TIER data into ETR
TIER allows for Data Exchange with ETR. Done creating a Data Exchange Standard (DES) file in TIER that can be used to import data into ETR at the SD Log into TIER.Net as admin/Implementer Select the ‘File’ menu at the top of the TIER screen Select ‘Export To ETR’ on the drop down menu and follow each of the next screen shots

How to Export TIER data into ETR (2)
Click the ‘Export’ button on the DES TB Registration Export screen Note the selected ‘level’ and Export folder A pop up screen will appear to confirm the successful Export process. Click the ‘OK’ button to finish the export process. Locate the export file on the Export folder for importing into ETR in the according to the next step

How to import data into ETR at sub-district level
This function can be done by the sub-district DC Responsibility lies with the TB coordinator to ensure this is done correctly and timeously Once all facilities in a SD have captured TB data into TIER, will no longer import data into ETR Log into ETR as admin/TB coordinator Select the ‘Tools’ page at the bottom of the ETR home screen Select ‘Import DES file’ under the Dispatch, Import and Export sub-menu and follow each of the next screen shots - TB cordinator level also has permissions needed for DES import

Data Exchange Standard (DES) Import Wizard
Always ensure the correct facilty to import into is selected to avoid overriding data Anticipate questions about when do we need to overide, why is the option even listed, What about multiple facilty import? Why can ETR auto allocate the facilty data according to the master tree? DES import option needs to be enabled at station setup

Questions?

Contact details of NIT members
Nevilla Somnath – National TB Programme – RIMES – Riona Govender – NDoH M&E – Catherine White – M&E Technical Support to NDoH - Barbara Franken – Project Manager for THIS integration - Ipeleng Mojaki – TIER Implementation Associate - Moeketsi Finger – TIER Implementation Associate -

Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation Change management processes to implement TIER at the.

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Presentation on theme: "Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation Change management processes to implement TIER at the."— Presentation transcript:

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Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation Change management processes to implement TIER at the.

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Presentation on theme: "Comprehensive Trainings to support the National Integrated TB/HIV Information System Implementation Change management processes to implement TIER at the."— Presentation transcript:

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About project

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