HIV: tracker innovations and adaptations for longitudinal analysis

Part of the HIV: tracker innovations and adaptations for longitudinal analysis DAC2021 Session: Wednesday 23nd June 14:00

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Jenny Mwanza, MPH, Data.FI, Palladium and Allison Connolly, MPH, COVIDA, Palladium are the presenters with Muhammad Salihu, Data.FI, BAO Systems and Lisa Marie Albert, PhD, (formerly Palladium) are co-authors.

This presentation covers lessons learned using DHIS2 for calculating and displaying complex PEPFAR indicators in OVC programs. We will also share challenges and our solutions for displaying performance of sub-partners, in addition to geographic organizational units using the Tracker module. Our examples are drawn from two USAID-funded projects, one in Mozambique and the other in Zimbabwe.

In addition to USAID/PEPFAR required monitoring, evaluation and essential survey (MER) indicators, orphan and vulnerable children (OVC) programs are being asked to report on additional custom indicators to provide new insights into the HIV risk assessment and clinical care cascades. Many implementing partners (IPs) are choosing DHIS2 as the platform to monitor their data longitudinally and across sub-partners and geographic regions. Given the high complexity of some OVC indicators, the formulation and visualization of these indicators challenges the capacity of the standard DHIS2 functions, often requiring innovative, customized solutions.

We will discuss our experience developing DHIS2 instances in two countries: 1) Zimbabwe for the USAID Mission under the Data.FI project (2019-2024) and 2) Mozambique for the USAID-funded COVida project (2016-2021); both projects aim to leverage data to improve the health and well-being of OVC living in PEPFAR priority districts for HIV epidemic control.

In Zimbabwe, we engaged with five IPs in country to map their data collection processes, align indicator definitions with the aim of producing a harmonized system to be used for all IPs for case management and real-time reporting to USAID. Two challenges encountered were related to the 1) calculation of the participant status which combines data that is both cumulative and point-in-time and 2) presentation of performance by sub-partners, in addition to geographic organizational units while using the Tracker module.

In Mozambique, the two challenges encountered were related to the presentation of 1) indicators measuring participant status over time and 2) data for indicators with complex combinations of age/sex disaggregates. When reporting on beneficiaries registered to receive services, the results cumulated over time were difficult to compare visually with the point-in-time indicator, which counts the number of beneficiaries active on the last day of the reporting period. When creating category combinations for OVC, it was challenging to visualize data for beneficiaries under age 18, which have fine age and sex disaggregates, alongside data for those over 18, for whom PEPFAR does not require the same disaggregation.

In each of these case studies, creative solutions were developed which may be leveraged by others seeking to seeking to use DHIS2 for monitoring performance, reporting, and possibly developing a longitudinal case management system for performance monitoring and reporting to ensure visualizations accurately inform evidence-based decision making.