Overview of the Problem
Recent video interview with Inter-American Development Bank (IDB) about our DHIS2 Implementation.
Trinidad and Tobago’s Ministry of Health faced a critical challenge in HIV case-based surveillance. We couldn’t get a clear national picture of who was testing HIV in real-time. Questions like: How many individual tests were conducted? How many positive results? Which populations were most affected? These were very difficult to answer.
Getting answers typically took weeks or months. A team of staff was responsible for sending physical forms from health centers to the Ministry of Health, entering data into a legacy Epi Info database, extracting line listings in Excel, and analyzing the data there. When it came to national reporting, there was a myriad of different source files, which made it difficult to have one source of truth.
The root cause of our problems came from these legacy paper-based systems and processes. Even when data finally reached us, it often had to be deduplicated. It was riddled with missing fields and inconsistent information. Reports had to be sent back for corrections. The whole process was a mess.
For context, this process involved over 60 health centers and laboratories across Trinidad and Tobago, with HIV testers at each site and staff members at the Ministry dedicated to manual data entry and verification.
Worse still, the delay between receiving a positive HIV result at the national level and our ability to respond immediately meant lost opportunities to link patients to care and prevent further transmission.
To address these challenges, the Ministry of Health implemented a DHIS2-based system designed to capture HIV testing and surveillance data in real-time at the point of testing.
Design of the Solution and Implementation
The solution developed was a DHIS2 Tracker program that modeled the current case-based surveillance form, the backbone of data collection for HIV in the Ministry of Health. The program was deployed at health centers via the Android Capture App on tablet devices, enabling on-the-ground data collection at testing sites and outreach locations.
Key features of the implementation:
Search-first functionality: The tracker program enabled users on the ground to perform a search first, which reduced duplicate client enrollments.
Built-in validation: Program rules were developed so that logical data issues became a thing of the past.
Offline capability: Offline functionality enabled users to enter information even when internet connectivity was spotty in certain areas.
This approach transformed data collection from a centralized, paper-dependent process into a decentralized, digital system that empowered frontline health workers.
The system was rolled out in March of 2025, following a 6-month period of development and pilot testing. We trained over 52 nurses across 32 facilities in the initial deployment phase.
Impact
When this system was implemented, the impact was immediate.
Operational efficiency: Report compilation time dropped from 1 month to real-time. Virtually 100% reduction in the time for reports since they can be generated from the data collected from the DHIS2
Improved data quality: Duplicate records were significantly reduced, and missing fields were eliminated through mandatory fields and standardized digital forms with built-in validation. A data quality assessment done in comparison with paper registers and logbooks done at the site showed that records matched the digital entries at 97%. Where few of the inconsistencies came from the fact that the tester may have calculated a wrong age or neglected to fill out a field on the paper register. Which with DHIS2 isn’t possible.
Enhanced national visibility: Data entered DHIS2 automatically populates Power BI dashboards, giving us instant access to national HIV testing trends and the ability to identify emerging epidemics early.
Evidence-based decision making: The system provides insights for implementing targeted programs and policies to meet population needs. For example, we can analyze the types of risk behavior people who are testing are engaging with to enhance our prevention strategies.
Impact Related to HIV
Real-time data has fundamentally changed our public health response. When someone tests HIV-positive, our linkage-to-care team receives immediate notification and can begin follow-up to navigate the patient toward treatment. This immediate response reduces transmission risk and improves patient outcomes in ways that were simply impossible with paper-based reporting.
Looking Ahead
Building on this success, our next steps include:
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Fully implementing this system across all 60 HIV Rapid Testing sites by January 2026.
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Customizing the system to collect all aspects of HIV Testing and Treatment and Care
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Using this implementation as a model for other diseases in the Ministry of Health since our implementation is the most advanced of its kind in our country.
Thanks to DHIS2, this is now possible.
Recently this project was recognized by Inter-American Development Bank (IDB) to win an award in innovation from the President of Trinidad and Tobago.