Implementation – HIV

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

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Subject: Use of DHIS2 Tracker for implementation of differentiated service delivery for HIV treatment in Nepal

Introduction: I am Keshab Deuba working as a Strategic Information Specialist at National Centre for AIDS & STD Control/ Global Fund Programs in Nepal. My academic background is in Public Health and Epidemiology, and my expertise are related to M&E, Surveillance and Research. One of my core interest areas is related to strengthening the use of routine health facility data using DHIS2 tracker for evidence-informed response.

Summary of presentation: There is always a challenge in implementing quality client-centered health services in low- and middle-income countries like Nepal due to low numbers of overburdened health workers and limited resources. To overcome aforementioned challenges, differentiated services delivery (DSD) approach is prioritized in HIV program globally i.e., moving away from a one-size-fits-all model, DSD tailors HIV services to diverse groups of people living with HIV (PLHIV) while maintaining the principles of the public health approach. DSD prioritize those clients needing more intensive services than those stable clients who do not require frequent visits to health centers due to good treatment adherence. This also support to reduce the unnecessary burdens in the health system. However, to implement DSD in HIV treatment services in Nepal is challenged by the paper-based health management information system (HMIS) registers. To overcome that challenge, we have transformed paper-based registers to e-registers using DHIS2 tracker and implemented in all HIV treatment centers of Nepal. We decided to monitor the early warning indicators (EWI) of HIV drug resistance at different levels from national, province to the HIV treatment centres using DHIS2 tracker. As per the recommendations of WHO a total of five indicators were developed based on the data recorded in DHIS2 Tracker: on-time pill pick-up; retention in care; no antiretroviral stock-outs; dispensing practices; and virological suppression. With technical support from HISP India, Nepal team used scorecard to monitor performance into three color codes (Green: >90% (Good Performance); Amber: 80%-90% (Fair Performance) and Red: <80% (Poor Performance). This helped at the federal/province level to monitor the performance of HIV treatment centers regarding EWI whereas treatment centers can not only monitor their aggregated EWI status but also identify the details of individual clients to implement services as per their need. For example, treatment centers can generate details of individual clients with poor retention (i.e., loss to follow up clients falls under red category) in HIV treatment to contact and counselling them for continuing treatment. Treatment centers can also share list of such clients and mobilize community and home-based care team and peer navigators to address common reasons for non-retention in treatment. This was not possible using paper-based registers when there are hundreds of PLHIV receiving HIV treatment services. More than 30000 PLHIV ever enrolled in HIV treatment data recorded in DHIS2 tracker are using by health workers to implement DSD approach for HIV treatment in Nepal.