1.
Using Routine Data to Improve ART Retention:
Examples and Lessons Learned
from the Literature and Experts in the Field
Photo credits: Left: CDC, http://africaunchained.blogspot.com/2014/08/malawis-national-electronic-medical.html; Center: Riccardo Lennart Niels Mayer, iStock Photo, 2015; Right: Paul Jeffrey
March 30, 2017
MEASURE Evaluation
Webinar
Nena do Nascimento, MPP
Michelle Li, MS
Catherine Barker, MPH

2.
Investigate how countries are
currently using routine health
facility records to improve adult
antiretroviral treatment(ART)*
retention in low- and middle-
income countries and recommend
how to strengthen data use for
higher ART retention.
* male and female, excluding PMTCT & pre-ART
Activity Purpose

3.
 As countries work towards an AIDS-free generation, they must be able to
use their routine health data to retain patients in the continuum of HIV care
by effectively tracking clients and ensuring that they follow their treatment
regimen.
Retention:
 Proxy for adherence
or programming
effectiveness (Geng
et al., 2010)
 Access to support services
to ensure continuous
treatment and reduce risk
to others (Messeri et al.,
2002)
Retention and 90-90-90
UNAIDS’ ambitious treatment target to help end the AIDS epidemic

4.
Facility
(pharmacy & clinic)
Use data to inform care
needs for patients & ensure
optimal treatment
Community
Trace patients, provide
support services, refer
patients to health facility
National and sub-
national level
Identify retention
performance and trends &
policies to improve
retention
Aggregate data
and send to
subnational and
national level
on retention
Send results of
patient tracing;
refer patients for
relevant services
Share reports on
retention at
subnational and
national level
Provide data on
defaulted patients
in need of follow-
up or patients in
need of additional
support services
Routine Health Data &
Retention

5.
Systematic review
 Close to 5,000 publications reviewed, including national
guidance
 Peer reviewed, grey literature, relevant websites
 Question: “How have low- and middle-income countries
routinely collected patient-level data to retain adults on
Online survey
 Purpose: to fill gaps in the literature
 62 practitioners completed a 16-question survey
In-depth interviews
 Purpose: deepen understanding of practitioners’
 Seven interviews with monitoring and evaluation experts
one MOH official from a PEPFAR country
Methods

6.
Survey Respondents

7.
Interventions that Support Use
of Data for ART Retention

8.
Improved Data Capture
Systems

9.
Data Review Meetings

10.
Patient Tracing

11.
Interventions that Support Use
of Data for ART Retention
 Interventions determined by:
 Patient load
 Type of the epidemic
 Health information system design
 Available technology and connectivity
 Human resource capacity

12.
Smart Care – Zambia Tickler File – Ethiopia
Photo credits: Lefthttp://ghcorps.org/uncategorized/cultivating-a-bias-towards-action-in-global-health/ Right: Tariq Azam
Interventions that Support Use
of Data for ART Retention

13.
Opinions on Interventions
“The use of the data have increased retention of patients on ART as
they guide the program to make informed decisions. [Interventions
include] early tracking of missed appointments, and set time blocks for
patients to reduce the long waiting hours at counseling and testing
clinics.”
- Survey respondent with experience in Tanzania
“The cohort reports specifically has enabled facilities to analyze
attrition rates and the reasons contributing to that. This has enabled
the facilities to focus their efforts on the gaps as part of their
continuous quality improvement.”
- Survey respondent with experience in Haiti, Kenya, Nigeria, Rwanda,
Uganda, and Zambia
Only1survey respondent of 57 indicated that use
of routine health facility records did not lead to increased
retention

14.
 Data quality
 Data use culture
 Human resources
 Parallel systems
 Linking
community
and facility data
 Sustainability
Challenges

15.
1. Patient tracing to improve ART retention most
commonly cited — less emphasis on data
review meetings and improving data capture
systems
2. Approaches should be fit-for-purpose
3. Human resources are a key to improved ART
retention
4. Community programming is integral
Conclusions

16.
1. More emphasis should be placed on data use as part of
retention interventions at the community and facility level.
2. Supportive supervision, mentoring, and training of health
facility workers on data collection and data use would
strengthen data quality and use of data to improve retention.
3. Strengthen and invest in community programming and
community information systems — and strengthen their
linkages to facility systems. The use of unique patient
identifiers and mobile technology could improve linkages and
enable more accurate measurement.
4. Reduce multiple vertical reporting mechanisms to reduce
workload of health facility workers and better use data
Recommendations

17.
 Retention within the context of multi-
month scripts, differentiated care
 Role of the community in tracking
retention and adherence through
community adherence groups and other
structures
What’s Next?

18.
Poll & Questions

19.
For more information…
https://www.measureevaluation.org/resources/publications/sr-17-141
Email: Nena.donascimento@thepalladiumgroup.com

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20
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21.
This presentation was produced with the support of the United
States Agency for International Development (USAID) under the
terms of MEASURE Evaluation cooperative agreement AID-OAA-L-
14-00004. MEASURE Evaluation is implemented by the Carolina
Population Center, University of North Carolina at Chapel Hill in
partnership with ICF International; John Snow, Inc.; Management
Sciences for Health; Palladium; and Tulane University. Views
expressed are not necessarily those of USAID or the United States
government.
www.measureevaluation.org