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Ministry of Health
M&E of DSD in Uganda
November 2017
Status of national guidelines update
Models included in guideline
Updates on DSD trainings
Elements of M&E system
Goals for Participation in this COP
Presentation Outline
Differentiated Service Delivery (DSD):Definition, Core Principles and Building Blocks
DSD refers to various ways of providing care and treatment services that are tailored to the needs and preferences of PLHIV with the aim of maintaining good clinical outcomes and improving efficiency in service delivery.
The 2 services for adopting differentiated models are:
Differentiated HIV testing services
Differentiated HIV treatment and care
3
The 4 building blocks of DSD
The core principles of differentiated care are:
Client-centered care
Improved health system efficiency
4ALL communities are eligible for HTS. However, the HTS model depends on the population vulnerability and their unique needs
Recommended Differentiated HTS Models and approaches and target populations
Recommended Differentiated HIV Treatment and Care Models and Approaches and Target
Populations
5
Client Categories for Differentiating HIV Treatment and Care
Stable Clients Unstable/Complex Clients
• PLHIV (Children, Adolescents, Pregnant and lactating women and adults) on current ART regimen for more than 12 months
• Virally suppressed: Most recent viral load result suppressed within the last 12 months
• WHO stages 1 or 2
• On 1st or 2nd line ART regimens
• Demonstrated good adherence (over 95%) in the last 6 consecutive months
• TB clients who have completed 2 months intensive phase treatment and are sputum negative
• PLHIV (Children, Adolescents, Pregnant and lactating women and adults) on current ART regimen for less than 12 Months
• Not virally suppressed
• Has current or history of WHO stages 3 or 4 opportunistic infections within the past one year
• On 3rd line treatment
• Poor adherence (less than 95%)
• TB clients in intensive phase of treatment (< 2 months) or who are still sputum positive after intensive phase treatment
• MDRTB/HIV co-infected clients
National DSD rollout Plan
ActivityJan-Mar'17
Apr-Jun'17
Jul-Sep'17
Oct-Dec'17
Jan-Mar 18
Apr –June 18
DSD task team meetings- monthly
Developing Training curricula/Job aides
National dissemination Launch anddissemination
Regional/district dissemination meetings
Pre-test of training materials- HCW and CHW
Review of the training materials after pretest-HCW& CHW
Review of HMIS tools
Printing training materials/Job aides for sites
National TOT
Preparatory meetings for roll out with IP’s
Training of regional and district trainers
Facility based trainings
Training of group leaders
1st mentorship
Quarterly site mentorship
Stakeholders meeting to share experiencesand review the rollout process
Monitoring and Evaluation
6. Training Curriculum for Training of Trainers (5 days)
Facilitator’s Guide: module guide, case studies, work planning, pre/post test assessments
Power point slides
7. Onsite Training Package (3 days)
Facilitator’s Guide
Facilitator’s flipchart
Participant’s workbook: Cases, Case Study, Role Plays, Work Planning
8. Group Leaders Training Curriculum (2/3 days)
Facilitator’s Guide
Differentiated Service Delivery Training Packages
Capacity building
National DSD training of trainers
4 trainings
153 national trainers
Regional DSD training of trainers
2 regions
6 trainings
174 trainers
6 pilot sites
Onsite training done
1st Mentorship done
DSD Stakeholders
AIDS Control Program
National Tuberculosis and Leprosy Program
Central Public Health Laboratory
National warehouses
Implementing Partners
AIDS Development Partners
Elements of M&E System
Historic M&E System
Strengths
Availability and use of standardised HMIS tools
Unique patient identifier within a facility
One national reporting system-DHIS2
Existence of QI and data-use teams at most of HFs
Weaknesses
Largely paper based
Weak M&E community component
Existing HMIS – recording, summarizing and reporting
Largely paper based – individual client forms; registers
EMR – care & treatment component at higher level/high volume facilities~ 600 HFs
• Move towards entry of MCH, TB, HTS data
Aggregate facility reports through DHIS2 – Monthly and quarterly
Medicines reports and orders through WAOS – 2 month cycle
Data Collection and Reporting
HTS Data Flow Chart
14
HIV Treatment and Care Data Flow Chart
15
Data Tools Processes
Existing data tools
Majority – 98%
Routine HMIS tools review
Target – DSD approach & models
Participatory process: – Different AIDS Control Program
units; District Biostatistician; Health workers; IPs; ADPs; Division of Health Informatics
TWG approves final changes
Changes effected in EMR and DHIS2
New data tools
Focus mainly on community component (CCLAD)
Based on experiences from pilots by different IPs
Development of guides to completing tools
Presented to be included among HMIS tools
Data Tools Modified
Existing data tools revised
HCT client card
HCT register
Pre-ART & Linkages register
HIV care/ART card
Appointment book
ART register
Psychosocial register
Unit TB register
Reporting forms
New data tools created
DSDM categorization tool
CDDP group enrolment form
CDDP group summary form
CCLAD monitoring form
CCLAD group enrolment form
CCLAD group summary form
Readiness to join community care and treatment DSD model form
M&E - Coding of DSD Approaches
18
DSD ApproachCode
Examples of
treatment
regimen
Combination with
treatment regimen
Facility Based Individual
Management
(FBIM)
D11f (TLE) 1f-d1
Facility Based Groups
(FBG)D2 1f 1f-d2
Fast Track Drug Refills
(FTDR)D3 1f 1f-d3
D4Community Drug
Distribution Point (CDDP)D4 1f 1f-d4
Community Client Led ART
Delivery (CCLAD)D5 1f 1f-d5
M&E – DSD HTS indicatorsData Element Data source Disaggregation levels
Number of clients tested
ALL entry points except MCH
HIV Counseling and Testing register – HMIS
055
MCH entry points
Integrated Antenatal register – HMIS 071
Integrated Maternity register – HMIS 072
Integrated Postnatal register – HMIS 078
HTS models (Facility,
Community)
HTS approaches
(PITC, VCT, HBHTS,
Outreach)
Age groups (2-4, 5-9,
10-14, 15-19, 20-24,
25+)
Sex (Male, Female)
Number of clients tested HIV
Positive
ALL entry points except MCH
HIV Counseling and Testing register – HMIS
055
MCH entry points
Integrated Antenatal register – HMIS 071
Integrated Maternity register – HMIS 072
Integrated Postnatal register – HMIS 078
Number of identified HIV
positive clients linked to careLinkages and Pre-ART Register
M&E – DSD C&T indicatorsData Element Data
source
Disaggregation
levels
Cross
sectional
Number of clients newly
enrolled in each DSD model
during the reporting quarter
ART
register
(HMIS
081)
DSD approaches
Age groups (2-4, 5-9, 10-14, 15-19, 20-24, 25+)
Sex: Male, Female
Number active on ART by DSD
approach
Number active on ART achieving
viral suppression by DSD
approach during the reporting
quarter
Goals for Participation in this COP
Others learning from Uganda
Comprehensive rollout of DSD models and approaches
Limiting new tools and focusing on revision of the existing HMIS tools
Uganda learning from Others
Use of electronic systems in patient management.
Guidance on psychosocial eligibility criteria for defining stability.
Managing children and adolescents in the community as recommended by WHO