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