Using Routine Data to Improve ART Retention: Examples and Lessons Learned from the Literature and Experts in the Field
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
Nena do Nascimento, MPP
Michelle Li, MS
Catherine Barker, MPH
Investigate how countries are
currently using routine health
facility records to improve adult
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
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
Proxy for adherence
et al., 2010)
Access to support services
to ensure continuous
treatment and reduce risk
to others (Messeri et al.,
Retention and 90-90-90
UNAIDS’ ambitious treatment target to help end the AIDS epidemic
(pharmacy & clinic)
Use data to inform care
needs for patients & ensure
Trace patients, provide
support services, refer
patients to health facility
National and sub-
performance and trends &
policies to improve
and send to
Send results of
refer patients for
Share reports on
Provide data on
in need of follow-
up or patients in
need of additional
Routine Health Data &
Close to 5,000 publications reviewed, including national
Peer reviewed, grey literature, relevant websites
Question: “How have low- and middle-income countries
routinely collected patient-level data to retain adults on
Purpose: to fill gaps in the literature
62 practitioners completed a 16-question survey
Purpose: deepen understanding of practitioners’
Seven interviews with monitoring and evaluation experts
one MOH official from a PEPFAR country
Interventions that Support Use
of Data for ART Retention
Interventions determined by:
Type of the epidemic
Health information system design
Available technology and connectivity
Human resource capacity
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
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
- 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
Data use culture
and facility data
1. Patient tracing to improve ART retention most
commonly cited — less emphasis on data
review meetings and improving data capture
2. Approaches should be fit-for-purpose
3. Human resources are a key to improved ART
4. Community programming is integral
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
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
For more information…
1. Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub‐Saharan Africa, 2007–2009: systematic review.
Tropical Medicine & International Health. 2010;15(s1):1-15.
2. WHO. Retention in HIV Programmes: Defining the challenges and identifying solutions. Meeting report, 13-15 September 2011, Geneva.
3. PEPFAR. FY 2015 Results - Tanzania. Available at: https://data.pepfar.net/global.
4. Hotchkiss DR, Diana ML, Foreit KG. How can routine health information systems improve health systems functioning in low-and middle-income countries?
Assessing the evidence base. Adv Health Care Manag. 2012;12:25-58.
5. Mugavero MJ, Westfall AO, Zinski A, Davila K, Drainoni, ML, Gardner, L et al. Measuring retention in HIV care: the elusive gold standard. Journal of acquired
immune deficiency syndromes (1999). 2012;61(5):574.
6. Massaquoi M, Zachariah R, Manzi M, et al. Patient retention and attrition on antiretroviral treatment at district level in rural Malawi. Trans R Soc Trop Med Hyg.
8. Tierney, William M., et al. "Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers." Journal of the American
Medical Informatics Association (2015): ocv074.
9. DHIS 2.20 Overview. Available at: https://www.dhis2.org/220.
10. REDCap Project lead by Project Hope in Namibia.
11. do Nascimento N, de Jesus Joao F. Formative Assessment of a Future mHealth Site in Nhamatanda, Mozambique. MEASURE Evaluation: Working Paper Series.
12. Wandina D, Odhiambo F, Ojoo S, Mongare J, Ogillo G, Muriuki J, et al. Strategies for reducing lost to follow-up rates in adult patients receiving antiretroviral
treatment in rural services in Kenya [Poster Presentation]. The 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Rome,
Italy, July 2011.
13. South African National Department of Health (SANDOH). Models for the scale up of HIV prevention, treatment and care from South Africa and beyond. 2010.
14. Rosen, S and Ketlhapile, M. Cost of using a patient tracer to reduce loss to follow-up and ascertain patient status in a large antiretroviral therapy program in
Johannesburg, South Africa. Tropical Medicine and International Health. 2010; 15 (I); 98-104.
15. Geng EH, Nash D, Kambugu A, et al. Retention in Care Among HIV-Infected Patients in Resource-Limited Settings: Emerging Insights and New Directions. Curr
HIV/AIDS Rep. 2010; Nov; 7(4): 234–244.
16. McMahon JH, Moore R, Eu B, et al. Clinic Network Collaboration and Patient Tracing to Maximize Retention in HIV Care. PloS one. 2015;10(5):e0127726.
17. Dalal, R.P., MacPhail, C., Mqhayi, M., Wing, J., Feldman, C., Chersich, M.F., Venter, W.D..(2008). Characteristics and outcomes of adult patients lost to follow-up at
an antiretroviral treatment clinic in Johannesburg, South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes, 47(1), 101-107.
18. Forster, M., Bailey, C., BrinkhofI, M.W.G., Graber, C., Boulle, A., Spohr, M., Balestre, E… Egger, M. (2008). Electronic medical record systems, data quality and loss
to follow-up: survey of antiretroviral therapy programmes in resource-limited settings. Bulletin of the World Health Organization, 86 (12).
19. Scheibe, F.J., Waiswa, P., Kadobera, D., Miller, O., Ekström, A.M., Sarker, M., Neuhann, H.W.F.. (2013). Effective Coverage for Antiretroviral Therapy in a Ugandan
District with a Decentralized Model of Care. PloS one, 8(7), e69433.
20. Ministry of Health and Ministry of Community Development, Mother and Child Health. Zambia Consolidated Guidelines for Treatment and Prevention of HIV
Infection. (2014, Feb). http://www.hivpolicywatch.org/duremaps/data/guidelines/ZambiaARTguidelines2013.pdf.
21. National AIDS & STI Control Program. Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection in Kenya (2016 ed.).
22. Republica de Mocambique, Ministerio da Saude, Direccao National de Assistencia Medica. (2014). Guia de Tratamento antiretroviral e infeccoes oportunistas no
adulto, adolescente, gravida e crianca 2014. http://www.who.int/hiv/pub/guidelines/mozambique_art.pdf.
23. South African National AIDS Council (SANAC). National Strategic Plan for HIV, STIs, and TB. (2012-2016). 2011.
24. The United Republic of Tanzania, Ministry of Health and Social Welfare, National AIDS Control Programme. National Guidelines for the Management of HIV and
AIDS (5th ed.). (2015, May).
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