ScanForm + HIV CBS
BackgroundCase-Based Surveillance (CBS) is a passive HIV surveillance system thatcollects longitudinal data from people living with HIV, from diagnosis
until death. As national HIV programs shift to a more human-centeredapproach, strengthening individual-monitoring systems like CBS are
essential for epidemic control.
ScanForm is a technology that extracts handwriting on paper into digital
data to auto-calculate summary statistics, saving time and eliminating
human errors. In Sub-Saharan Africa, ScanForm has been successfully
used for: epidemiological surveillance (HIV/AIDS, malaria, COVID-19),
clinical trials, routine health reporting, vaccine delivery, agricultural
data collection, and refugees and human rights.

Migori was the first
county in Kenya toachieve 100% HIV
CBS in 2021, with 70%of the data collectedwith ScanForm andthe remaining 30%
with EMR.

For facilities unable to implement electronic medical record systems (EMRs), ScanForm is a smart and sustainable solution for paper-based reporting. As a data system, ScanForm can function independently or as a stopgap/transition platform for countries scaling up their information technology (IT) infrastructure. Once the IT
infrastructure is ready, ScanForm data can integrate harmoniously with EMRs to achieve a holistic national
digital health data system.

How it works
One ScanForm HIV CBS tool captures a client’s clinical history with HIV/AIDS:(a copy of the tool is shown on the next page)•

Prospective (newly diagnosed with HIV): Complete left column (Sections A-C) on the same day of diagnosis. Update Sections D-F as client continues treatment.

•Retrospective (previously diagnosed with HIV): Back-fill left column (Sections A-C) with data abstractedfrom the registers from Section G, and include Sections D-F depending on client’s status. Case-Based
Reporting (CBR) only collects the first year of care.

The HIV CBS tool is updated from eight Ministry of Health (MOH) registers (section G) as the client continues along the HIV care cascade, including the green card. ScanForm auto-extracts the new information byretaking a photo of the page using a smartphone.

1. Write on paper

2. Take a picture

3. Data is digitized

4. Export andanalyze data

HIV CASE - BASED SURVEILLANCEPage No.
DiscardRecord
Photo Taken ByPhoto Taken

A. REGISTRATION
Reporting Date (dd/mm/yyyy)*/Yes

Sub-County

Section C: Diagnosis and Linkage

ScanForm
HIV-CBS 2.4

NoYes

NoYes////

Date changed to 3rd line (dd/mm/yyyy) 3rd line Regimen

Reporting Facility KMHFL Code*Update of existing case(new sentinel event)Correction of previous case report

New case

TB TREATMENT
Date of start of TB treat. (dd/mm/yyyy)

Transfer InNo

Sex*

National ID No.

NoneM

the Regimen will beprovided at the backpageF••/Baseline
cells/mm3 Baseline CD4CD4 count
Additional CD4 sample collection date (dd/mm/yyyy)

None/

CountySub-County
Sub-Location•%
Additional CD4
Viral load results (c/ml) <LDL Lower limit is(c/ml)
cells/mm3

4 5////
Phone No.
//
+Age as documented on MOH257 (yrs + mos)//
+Age as documented on HTS register (yrs + mos)//MSM FSW PWIDGen Pop Key Pop//
If Key Pop, tick one
Population Type*HIVIf patient
CASEis a-child,
BASED
SURVEILLANCE
please ﬁll
the information below, if known: NON SCANNABLE//
None
HEI number//INSTRUCTIONS
Ovals Mother's CCC number Book No.
• When/writing numbers,/ only use Arabic• Cross ovals with an “X”, like this:numerals 0 through 9. No Roman numerals!
in an oval, shade• When you make a mistakeTREATMENTof boxes for a numerical• If the number
AND LINKAGE TO CARE/ANTIRETROVIRAL
itcompletely like this:ﬁeld is/more than the /number of digits you
1 C.DateHIVofDIAGNOSISPage No.
and thenby
mark the correct oval with an X.
have, zero-pad theDiagnosis
Diagnosis (dd/mm/yyyy)
QRHIVCODEBoxes
numberfromthe/ left side:/ 0 5 3.0
inside the• Write
PCRlegibly and completely
Rapid Antibody
testboxes.
Photography//• Write only one symbol in each box.
• Lay the page ﬂat for photography. Please
Always use BLOCK CAPITAL LETTERS for boxes F. CURRENT STATUS
Village/Estate

Self Next of Kin None

Date enrolled in HIV care Discard(dd/mm/yyyy)
Record/ Photo Taken By

3 Date of ART initiation (dd/mm/yyyy)

CASE REPORT FORM
Data Matrix
ID here• stageStatus Change
do NOT bend or wrinkle the paper!
WHO
ScanForm
requiring letters.
discard a patient record, just mark the(dd/mm/yy)
LTFU
Transfer LTFU returned• When you maketoa mistakeat enrollment
care*in a box, shade the Date• ToDiscardDeath(28 days) 2.4 outto care
Record ﬁeld. DON’T cross out theHIV-CBS
box completely like this:entire record or page! And never rip out pages!
/ marked• Questions
with/an asterisk * areand write
the correct
answer to the side of it.
Historyof ART
at enrollment
mandatory
makesurethey
werealldone.
Whendataisunknown,
justleavetheboxesblank.
•PrEP
PEP
PMTCT None

6///
PATIENT /IF PATIENT IS A CHILD, FILL MOTHER'S PROFILE/Recency
HIV infection test conducted? If yes, HIV infection recent?
FirstName*
Mother's/First Name*
YesYesNoNo//
ARV Regimen Line*Start Regimen The codes matching
the Regimen will be/
Last Name*
provided at the back Mother's/Last Name*
Second line
Third line
First line
page
G. DATA SOURCE USED* (Select all applicable)

Referred from (Place of 1st diagnosis)
IPD-Adult

VCTSelf-test

MCH

TB Clinic

HTS Register

HEI registerTreatment Preparation Register1516171819(AS1B)(AS1C)(AS2A)(AS2B)(AS2C)NON SCANNABLE

CASE REPORT FORM

PAGE 2••

TX_CURR
TX_TB

TX_PVLS

TX_ML
TX_RTT

Other sections:•••

Section A: Facility information
Section B: Patient profile, without PII
Section G: MOH data sources used

6 Sentinel Events Captured
with ScanForm
1.
2.
3.
4.
5.
6.

HIV diagnosis
1st CD4 test
Initiation of ART
1st VL test		
VL suppressionDeath		(section C)(section E)(section C)(section E)(section E)(section F)

Unique Identifier
Backside
ScanForm can generate or capture
any unique identifier. In Kenya, it
computes the same Personal Key
Verifier (PKV) used by KenyaEMR,
based on personal identifiable information (PII) collected on the backside of the form. This allows paperand electronic records to be linked
and deduplicated. PII is stored in a
separate repository for additional
security.

NON SCANNABLENON SCANNABLENON SCANNABLENON SCANNABLENON SCANNABLE

TB_STATPMTCT_STATPMTCT_FO
HTS_INDEX

Section F: Patient Status

NON SCANNABLE

REGIMEN
CODES IPD-ChildANC register
Individual Clinic Record (e.g. MOH257)
CCC
TB Register
OPD
Other (eg STI)
RegimenCode
ARV Combination
Other
Viral Load Register
ART Register
NoClienttestedthroughPartner Notiﬁcation Services (PNS)?
Yes
01(AF1A)
02(AF1B)
03(AF1D) First and Middle Name
Last NamePERSON COMPLETING
FORM:
04(AF1E)
PAGE 105(AF1F)
06(AF2A)
07(AF2B)
08(AF2D)
09(AF2E)
10(AF2F)
11(AF4A)
INSTRUCTIONS
12(AF4B)
Book No.
Ovals• When writing numbers, only use Arabic• Cross ovals with an “X”, like this:numerals 0 through 9. No Roman numerals!
13(AF4C)• When you make a mistake in an oval, shade• If the number of boxes for a numericalitcompletelylikethis:ﬁeld is more than the number of digits you
14(AS1A)
Data Matrix
Page No.
and then mark the correct oval with an X.
have, zero-pad theQR
CODEBoxes
number from the left side: 0 5 3 . 015(AS1B)• Write legibly and completely inside the boxes. Photography
ID here•Writeonlyonesymbolineachbox.
16(AS1C)• Lay the page ﬂat for photography. Please• Always use BLOCK CAPITAL LETTERS for boxes
Discarddo NOT bend or wrinkle the paper!
ScanForm
requiring letters.
17(AS2A)•To discard a patient record, just mark theRecord
Whenyoumakea
mistakeinabox,shadethe•Discard Record ﬁeld. DON’T cross out theHIV-CBS 2.4
box completely like this:18(AS2B)
entire record or page! And never rip out pages!
Photo Taken By• Questions marked with an asterisk * areand write the correct answer to the side of it.
Photo Taken
19(AS2C)• When data is unknown, just leave the boxes blank. mandatory - make sure they were all done.
20(AS5A)
PATIENTIF PATIENT IS A CHILD, FILL MOTHER'S PROFILE
21(AS5B)
First Name*
Mother's First Name*
22(AS5C)
23(CF1A)
Last Name*
Mother's Last Name*
24(CF1B)
25(CF1C)
26(CF2A)REGIMEN
27 CODES (CF2B)
Regimen
Code
ARV
Combination
28(CF2D)(AF1A)
2901(CF2F)(AF1B)
3002(CF2G)(AF1D)Space to support more data elements, such
3103
(CF4E)(AF1E)
3204(CS1A)
as additional sentinel events, and capture(AF1F)
3305(CS2A)of related issues such as TB, Hepatitis, and(AF2A)
3406(DRV/r)(AF2B)3507(DTG)
COVID-19.
(AF2D)
3608
(RAL)
3709
Others,(AF2E)
Specify10(AF2F)
11(AF4A)
12(AF4B)
13(AF4C)
Last NamePERSON COMPLETING
FORM:
14(AS1A)First and Middle Name

HIV CASE - BASED SURVEILLANCE••••

Section E: Lab%/Additional
CD4 count
Viral load sample collection
date (dd/mm/yy)

HTS_TST_POS
PMTCT_HEI_POS
HTS_RECENT
TX_NEW

Section D: Regimens and Treatments/E. LABORATORY INVESTIGATION: VIRAL LOAD, CD4 2Baseline CD4 sample collection date (dd/mm/yyyy)//Transit

B. PATIENT PROFILE/DEMOGRAPHICS
Date of Birth*//(dd/mm/yyyy)
CCC No.*

HBTC•
•••

NON SCANNABLENON SCANNABLE

Data Matrix
ID hereD. CLINICAL EVENTSARV REGIMEN CHANGES
Date changed to 2nd line (dd/mm/yyyy) 2nd line Regimen The codes matching

Facility Name/Photo Taken

PEPFAR MER 2.6 Indicatorsthat can be auto-generated:

TB infected at enrollment Pregnant at enrollment Breastfeeding at enrollment/CountyReport type*

CASE REPORT FORM

INSTRUCTIONSOvals• When writing numbers, only use Arabic• Cross ovals with an “X”, like this:numerals 0 through 9. No Roman numerals!
• When you make a mistake in an oval, shade• If the number of boxes for a numericalitcompletely like this:ﬁeld is more than the number of digits you
and then mark the correct oval with an X.
have, zero-pad theBoxes
number from the left side: 0 5 3 . 0• Write legibly and completely inside the boxes. Photography• Write only one symbol in each box.
•
Lay the page ﬂat for photography. Please• Always use BLOCK CAPITAL LETTERS for boxes
do NOT bend or wrinkle the paper!
requiring letters.
discard a patient record, just mark the• When you make a mistake in a box, shade the • ToDiscard
Record ﬁeld. DON’T cross out thebox completely like this:entire record or page! And never rip out pages!
• Questions marked with an asterisk * areand write the correct answer to the side of it.
• When data is unknown, just leave the boxes blank. mandatory - make sure they were all done.

Book No.

QR CODENON SCANNABLE

Advantages
Compliance and security•Data and servers are only in Kenya. Compliance with Kenya’s Data Protection Act,NASCOP, and GDPR.

•Auto-deletion of images after upload.

Interoperability••

Generates same patient identifier asKenyaEMR.
Data is synced with NASCOP data warehouse and dashboards.

Simplicity saves money•

Easy to use. No need to hire auxiliary dataclerks.

•No need for stable electricity, network,scanners, computers, or tablets. Works
offline and uploads when network is available.

•Extremely low paper costs — a single sheet
for the client’s life.

Saves time•

3x faster data entry compared to tablets.

•Scanned source documents are remotely
available for verification, backed by physicalrecords stored in the facility.

•Auto-generates monthly summary statistics
by the 2nd of the month.

Improves data quality•

OCR > 98%, calibrated to local handwriting
and self-learning.

•Compiles facility data quality reports forcontinuous quality improvement.

•Imputation corrects logic errors and missing data.

Data Flow Diagram