Enhanced Surveillance in a Digital Health Landscape: The role of near to real time data availability through the Knowledge Center within South Africa’s APACE HIV program (Preprint)
Authors: Pisa Pedro , Sanne Ian , Potgieter Melinda , Rennick Marcus , Onaga Chuka , Molefi Seithati , Muzvidziwa Tafadzwa , Chirowodza Admire , Majuba Pappie , Brahmbhatt Heena , Mdluli David , Mdlovu Bhekisizwe , Mtungwa Ishmael , Mogane Pharais 
Published: August 2022

BACKGROUND

Right to Care (RTC), through support from the United States Agency for International Development (USAID) implements various innovations that improve data accessibility and utilization to improve program performance and patient outcomes within large scale HIV care and treatment programs. We present the impact of enhanced surveillance through RTCs Knowledge Center (KC) on key program indicators and patient outcomes in RTC-USAID-supported HIV care and treatment facilities in Ehlanzeni district, South Africa.

OBJECTIVE

To compare key HIV patient outcomes before and during operationalization in an intervention called Siyenza where an online data warehouse and visualization system called the KC was used.
To determine the impact or effect of the intervention focusing only on the performance of key outcomes.

METHODS

In South Africa, within the USAID Accelerating Program Achievements to Control the Epidemic (APACE) program, a nested acceleration drive termed Siyenza was operationalized targeting key facilities to improve their outcomes and performance. The KC – an interoperable automated and centralized data warehouse, that powers various visualization and reports in near real-time, allowing for rapid daily assessment and diagnostics related to over- and under-performance across the programme was instituted. The authors established the impact of the KC intervention through an ecological analysis, using 29 RTC-USAID-supported Siyenza facilities from aggregated secondary data. The impact of the KC was assessed by comparing key patient outcomes before (Dec 2018 to Feb 2019) and during its operationalization (March 2019 to May 2019).

RESULTS

Average facility ART initiations increased by 16% from a monthly average of 54 new initiations pre-Siyenza to 62 new initiations at the end of Siyenza whereas retention in care increased by 57%, and the treatment cohort increased by 7%. At the end of the intervention period, an independent-samples t-test indicated that the net retention scores were significantly higher for Siyenza facilities (M =.379, SD =.808) compared to non-Siyenza facilities (M=-.061, SD =1.016), t(208) = 2.224, p < .027, d = .445. The common language effects sizes were computed, to reflect the probability of a random observation from one population being larger than one from the other population. Results indicate that Siyenza facilities maintain cohort growth, while non-Siyenza facilities continued to lose patients.

CONCLUSIONS

The accessibility and utilization of near to real-time data within HIV programs allowed for rapid responses and targeted data driven interventions. Daily data review meetings facilitated precision programming and contributed to the behavior change necessary to institute routine data use for decision making and evaluations within programs.

CLINICALTRIAL

Not applicable