Our aim is to support the utilisation of routinely-collected HIV data for strengthening services, and provide transparency about the benefits and equity in delivering services to people living with HIV.
SEARCH is a collaboration between the London School of Hygiene & Tropical Medicine and the Ministries of Health in Malawi, Tanzania and Zambia, and is funded by the Bill & Melinda Gates Foundation.
There are 23.5 million people living with HIV in sub-Saharan Africa, and this has triggered an impressive response to prevent new infections and to treat people living with HIV. With assistance from international organisations, health systems in many African countries are now leading the way to deliver prevention programmes targeting behaviour change, offer medical circumcision, scale up HIV testing and counselling, and deliver antiretroviral therapy (ART). Around these programmes, health management information systems (HMIS) are being developed for monitoring and evaluation, and to ensure that effective and cost-effective services are being implemented and rolled out. Since the initiation of ART, and its subsequent scale up, both HMIS data and patient-level data have been routinely collected in many countries. However, there are no standardised methodologies to extract the data, use the results to improve programmes in the field, and understand the impact of these programmes on the health of people living with HIV.
Health management information systems across three countries
Previous research has shown that HIV services can transform the lives of people living with HIV, enabling them to continue regular work and maintain family commitments while living with HIV. However the scale of the HIV epidemic in sub-Saharan Africa raises the question of how national programs can maximise the impact of their services, provide transparency about the benefits, and equity in delivering services to people living with HIV.
In Malawi, Tanzania and Zambia, national HMIS are available and opportunity exists to explore these data to assess the impact that services have on those that access it. This will necessitate developing and documenting data extraction and analysis tools, so that national and international players can identify and use opportunities to improve service delivery.
Integration into the Ministries of Health
The SEARCH project will be integrated into the work programs of the national Ministry of Health (MoH) in each country, in order make the tools relevant, and to build capacity to develop further analytic tools in the future.
In the first year, a priority will be to identify and recruit three members of staff to work on these data in each country. The participating staff within the MoH will learn how to apply the methods and tools that have been developed and to disseminate strong, rigorous results, within their own MoH, to international players, and through publishing in peer-reviewed journals. This will widen understanding of the analytic techniques and reporting tools, and will provide a strong platform for further analysis in country, as well as providing the basis for further work in other countries with similar data.
Furthermore, the project will build links between MoH and local academic institutions in each country, which will ensure a proper training for the MoH staff. This will build sustainability of the training program, so that it can be replicated in the future, and strengthen the collaborative links in-country to train more people in statistical and epidemiological analyses, which is greatly needed in these countries. The overall objective of this project is for the MoH to use their results to improve the HIV programmes and policies within their countries.
SEARCH is just one project aiming to improve the use of routinely-collected data and train researchers.
This section will describe the work already being done in Malawi.
The government of the United Republic of Tanzania launched the HIV/AIDS Care and Treatment Plan in October 2003, and since 2004 a rapid roll-out of antiretroviral treatment (ART) has been ongoing. A number of partners have been working with the government of Tanzania in this undertaking, including the governments of Sweden, Canada, Norway, the Netherlands and Japan, along with the US government through the President’s Emergency Plan for AIDS Relief (PEPFAR). Agencies such as the United Nations Development Programme (UNDP), the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have also collaborated with international funding through the Global Fund for AIDS, TB and Malaria (GFATM).
The implementation of care and treatment services at the health facility level has been regionalised, with each partner – AIDS Relief, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), TUNAJALI (Deloitte/Family Health International), International Centre for AIDS Care and Treatment Program (ICAP), Muhimbili Dar City Harvard (MDH) and Walter Reed – supporting one or multiple regions, and PharmAccess International (PAI) supporting the military and the uniformed forces. To contribute further to Tanzania’s development goals in health, the United States government (USG) has now set transition mechanisms to strengthen health systems and create ownership for sustainability of health programs, particularly HIV care and treatment programs. Most of the implementing partners have collaborated with or established local non-governmental organisations to facilitate the transitions.
Tanzania has benefited from the investment in data collection at care and treatment clinics (CTCs). Through the generous support of various donors (PharmAccess International, PEPFAR, Global Fund for AIDS, TB and Malaria), a rigorous system of routine data collection was initiated to record the patients attending CTCs. Through the years, the systems has been revised to accommodate new or changed recording and reporting obligations from implementing partners, donors and international reporting commitments, such as the Global AIDS Response Progress Reporting (formerly UNGASS) and the Universal Access to HIV services.
The University of Dar es Salaam Computing Centre (UCC) supports database systems, including both the CTC2 database, used at a large number of CTCs, and the CTC3 macrodatabase database at the National AIDS Control Program (NACP). By the end of 2011, Tanzania had more than 1100 health facilities approved to provide care and treatment services, estimated to enable more than 1,000,000 patients to access HIV care services.
Analysis workshops are held biennially to analyse the national CTC data, following which a report is written. In 2010, the second report on CTC services showed the impact of ART on the lives of people living with HIV. The third report is due to be published in 2014; it builds on the second report and provides an update on the impact of ART on people living with HIV, and tackles the further analysis of important data collected by the CTC programme. These reports will become a regular part of the monitoring of the CTC programme, and help policy makers and funders evaluate the program. The workshops are facilitated by LSHTM staff.
The reports are available from:
Tanzania National AIDS Control Program, Ministry of Health and Social Welfare
Discussions both within and outside of Zambia indicate routinely-collected data from the HIV services implementation is being collected. These data cover care and treatment programs, PMTCT, and HIV testing and counseling services. There has been little analysis of the data, to demonstrate the impact of the programs on the lives of people living with HIV. Part of the difficulty comes from issues around the access to the data, but there is also a great need for training in the types of analyses that can be carried out on such data. The SEARCH project is focusing on:
- Building links between academic institutions including the University of Zambia (UNZA), the Ministry of Health (MoH), and the Ministry of Community Development, Mother and Child Health (MoCDMCH)
- Developing analysis tools for use with the HIV service data that is available in Zambia
- Training three fellows to spearhead the analysis of HIV service data in Zambia
- Providing funds for the three fellows to complete their PhD studies based on the analysis and research questions obtained from the HIV service data
Health management information systems (HMIS) data are reported to Ministries of Health (MoH) in many different ways, through summary counts of service delivery, through anonymous patient records, and through surveys of clinic services. The overall aim of the SEARCH project is to enable the MoH in Malawi, Tanzania and Zambia to use their routinely collected data to improve the HIV programmes and policies within their countries.
We have two main objectives:
- To collate, validate and publish methods and tools used in the analysis of HIV service data.
- To develop capacity for development of further analysis tools, and to build links between MoH and local academic institutions in each country.
As the project progresses, we will develop country-specific objectives for Malawi, Tanzania and Zambia.
- Objectives for Developing Analysis Tools
The first objective is to collate, validate and publish methods and tools used in the analysis of HIV service data. We aim to develop generic tools that could be used in any country. Three service delivery areas will be covered by this project:
- HIV care and treatment clinics (CTC)
- Programmes to prevent mother to child transmission of HIV (PMTCT)
- HIV testing and counselling services (HTC)
This phase of the project will start with electronic consultation and then a face-to-face meeting in each country between the data owners (HIV programme heads and National Statistical Office for DHS data), data users (policy makers in MoH), and technical advisors and analysts (LSHTM and local university statisticians and epidemiologists) to agree on the aims and indicators, and the accountability and procedures of the project.
The key questions to be asked include:
- What events are being reported by the different services (access to care, access to ART, PMTCT delivery, HIV testing and counselling)?
- How are these events being reported?
- How can the reporting of these events be improved (by collecting more data items, or by improving the quality of the data collected, or by exploiting available indexes to link data between different datasets)?
The statistical indicators developed will include counts of new people accessing and continuing to use the services each year, and measures of the health and survival status of service users.
The deliverables fall under two distinct activities.
Data inventory and documentation
The first activity is specific to the structure of the general subset of data that is required for the analysis, which may differ from one country to another. We will provide a data dictionary for the dataset, detail internal checks that should be run on the data, document the analysis programs that could be used to obtain the results, and prepare the data for the calculation of specific indicators. As part of this process, gaps in the data will be noted, so that improvements to the data collection and organisation can be developed after discussions with local agencies responsible for the implementation of the HIV programmes.
Generate analytical datasets
The second activity is to create and use the analysis dataset. This requires extraction tools, and documentation of the methods and processes by which the data are collected and extracted. We will develop analysis tools in Stata, and later in R, to run on the extracted data, and to make tables of the results.
This work will be undertaken in collaboration with WHO and UNAIDS. We will develop guidelines for HIV health management information systems data extraction from different sources, data quality checks, data manipulation and output specifications. Where possible, automatic data correction procedures will be used to eliminate minor inconsistencies. To address more fundamental errors, we will create procedures for sending queries to clinics and data managers for resolution.
Across Malawi, Tanzania and Zambia
This work will be informed by our understanding of the data from the Tanzanian HIV care and treatment database. However, we will make the tools to be used on other country data, and to use on other HIV service data (for example, prevention of mother to child transmission, and testing and counselling data). That is, a general subset of the data will be defined to obtain specific indicators and analytical objectives, analysis tools will be defined and documented for each data subset, and extraction tools will be developed and documented.
- Objectives for Developing Sustainable Capacity
This project will be integrated into the work programs of the national Ministry of Health (MoH) in each country, in order make the tools relevant, and to build capacity to develop further analytic tools in the future.
In the first year, three professional staff within the MoH of each of Malawi, Tanzania and Zambia will be recruited to work on these data in each country. These staff will learn how to apply the methods and tools that have been developed and to disseminate strong, rigorous results, within their own MoH, to international players, and through publishing in peer-reviewed journals. This will widen understanding of the analytic techniques and reporting tools, and will provide a strong platform for further analysis in country, as well as providing the basis for further work in other countries with similar data.
The analysis strategies that have been developed by London School of Hygiene & Tropical Medicine (LSHTM) analysts will be applied by the MoH staff, under supervision of statisticians from local universities, staff from LSHTM, and suitably experienced data managers/analysts familiar with the data in the country. Analysis and dissemination workshops will be held in country to look at different ways the tools could be used within the country, and how results vary across sub-national boundaries. Analyses will aim to answer questions on the following topics:
- Access to and coverage of services such as HIV care, antiretrovial therapy (ART), prevention of mother to child transmission and HIV testing and counselling (HTC) services
- Mortality, morbidity and retention on ART treatment of service users
- Coverage of HTC in the general population, with the proportional coverage from different testing strategies, such as voluntary counselling and testing, provider-initiated counselling and testing, antenatal clinic testing, and couple testing.
One of the main impediments preventing greater use of routine data from clinics is the perception that the data may be of poor quality. The best way to improve quality is by using the data, and by giving feedback. The SEARCH team will work with MoH to develop suitable dissemination and further applications in each country.
Furthermore, the project will build links between MoH and local academic institutions in each country, which will ensure proper training for the MoH staff. This will build sustainability of the training program, so that it can be replicated in the future, and strengthen the collaborative links in-country to train more people in statistical and epidemiological analyses, which is greatly needed in these countries. LSHTM staff will supervise the transfer of tools and skills to staff within MoH and develop collaborations between MoH and epidemiologists at local universities.
We eventually aim to have a group of people within MoH in all three countries who will form the basis of an Analysis Unit. These people will be able to identify the indicators to measure HIV programme performance and questions that need to be answered, and to extract and analyse data to provide the results. These people will link with collaborators, both in local universities, and with international researchers to help them adapt the tools and methods from this project to other research questions. Results from these analyses will be used in strategic and operational planning, to improve the performance of the HIV programs, and to compare results across partners within the programmes.
- Objectives in Malawi
This page will contain details of our objectives specific to Malawi.
- Objectives in Tanzania
Our first objective in Tanzania is to document and publish tools for the extraction and analysis of data collected in HIV care and treatment clinics.
We are also using these data to analyse outcomes of adults on first-line therapy, to assess their need to switch to second-line therapy, and whether this switch happens. These results are currently being written up for publication in a peer-reviewed journal and will be made available when ready.
- Objectives in Zambia
This page will contain details of our objectives specific to Zambia.
The SEARCH team is based between LSHTM, Malawi, Tanzania and Zambia.
The SEARCH project is funded by a grant from the Bill & Melinda Gates Foundation to LSHTM.
- The SEARCH Team at LSHTM
The SEARCH team includes LSHTM staff based in London and Tanzania.
In July 2015 we have had a few changes to the LSHTM team. Frankie Liew has taken over the Administrative roles with the search project, after Christina Albertsen moved to a different project. Jenny Renju is a new part-time appointment, and will cover Fiona’s maternity leave.
- Jim Todd, Principal investigator, Reader in Applied Biostatistics
- Paul Mee, Research Fellow LSHTM based in London supporting SEARCH fellows in Tanzania and Zambia
- Frankie Liew, Administrator, project management and coordination
- Ab Schaap, Statistician in Infectious Disease Epidemiology, based in Lusaka with ZAMBART
- Fiona Vanobberghen, Lecturer in Medical Statistics
- Jenny Renju, Lecturer in Epidemiology, based in Moshi, Tanzania with Kilimanjaro Christian Medical University College
- Basia Zaba, Brass-Blacker Professor of Demography and Health
- The SEARCH Team in Tanzania
The SEARCH team in Tanzania includes staff from the Ministry of Health and Social Welfare (MoHSW) and Kilimanjaro Christian Medical University College (KCMUCo).
The following MoHSW staff have been appointed as SEARCH fellows:
- Joseph Nondi, data manager/statistician in NACP
- Prosper Njau, progamme officer in PMTCT
- Renatus Kisendi, programme officer in HIV counselling and testing
- Werner Maokola, HIV/TB coordinator
Read more about the Tanzania Ministry of Health and Social Welfare.
Staff from KCMUCo will be involved in the academic supervision of the students. This includes:
- Sia Msuya
Read more about Kilimanjaro Christian Medical University College.
- The SEARCH Team in Zambia
The SEARCH team in Zambia include:
- Patrick Musonda, Lead Medical Statistician, University of Zambia
- Tendai Munthali, SEARCH fellow and Senior TB officer, Ministry of Community Development Mother and Child Health
- Brian Muyunda, SEARCH project fellow and Senior Health Information officer, Ministry of Health, based in University Teaching Hospital in Lusaka
- Lloyd Mulenga, SEARCH project fellow and Clinician, Adult Infectious Diseases Clinic, University Teaching Hospital, Lusaka, Zambia
Organisations which we work with in Zambia include:
- Bill & Melinda Gates Foundation
The SEARCH project is funded by a grant from the Bill & Melinda Gates Foundation.
Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people’s health and giving them the chance to lift themselves out of hunger and extreme poverty.
Based in Seattle, Washington, the foundation is led by CEO Jeff Raikes and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.
Read more about the Bill & Melinda Gates Foundation.
Werner Maokola was appointed as a SEARCH fellow in Tanzania at the end of 2014, and has now successfully registered for the PhD programme at KCMU College in Moshi, Tanzania. Werner will assess the implementation of isoniazid preventive therapy (IPT) and its impact on TB incidence and mortality among people living with HIV in Tanzania. His work will use routinely-collected HIV data from 19 clinics involved in the first roll-out phase of IPT. The aims of his work are to determine the coverage of IPT, the barriers to implementation and the impact on TB incidence and overall mortality. His work will broaden our knowledge on the effectiveness of IPT in routine programmatic settings and inform the government on scale-up.
We warmly congratulate Werner on this important step and wish him well in the next stages as a PhD candidate.
The second SEARCH project meeting was held on February 22nd 2016 at the Southern Sun hotel in Lusaka. The event organised by Dr Patrick Musonda and his team from the University of Zambia School of Public Health brought together over 50 delegates from the various stakeholders associated with the SEARCH project in Zambia. Attendees came from the Zambian Ministry of Health, the Zambian office of the US Centre for Disease Control (CDC) , the University of Zambia Teaching Hospital (UTH) , ZAMBART and the University of Zambia School of Public Health. The meeting was launched with excellent presentations from Professor Charles Michelo and Dr Alwyn Mwinga which emphasised the importance of data sharing and the development of skills in data analysis in order to effectively develop health programmes. The SEARCH project was introduced by its Principal Investigator Dr Jim Todd who also presented formative research carried out in Tanzania on how HIV related clinical data was collected and used in the country. There were presentations from the Zambian SEARCH fellows , Tendai Munthali, Brian Muyunda , Aggrey Mwemba and Seh Gumede who is associated with the project. Each of these presentations introduced their individual research plans and described results from analytical work carried out so far. Dr Paul Mee from LSHTM introduced results from an analysis he has been carrying out of the HIV treatment cascade in Tanzania.
Thanks must go to Dr Musonda and his team for their excellent organisation of the event.
Prosper Njau one of the Tanzanian SEARCH fellows has now registered for his PhD program with KCMU college based in Moshi Tanzania. Prosper’s research is related to the effect of the roll-out of Option B+ for the prevention of mother to child transmission of HIV (PMTCT) in Tanzania. With option B+ any expectant mother found to be HIV positive during antenatal care will be offered anti-retroviral therapy (ART) irrespective of their CD4 cell count and will remain on treatment subsequent to the birth. Prosper will investigate how the maternal and infant morbidity and mortality outcomes have changed as a result of the introduction of Option B+ and whether there is evidence for any changes in treatment adherence or loss to follow-up.
We congratulate Prosper on this significant step in his academic career.
We are pleased to announce that a third SEARCH fellow has been appointed in Zambia: we welcome Lloyd Mulenga to the team. Lloyd is a clinician, working in the Adult Infectious Diseases Clinic in the University Teaching Hospital (UTH). His initial plans for research are around adverse events and resistance to ART, concentrating on second-line therapy.
In addition, Seh Gumede, who is a PhD student at LSHTM, has been recruited to help with nutrition teaching in Public Health at the University of Zambia (UNZA). Seh has an interest in analysing some of the routine data on nutrition and development in children infected with or exposed to HIV.
Read more about the SEARCH team in Zambia.
The SEARCH fellows in both Tanzania and Zambia are busy with various training programmes, including visits to LSHTM later this year for short courses and meetings with colleagues based at the School. We look forward to welcoming them to London.
We are planning to hold short workshops in Tanzania and Zambia later this year or early in 2016, for the fellows to present their ideas and work within the SEARCH project. Watch this space for further updates.
In July 2015, a few changes took place within the SEARCH team.
Frankie Liew has taken over the Administrative roles with the project, after Christina Albertsen moved to a different project. Jenny Renju is a new part-time appointment, and will cover Fiona’s maternity leave.
We thank Christina for all her contributions to the SEARCH project, and welcome the new members of the team!
Read more about the SEARCH team at LSHTM.
We are delighted to announce that Brian Muyunda has been appointed as a SEARCH fellow in Zambia. Brian is the second SEARCH fellow to join the team in Zambia, following the appointment of Tendai in June.
Brian currently works as a Senior Health Information Officer in the Ministry of Health (MOH).
Brian works with SmartCare data, and has identified PMTCT as his area of research. He is interested in developing his research on the uptake of services throughout the PMTCT cascade. This includes attendance at ANC, testing for HIV, delivery of preventive measures, treatment (Option B+) and new born care.
We are delighted to announce that Tendai Munthali will be joining the team, as a SEARCH fellow in Zambia. Tendai currently works as a senior TB officer for the Ministry of Community Development Mother and Child Health (MCDMCH), in Lusaka.
Tendai will commence her fellowship with a literature review of HIV and SmartCare data in Zambia. Over the next year, she will develop her research proposal in close collaboration with Ministry colleagues and policy makers, and will attend courses to prepare her for the work ahead. Tendai will remain working with the Ministry while undertaking her fellowship, to ensure that her research focuses on issues relevant to policy decision making.
It is anticipated that further SEARCH fellows will be recruited in Zambia soon. Read more about the SEARCH team in Zambia.
In June 2015, a collaborative analysis workshop took place in Moshi, Tanzania. It was led by the National AIDS Control Program, and included 46 participants from the Ministry of Health and Social Welfare, Kilimanjaro Christian Medical University College, London School of Hygiene and Tropical Medicine, the Centers for Disease Control in Tanzania, and several partner organisations involved in the delivery of HIV care in Tanzania.
The aim of the workshop was to process and analyse the rich data collected throughout the HIV Care and Treatment Clinics across Tanzania. This is the fourth such workshop of its kind, and previous reports are available on the NACP website.
Data were available from 746 clinics, and included data on 1,180,121 patients over the last 10 years. Analyses were performed on adults and children, assessing coverage, enrolment to care, ART initiation and retention in care. A full report is now in preparation and will be made available by August 2015.
The workshop offers additional benefits, bringing people from a range of disciplines together and enabling sharing of knowledge and skills. In addition, as part of the SEARCH project, we will make the final analysis programs from the workshop available when ready, so that they are available for use by others.
We are pleased to announce that four staff members of the Ministry of Health and Social Welfare (MOHSW) in Tanzania have been appointed as SEARCH fellows:
- Joseph Nondi, currently data manager/statistician for NACP (National AIDS Control Program)
- Prosper Njau, progamme officer in PMTCT (prevention of mother to child transmission)
- Renatus Kisendi, programme officer in HIV counselling and testing
- Werner Maokola, TB/HIV coordinator
The selection procedure was competitive, with a number of excellent candidates, and we warmly congratulate the successful fellows. Over the next year, the fellows will be developing their research proposals in close collaboration with MOHSW policy makers, and attending statistical and epidemiological courses to prepare them for their research. The fellows will remain integrated with their current work to ensure that their research addresses relevant questions to directly inform policy.
Read more about the SEARCH fellows in Tanzania.
On 17 September 2014, members of the SEARCH team attended an LSHTM symposium entitled “Improving health worldwide: strengthening research capacity”, where they presented a poster on the SEARCH project.
The day included stimulating talks from staff at LSHTM, UK Collaborative Development Sciences, the Medical Research Council, the Department for International Development, and the Malawi Epidemiology and Intervention Research Unit. Participants came from institutions all over the world, and engaged in lively discussions on their experiences and visions for capacity strengthening.
Our poster discussed the background to the SEARCH project, including the long-standing collaboration between LSHTM and the Tanzanian National AIDS Control Program. We outlined our plans for the future, such as the training of ministry of health staff in Malawi, Tanzania and Zambia and their enrolment into PhD programmes in within-country academic institutions. Download the SEARCH poster (pdf).
Initial meetings for the SEARCH project took place in Lusaka, Zambia in September 2014. The principal investigator of the SEARCH project, Jim Todd, met with collaborators from ZAMBART (the Zambia AIDS Related Tuberculosis project), the University of Zambia (UNZA), the Ministry of Health (MOH) and the Ministry of Community Development, Mother and Child Health (MOCDMCH).
Throughout a series of meetings, there was general agreement on the need for more analysis capacity within the ministries, and that greater collaboration between ZAMBART and UNZA would be a good way to achieve this. Dr Alwyn Mwinga from ZAMBART has been appointed as coordinator of the SEARCH project in Zambia. Statistical expertise and oversight will be provided by Ab Schaap (ZAMBART), Professor Charles Michelo (UNZA) and Dr Patrick Musonda (UNZA) for the supervision of the PhD candidates. Three fellows will be put forward by the health ministries, with the final selection by the SEARCH project committee including academic representation from UNZA. Administrative support will be provided by Brenda Munugwe (ZAMBART) and Dr Martina Mitambo (UNZA).
Contracts are now being prepared, and a follow up meeting is planned for November. We are all looking forward to taking forward this work in Zambia.
Read more about the SEARCH team in Zambia.
A key principle of the SEARCH project is the engagement of Ministries of Health and academic institutions in Malawi, Tanzania and Zambia, to ensure long-term durability of our work. We are pleased to announce that contracts have recently been signed between LSHTM and Kilimanjaro Christian Medical University (KCMU) College in Tanzania, thus formalising our mutual commitment to the SEARCH project. The aims of the project include the development and publication of tools to enable analysis of routinely-collected HIV data, and building in-country capacity to further develop and apply the analysis tools. Read more about our objectives.
The signing of the contracts means that we can now recruit up to three research fellows from the Ministry of Health and Social Welfare (MoHSW) in Tanzania. The fellows will be trained to apply the methods and tools that have been developed to date, providing the basis for an analysis unit at the Ministry of Health. This will ensure that there is capacity to develop further analyses in the future thus leading to rigorous results to directly inform policy.
We now have a formal commitment with KCMU college. Both KCMU college and LSHTM will be building on a long-standing collaboration with the MoHSW in Tanzania. This collaboration has already demonstrated a number of important outputs. Read more about the background to this project and our outputs.
The World Health Organization, the US Agency for International Development and the University of Oslo held a technical consultation in June 2014 in Switzerland on “Monitoring results with health facility information systems”. Delegates included representatives from Afghanistan, Cambodia, Ghana, Kenya, Nigeria, the Philippines, Rwanda, South Africa, Tanzania and Uganda. Many global partners were present, including from the Bill and Melinda Gates Foundation, US Centers for Disease Control, GAVI Alliance, and the Global Fund to Fight AIDS, TB and Malaria. Jim Todd and Fiona Vanobberghen from the SEARCH team were also present.
Objectives of the meeting were to:
- Take stock of the current situation concerning health facility information systems with a focus on innovative approaches.
- Identify the key elements of a well-functioning health facility information system.
- Identify existing and required tools and approaches to strengthen the implementation of a new generation of country health facility information systems.
- Discuss ways in which global partners can best support the strengthening of country facility information systems and institutional capacity.
During two days of workshops and presentations, a draft toolkit was developed, to support the development of a new generation of country health facility information systems. This covers wide-ranging aspects such as governance; innovations in data collection and management; and data quality, analysis, dissemination and use. Work will continue to develop this document further, with the overall aim of outlining the priority investments that countries and global partners need to make to develop an efficient and effective system with facility-based data. Such a document would have direct applicability to the systems currently existing in countries such as Tanzania, with whom the SEARCH project is working.
Members of the SEARCH team will be taking part in a technical consultation on “Strengthening Routine Monitoring with Health Facility Data”, jointly organised by the World Health Organization (WHO) and United States Agency for International Development (USAID). The meeting will take place in Glion-sur-Montreux, Switzerland on 11-12 June, 2014. The aim of the workshop is to share and discuss progress, gaps and best practices regarding strengthening the availability, quality, analysis and use of health facility data and statistics through innovative forward-looking approaches. This has direct links with the aims of the SEARCH project and the team are looking forward to the meeting to hear the perspectives of others working in this area. Watch this space for an update after the meeting!
Our work has a broad range of output:
- Peer-reviewed papers
- Projects by Masters students
We also produce tools for data extraction and analysis.
Projects by Masters students
Joseph Nondi was awarded a Master of Science in Epidemiology and Applied Biostatistics from Kilimanjaro Christian Medical College in 2013, and his Masters thesis used the Tanzanian Care and Treatment Clinic data from Mwanza region to assess time from enrolment to ART initiation among adults. He used complex competing risks methods to take account of persons who die before initiation of ART.
Escor Tweve an MPH student at Kilimanjaro Christian Medical University college in 2013/14 used data from the CTC database in Dodoma to undertake his Masters project. His analysis showed that mortality and losses to follow up have reduced over the four years from 2010 to 2014. His work is published in Tropical Medicine and International Health.
Asungushe Kayombo obtained a scholarship from EDCTP to study the MSc in Epidemiology and Applied Biostatistics in KCMU college 2014/16. His research project is on access to care and treatment and retention on ART in Kagera region.
As part of our objectives, we produce tools which may be used and adapted for the analysis of routinely-collected HIV data.
Tanzanian Care and Treatment Clinic Data
Much work has already been done using these data. The following sections describe the data, and the procedures for extracting and analysing the data, illustrated with some example output.
Description of the database
The CTC data are documented in the Study Documentation. This provides all of the meta data, including descriptions of the tables and variables.
Further details about the database will be provided soon.
Data extraction methods
We will soon add a description of the data extraction methods.
Data processing and analysis
Data processing and analyses are performed in Stata version 12 (StataCorp. 2011. Stata Statistical Software: Release 12. College Station, TX: StataCorp LP). It is anticipated that the programmes will also be translated into R.
Of note, the datasets used by these programmes are processed versions of the tables described in the Study Documentation. Further explanations of the generation of these datasets from the tables will be provided soon.
We will soon add example output, generated from the analysis programmes.
There are a number of programmes addressing the use of routinely-collected data and the training of researchers, including:
The ALPHA network: This network aims to maximise the usefulness of data generated in community-based longitudinal HIV studies in sub-Saharan Africa for national and international agencies involved in designing or monitoring interventions and epidemiological forecasting.
The THRiVE consortium: This consortium aims to train East African health researchers in excellence. The model for supervision of PhD studies from THRiVE has been used for the SEARCH project. THRiVE is one of the Wellcome Trust African Institutional Initiatives, for strengthening health-related research, with Kilimanjaro Christian Medical University college as one of the collaborating institutions.
The SACORE consortium: This consortium is supported by the Wellcome Trust African Institutional Initiative. It focuses on developing research capacity in Zambia and Malawi, tying in with the SEARCH project work in the School of Medicine in the University of Zambia and the College of Medicine in Malawi.
Here we explain some of the abbreviations and terms that we use.
ANC: antenatal clinic. All pregnant women attending ANC are offered counselling and testing for HIV. Those who do not wish to be tested have the option to opt-out of the testing. This is an important component of PMTCT (see below).
ART: anti-retroviral therapy. This refers to the treatments given to HIV positive patients to reduce the amount of HIV virus, and to restore the immune system. Once initiated, ART should be taken for the rest of one’s life.
CTC: HIV care and treatment clinics. This is the name given to clinics in Tanzania which provide services to those who are HIV positive. Care refers to the services available prior to initiation of ART, and treatment refers to the ART treatment.
EGPAF: Elizabeth Glaser Pediatric AIDS Foundation. EGPAF is an NGO that provides HIV services in Tanzania, Zambia, and many other countries in Africa.
Futures Group: The Futures Group is an NGO that provides technical support for HIV services in many countries in Africa, including Tanzania and Zambia.
GFATM: Global Fund for AIDS, TB and Malaria.
HTC: HIV testing and counseling services. HTC includes many routes by which a person may be tested and counselled for HIV, including voluntary counselling and testing, and routine testing while attending health services (such as ANC).
ICAP: International Centre for AIDS Care and Treatment Program. ICAP is an NGO that provides HIV services in Tanzania, and many other countries in Africa.
KCMUCo: Kilimanjaro Christian Medical University college is a Tanzanian medical school providing Masters-level and PhD-level training in Public Health.
LSHTM: London School of Hygiene and Tropical Medicine is one of the leading research-focused graduate schools. It is leading the work in the SEARCH project with funds from the Bill and Melinda Gates Foundation
MDH: Muhimbili Dar City Harvard. MDH is an NGO that provides HIV services in Tanzania, and many other countries in Africa.
MoH: Ministry of Health. MoH provides the basic health services in many countries including Malawi and Zambia. In Tanzania, it is called the Ministry of Health and Social Welfare (MoHSW). In Zambia there are two health ministries, the Ministry of Health (MoH) and the Ministry of Community Development, Mother and Child Health (MoCDMCH).
NACP: National AIDS Control Program. NACP is the section of MoHSW that coordinates the HIV services in Tanzania.
PAI: PharmAccess International. PAI is an NGO that provides HIV services in Tanzania, and many other countries in Africa.
PEPFAR: President’s Emergency Plan for AIDS Relief.
PITC: provider-initiated counselling and testing.
PMTCT: prevention of mother to child transmission of HIV.
SEARCH: sustainable evaluation using analysis of routinely collected HIV data.
TUNAJALI: Deloitte/Family Health International. TUNAJALI is an NGO that provides HIV services in Tanzania, and many other countries in Africa.
UNAIDS: Joint United Nations Programme on HIV/AIDS.
UNDP: United Nations Development Programme.
UNZA: University of Zambia, School of Medicine provides postgraduate training at Masters-level and PhD-level. It provides the academic training for SEARCH fellows in Zambia.
USG: United States Government. USG provides the funds for PEPFAR (see above).
VCT: voluntary counselling and testing. One of the ways a person can find out their HIV status is by attending VCT clinics.
WHO: World Health Organization.
ZAMBART: The Zambia AIDS Related Tuberculosis (ZAMBART) Project is a Zambian NGO which is administering the SEARCH project in Zambia.