By Centre for Disease Control and prevention CDC Zimbabwe continued to play a leading role in supporting the MoHCC’s strategic information activities in 2019 by providing technical leadership and programmatic guidance for routine monitoring and reporting, newly diagnosed HIV & recent infection surveillance, and health management information system support. In 2019, significant progress was made in transitioning from paper-based to electronic systems through CDC’s support towards developing a comprehensive EHR and LIMS. The long-term goal is to build integrated and interoperable electronic data collection systems that will feed into the District Health Information System (DHIS-2) national repository.
In order to ensure sites are reporting accurate information on the number of patients receiving HIV treatment, the MoHCC led a national data quality audit to update the number of PLHIV on HIV treatment as of Oct 31, 2018. This activity took place between December 2018 and March 2019. Each of the 1700+ sites were instructed to abstract a limited amount of information from each patient record including OI/ART number (unique ID), demographic information, date of ART initiation, most recent visit date, and next visit date. Any additional information related to the status of the patient (documented transfer out, death, etc.) was also abstracted. These data were critical for input into the Spectrum model which estimates the number and ages of PLHIV living in the 62 districts across Zimbabwe. This information forms the basis for PEPFAR annual planning, helping the country team determine strategies to employee across the districts based on demographic factors associated with those not yet on HIV treatment.
CDC/PEPFAR worked with our clinical implementing partners to ensure a full listing of HIV patients was line-listed and transmitted to national level for the 1,129 PEPFAR-supported sites (449 CDC- supported sites). To verify the accuracy of the information, the CDC/PEPFAR teams led a national data validation exercise. A sample of 10% of the PEPFAR-supported sites were visited by interagency PEPFAR teams compromised of at least 1 CDC and 1 USAID lead. A manual recount of all active patient files was conducted onsite to validate the line-listed data from the visited site. More than 200,000 patient files were reviewed as part of this initiative from 114 sites across 11 districts. The activity took 12 weeks to complete and CDC Zimbabwe staff across all technical branches contributed more than 160 person-days.
This exercise validated the MoHCC ART census and confirmed the correct national number of patients receiving ART in Zimbabwe was not 1,172,978 as previously reported but 1,021,167 people. Input of the corrected figure into a Spectrum re-run reduced the national PLHIV estimate from 1,361,055 to 1,315,645 a reduction of more than 45,000 people, suggesting a true ART coverage of about 77% at the time of ART census (October 2018).
Large changes in the estimated ART coverage occurred in several district which led to modifications in the case-finding strategies and allowed for PEPFAR programs to identify and initiate 100,601 newly diagnosed patients on treatment (47,985 through CDC-supported activities). The CDC/PEPFAR implementing partners also used this exercise to improve their documentation processes at the supported sites and conducted rigorous trace-back of patients who had been identified as LTFU. At the end of 2019 the estimated national ART coverage in Zimbabwe is now 84%.
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