Tanzania Program

Project Overview

UCSF has provided strategic information technical assistance to CDC Tanzania and the National AIDS, STI, and Hepatitis Control Programme (NASHCoP) since 2008. While monitoring and evaluation and surveillance have been the backbone of UCSF’s work in Tanzania, our office has grown to include a strong informatics team of health information systems (HIS) developers, analysts, and officers. This team supports national HIV information systems and improves access to, analysis and use of routine data. UCSF collaborates closely with the Ministry of Health, the United States President's Emergency Plan for AIDS Relief (PEPFAR), the United States Centers for Disease Control and Prevention (CDC), and US government implementing partners.

UCSF's work in Tanzania covers the entire spectrum of strategic information, starting from data collection and reporting at the health facility level, through to analysis and visualization of critical performance and programmatic indicators at the national level. We collaborate with the Ministry of Health to develop guidelines and toolkits to improve the use of paper tools and have the informatics expertise to support and develop innovative electronic data collection systems and visualization platforms. UCSF also supports HIV surveillance, working to identify key epidemiologic trends in HIV transmission to inform a targeted public health response.

Areas of Support

  • Facility-level Data Used for Quality Improvement Tools – UCSF works with the MOH and NASHCoP to create tools that enable health facilities to visualize critical HIV service and laboratory data to improve the quality of care for clients
  • PEPFAR Data Warehouse and Reporting Tools –  UCSF supports several tools used by PEPFAR implementing partners (IPs) to report key performance indicators, visualize data and monitor their performance

Accomplishments

Improved HIV/AIDS Care and Treatment Clinic (CTC) Analytics Application

  • General maintenance and development of CTC-Analytics, a C#-based facility tool to report and analyze data from the CTC2 HIV EMR, which is installed at more than 3,000 facilities
  • Facilitated adoption of the system by the government and worked on compliance recommendations such as use of a token to connect the facility database to CTC Analytics
  • Developed and revised SQL-based queries to ensure correctness per indicator definitions (e.g., viral load coverage, TX_CURR, etc.)
  • Deployed a feature that supported remote updating of queries, allowing the central level to remotely “push” new queries and analytics to all installations
  • Introduced new queries and domains including queries related to the prevention of mother-to-child health, non-communicable diseases, low-level viremia, and use of the pharmacy module within the CTC2 database
  • Improved report submission time from eight hours to one hour for large sites with large amounts of data

Impact: Facilities using the CTC-Analytics application have improved client management and the quality of their HIV prevention, care, and treatment services. The application’s ability to generate lists of clients who require critical services, such as clients eligible for an HIV viral load test and clients eligible for intermittent preventive therapy (IPT), helps providers to appropriately plan for and ensure that all required services are offered to clients at the right time. Built-in analysis of key performance indicators allows facility teams to monitor their performance and identify areas that need improvement.

Lab Visual Tool

  • Developed and implemented the Lab Visual tool for PCR labs to visualize laboratory continuous quality improvement indicators, including weekly trends in samples received and tested and machine performance
  • Re-engineered Lab Visual tool by upgrading to C#, implementing an ETL approach, and improving visualizations to enhance usability, security and report generation effectiveness
  • Enhanced the dashboard to allow users to view data trends for previous weeks and access data for any week of interest
  • Developed a reports section within the Lab Visual tool where users can download reports
  • Rolled out and trained users at seven PCR labs on Lab visual tool, including an orientation on data use 
  • Created a Data Management page to capture all data issues, allowing users to download, rectify and update data issues in the LIS database
  • Impact: The Lab Visual tool has empowered laboratory managers and staff with insightful and actionable analysis of key data, promoting data use, improving data quality and ensuring that laboratories generate more timely and accurate data. Improving lab indicators reporting by the labs, using the data generated by the lab visual, they can report more timely and accurate data.

CQI Monthly Reporting Tool

  • Developed and deployed a weekly performance tracker in the monthly portal to track near real-time process indicators to support facility staff in providing high-quality care to clients living with HIV
  • Developed an advanced ETL/analytics component based on SQL and Modular BI computing detailed CQI indicators for over a period of two years
  • Additional visuals, Testing and Prevention, PrEP, PMTCT_EID Cascade, PMD and VMMC visuals(trend and comparison) for facility and community
  • API to enable various Implementing partners  to connect with the monthly portal and pull various data points e.g. facility submission status 
  • Improved visualizations and scorecards to provide implementing partners with more meaningful analysis of routine data
  • Impact: The CQI Monthly Reporting Tool helped program implementation to be more data-driven, e.g. site visit is guided by data, and priority is given to facilities with low performance on the monthly portal CQI indicators.

DAMES System

  • Developed a PowerBI-based comprehensive online dashboard for the Tanzania DREAMS program, used by all DREAMS stakeholders, including implementing partners (IPs), the PEPFAR interagency DREAMS team and government institutions, to visualize key indicators, monitor programmatic outcomes and performance and analyze data through downloadable charts and aggregate data tables, leading to better program insights and more data-driven decision-making
  • Integrated each DREAMS partner's data system with the DAMES server to support standardized reporting of DREAMS indicators, allowing all implementing partners to report data in a uniform manner and enhancing the accuracy and comparability of data across the entire DREAMS initiative
  • Developed a real-time mobile data collection app based on Flutter and Java, used by over 300 DREAMS peer educators to register beneficiaries and log services received
  • Developed a DATIM export feature that allows IPs to report DREAMS data directly into DATIM

Impact: The DAMES centralized dashboard has given DREAMS program managers and stakeholders the ability to monitor performance of the program through the visualization and analysis of program performance across age groups and interventions, empowering them to identify programmatic successes and challenges and use data to improve the DREAMS program.

Additional Accomplishments

  • Developed a PowerBI dashboard to display key analysis of HIV-1 recency surveillance data, allowing stakeholders to monitor the performance of recency surveillance and providing access to meaningful analysis to promote data use
  • Developed the TEPI (Tracking and Enhancing Pediatric Identification) Dashboard, which was designed to support the integrated, collaborative efforts of PEPFAR Tanzania and its implementing partners in their mission to improve the identification of children living with HIV. This weekly dashboard enables stakeholders to monitor, evaluate and enhance the performance of pediatric identification through near-real-time data visualization and analysis

Key Leadership

UCSF

  • Principal Investigator: George Rutherford, MD, MS
  • Project Director: Christen Said – Tanzania Country Representative 
  • Leadership Team: Fitti Weissglas – Director of Health Informatics, Peter Lubambi – Tanzania HIS Team Lead