Strengthening Jakarta and Program HIV Data Systems;

development, analysis and use of cohort data for HIV treatment

acceleration

Siti Sulami, M.Epid

Senior Technical Advisor, Strategic Information

LINKAGES

Collaboration Work with

MOH & PHO Jakarta

Outline Presentation:

I. Why cohort data is needed?

II. Development & Roll Out Aplikasi Rekap Kohort (ARK)

III. Strengthening Data Management, Analysis, and Use

Why cohort data is needed?

Jakarta Cross-Sectional Cumulative Cascade,

up to September 2020

ART coverage against 40% MOH 2020 target, 2020

ART coverage based on 2020

PLHIV Estimation

N=65,940

Development and Roll Out ARK

APLIKASI REKAP KOHORT (ARK)

• A tool for processing HIV treatment cohort data, two type of ARK

as user:

1. Facility level ARK

2. National/Province/District level ARK

• Cohort/Individual data is only accessed by facility

• Facility with use MOH standard forms:

• Pra ART & ART registration form

• VL testing form

• HIV care/ART card/Ikhtisar Perawatan

PERTAHANKAN/90 KETIGA

Fitur ARK terintegrasi dengan SIHA mencakup:

• Viral Load

(Notifikasi ODHA yang eligible tes VL, tes VL & hasil

VL)

OBATI/90 KEDUA

Fitur ARK terintegrasi dengan SIHA

mencakup:

• Test & Treat All

• ODHA yang eligible MMD dan ODHA on MMD

• ODHA baru on TLD

• LTFU/Miss Appointment

• Retention analysis (6,12,36,dstnya)

• Laporan LBPHA Lembar 1

• ODHA yang terdampak COVID-19

TEMUKAN/90 PERTAMA

Tool notifikasi pasangan yang

diintegrasi dengan SIHA dan

dashboard akselerasi

pengobatan.

Strengthening SIHA dan ARK

Kualitas data SIHA/ARK:

• Tool verifikasi data SIHA (DQA/E-

MON)

• PERSIS data validation tool

FRONT PAGE of ARK

Roll Out ARK: Jakarta (109 facility) & Other Provinces

Strengthening Data Management, Analysis & Use

IKHTISAR

PERAWATAN

FOLLOW UP

(ikhtisar lembar 2)

EXCEL BANTU

REGISTER PRA-

ART & ART

LBPHA KOHORT

SIHA

ONLINE

A R K

(upk)

HASIL TES VIRAL

LOAD

MOH PROV KABKOTA

TEST AND

TREAT,LTFU/MA,

MMD, TLD

SIHA

OFFLINE

TEST AND

TREAT

Proses manual

Proses otomatis/sistem

Technical Assistance follows Workflows of ARK

Form of support on:

• Hired data clerks/short term technical staff for supporting

Jakarta facility to complete and report cohort/individual data

into MOH system

• Routine TA to HFs

• Hold coordination and evaluation meetings for improvement

purpose

• Hold PERSIS data validation meetings

• PHO initiated Jakarta Memanggil champaign (e.g. use data

and ICT for improvement)

Results of TA: Quality of Data

Status: 60 sites, Sept’20

INTEGRATION PLAN: ARK AND SIHA 2.0

IKHTISAR

PERAWATAN

FOLLOW UP

(ikhtisar lembar 2) EXCEL BANTU

REGISTER PRA-

ART & ART ++

LBPHA KOHORT

SIHA 2.0

A R K

(upk)

HASIL TES VIRAL

LOAD

MOH PROV KABKOTA

TEST AND

TREAT,LTFU/MA, MMD,

TLD

SIHA 2.0

VIRAL

LOAD

Proses manual

Proses otomatis/sistem

Test & Start/Treat all: Diagnosis – ART Initiation, Jakarta

82%

Test &

Start

92%

Test &

Treat

N = total diagnosis - meninggal setelah diagnosis, meninggal dan rujuk keluar setelah masuk perawatan

29% 35%

43% 52%

65% 65% 62%

17%

18%

19%

19%

20% 14% 20%

22% 18%

14%

12%

7%

7%

9% 31% 28%

24% 17%

7% 14%

8%

J A N - M A R 1 9 A P R - J U N E 1 9 J U L Y - S E P T 1 9 O C T - D E C 1 9 J A N - M A R 2 0 2 0 A P R I L - J U N E 2 0 2 0

J U L Y - S E P T 2 0 2 0

Same day 2-7 days >7 day ART Not yet initiated

42 Puskesmas + 4 klinik swasta melapor dari 5 wilayah melapor di TW 3 2020

N=690 N=884 N=672 N=776 N=790 N=396 N=578

Source: MOH ARK 6.0, September 2020

69%

Test &

Treat

46%

Test &

Start

12-month retention rates , ART cohorts 2016 - 2019

All facilities show improvements in retention by cohort/year

Source: MOH ARK 6.0, September 2020

RETENTION ANALYSIS - including % LTFU, % Death -

Source: MOH ARK 6.0, September 2020

Before After

Data from 42 Puskesmas, 4 klinik dan 14 RS, Sept’20

LTFU Patients Cascade, 23 “SEHATI” facilities, July-Sept’20

Source: MOH ARK 6.0, September 2020

District-level two-month ARV dispensing, Oct’19-Sept’20

Source: MOH ARK 6.0, September 2020

Jakarta PHO to introduce home-based

ARV delivery services (JAK-ANTER)

as a means to ensure treatment

continuity for PLHIV who were unable

or unwilling to travel to HIV treatment

sites. Also supporting Jakarta’s

responses to both HIV and COVID-19

Initiate TLD: TLD provision by month and by district,

67 facilities, July-Sept’20

The proportion of new PLHIV receiving TLD rose in each month of implementation, from a low of 2% in July to 50% in September 2020

District-level coverage ranged from 10% in East Jakarta to 44% in Central Jakarta, and averaged 30% across the province

Source: MOH ARK 6.0 & PSM, September 2020

Trends in VL Uptake and Suppression – 60 sites, Oct’18-Sept’20

Source: MOH ARK 6.0, September 2020

13

,11

4

13

,75

6

13

,94

3

14

,44

3

14

,80

9

17

,62

5

15

28

5

16

71

9

1,3

74

3,6

04

4,7

99

5,5

74

8,9

23

10

,60

6

10

26

8

11

18

5

1,3

10

3,2

79

4,3

94

5,0

99

8,1

73

9,7

63

94

58

10

33

3 10%

26%

34% 39%

60% 60% 67% 67%

95% 91% 92% 91% 92% 92% 92% 92%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Q1 FY19 Q2 FY19 Q3 FY19 Q4 FY19 Q1 FY20 Q2 FY20 Q3 FY20 Q4 FY20

Eligible for VL With Documented VL Suppressed VL (<1,000 c/ml)

VL coverage Rate (%) VL Suppression Rate (%)

VL Testing, district-level coverage, 60 sites, July’19-Sept’20

Source: MOH ARK 6.0, September 2020

Program/Data Outcome Results

ICT and M&E

support

Data

Analysis Support

Program Innovation Strategy

Harmonization within one bowl

ARK as a tool to monitoring HIV

treatment acceleration

The new treatment facility is trained on ARK at

MOH Training for Scaling Up Treatment Sites,

since last week (3 batches)

“TERIMA KASIH”