The Global Programs (GP) Office in Tanzania provides targeted HIV/TB strategic information (SI) technical assistance to improve the availability of high-quality HIV program data and to encourage the use of data for decision-making. Our staff work with CDC-Tanzania to provide the training, TA, and long-term capacity building to improve HIV prevention and care programs, surveillance systems, the capacity to monitor and evaluate these programs, including technical support to HIV-related data collection and reporting systems, and the ability to use results to guide program planning, program improvements, and allocation of resources. We provide training, mentorship, and technical assistance to build capacity in epidemiologic surveillance, monitoring and evaluation, health information systems, improving data quality and increasing data use, data science, and applied public health research among health ministries and local partners.
The GP Tanzania office has built a strong informatics team of HIS developers, analysts, and officers to support PEPFAR, CDC, and national HIV information systems and improve access to, analysis, and use of routine data. Our team maintains several informatics applications that provide data analysis and visualization functionalities that support improved delivery of health services to people living with HIV in Tanzania. Working closely with PEPFAR, NACP, ZIHHTLP, and other key stakeholders, we are continuously reviewing and improving these applications to meet user needs, to improve the user experience, and ultimately to improve the quality of services offered to HIV care and treatment clients.
In close collaboration with NACP and ZIHHTLP, our team is providing technical assistance to improve data completeness and quality, functionality and visualizations, interoperability, and effective use of national electronic patient monitoring systems.
In collaboration with PEPFAR through the DREAMS initiative, which seeks to reduce new HIV infections in vulnerable adolescent girls and young women, our staff developed an innovative platform that aggregates, analyzes, and visualizes data across all DREAMS implementing partners in Tanzania. This system allows DREAMS providers to link individual participants across interventions to assess the layering of DREAMS services. The platform also includes a mobile application, designed to facilitate DREAMS data collection and reporting.
In addition to our in-house expertise, we have access to and routinely collaborate with HIS professionals in our sister Global Programs offices in Kenya, Namibia, Uganda, and San Francisco through the UCSF Institute for Global Health Sciences Informatics Hub. This team has expertise in:
- Software development
- Server administration
- Systems design, development, testing and implementation
- Database management
- Popular open-source health information systems such as DHIS2, OpenMRS and ODK; data analysis, visualization, reporting and business intelligence systems
- App development for Android and iOS
- Dashboard development
- GIS mapping to design, develop, implement and use health information systems at national and sub-national levels
- User training
Data Quality Improvement and Program Monitoring and Evaluation
UCSF and Global Programs developed a standardized quarterly analysis of routinely reported PEPFAR data to assess the quality of the data and support implementing partners to address data quality issues. We are working with NACP to develop a Data Quality Improvement plan that will target routinely collected and reported HIV program data.
We have supported and continue to support NACP through the review and revision of national HIV patient monitoring tools to ensure they respond to national and international reporting requirements. The GP team also supports routine reviews of national data and information systems, and improvements to national tools to capture key indicators needed for program monitoring and improvement.
Our staff are working with the MoH to implement continuous quality improvement measures that will improve the quality of PMTCT and EID programmatic data. Our support starts from the conceptualization of steps that can be taken at the facility to improve data quality and extends through the development of an SOP and orientation of key stakeholders.
Tanzania – What we have done
UCSF and Global Programs developed the impact evaluation of the DREAMS Tanzania program. DREAMS is a global partnership between PEPFAR, Girl Effect, and the Bill & Melinda Gates Foundation to reduce new HIV infections in vulnerable adolescent girls and young women. This evaluation used innovative technology platforms and mixed methods including a longitudinal cohort, time-location sampling (TLS), and qualitative interviews to assess intervention effect and reach, program acceptability within target communities, and fidelity of implementation.
Program Monitoring and Evaluation
We supported the MoH to develop and roll out national data-quality assessment guidelines. The guidelines use the data-quality applications within the national HMIS (DHIS2) and routinize the assessment of routinely reported data within the national health system. We also supported NACP to develop and roll out the National Data Quality Guidelines for Care and Treatment. We also conducted a data-quality assessment of PEPFAR-required indicators for ART, HIV Testing and Counseling (HTC), and PMTCT to inform partner- and facility-level data quality improvement systems.
Our work supported the development and implementation of Monitoring and Evaluation (M&E) plans to help partners measure progress towards stated objectives and track program effectiveness. We have supported monitoring and evaluation of the PEPFAR Gender-Based Violence Initiative as well as the development of the M&E sections of the Zanzibar Health Sector HIV Strategic Plan II and the mainland Health Sector HIV Strategic Plan III.
Our staff provided technical assistance to NACP and ZIHHTLP in planning and implementing a number of integrated biological and behavioral surveillance surveys (IBBS), which are designed to improve understanding of the disease burden and unique service needs among key populations at risk for HIV. Our support for these surveillance activities began from the protocol development stage and continued through to report writing and dissemination. Results from these studies have been the basis for developing and improving programmatic interventions.
We supported two rounds of IBBS studies in Zanzibar among men who have sex with men, people who inject drugs, and female sex workers, as well as an IBBS among fisherfolk on Tanzania Mainland. In addition to documenting HIV status, risk behaviors, and other behavioral information, these studies included key population mapping and size estimation activities to better understand key population sizes, distributions, and characteristics. We also worked with NACP to conduct a study (known as TISINI) to identify and characterize high-risk populations at areas of high transmission along major transit corridors in Tanzania. The study assessed HIV prevalence and incidence measures, linkage to HIV services, sexual networks, high-risk behaviors and other drivers of the epidemic.
We provided technical assistance to NACP in conducting a SWOT assessment of the HIV/AIDS surveillance system and in determining the feasibility of implementing HIV case-based surveillance in Tanzania.
Our staff provided technical assistance to the Drug Control Commission of Tanzania in planning, implementing, and analyzing data for a mixed-methods assessment to better understand the scope of drug use in Tanzania, to estimate population size, and to map the geographic distribution of people who use and inject drugs along the coast and in other regions of the country. Key stakeholders used findings from this student to target and plan interventions for people who inject drugs.
We have also provided support to NACP on ANC/PMTCT sentinel surveillance among women attending antenatal care clinics to estimate trends in HIV prevalence.
Training and Capacity Building
We collaborated with the Tanzania Commission for AIDS (TACAIDS) to coordinate triangulation workshops with regional-, district- and facility-level HIV/AIDS providers. Workshops included training in Microsoft Excel, DHIS2 and mapping software to produce visual data displays; building local capacity to analyze and use sub-national data for program improvement; and developing HIV triangulation reports to assess and address challenges affecting service provision. GSI has coordinated 26 workshops covering 24 regions of Tanzania in an effort to promote a culture of data use and encourage evidence-based decision making.
Our team at UCSF Institute for Global Health Sciences and in Tanzania supported the launch of the Master’s of Science in Health Monitoring & Evaluation at Mzumbe University in 2013 and provided significant technical input to the curriculum’s development. The first cohort of students graduated in December 2015 and additional cohorts continue to enroll, thereby increasing the human resource capacity in M&E within the public sector. GSI also supported the launch of the East African Journal of Applied Health Monitoring and Evaluation, which is housed at Mzumbe University’s Centre of Excellence in Health Monitoring and Evaluation. As one measure to ensure sustainability of the journal, UCSF Institute for Global Health Sciences faculty mentored Mzumbe University faculty on scientific writing.We have conducted four scientific writing workshops to support CDC, NACP and ZIHHTLP staff to develop scientific manuscripts and guide participants through the manuscript submission and review process.