What was the problem?
Before 2012, Haiti did not have a system for following HIV-positive patients along the continuum of care. The Ministry of Health (MoH) realized that the lack of an integrated surveillance system was contributing to difficulties in tracking and treating people living with HIV (PLHIV). Whether PLHIV chose to use a different health facility, discontinued care altogether, or died, there was no system in place to track these individuals. As a result, in order to advance Haiti’s efforts to end its HIV epidemic and meet the Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets, the MoH developed one of the first longitudinal case-based surveillance systems in the Caribbean region.
HIV case-based surveillance is the systematic reporting of newly diagnosed HIV cases and sentinel events (Figure 1). Longitudinal records are created when HIV case-based surveillance data are reported to a central data repository where HIV-related events are matched and de-duplicated. Using longitudinal case-based surveillance data allows for the monitoring of key indicators in the HIV disease progression. Currently, few PEPFAR countries have longitudinal case-based surveillance systems in place to collect these type of data.
What is the tool?
A National HIV Reporting Electronic Platform in Haiti, known as Suivi Actif Longitudinal du VIH en Haiti (SALVH), integrates data from multiple sources into a single national dataset. HIV is a name-based notifiable health event, therefore all HIV testing facilities are required to report core sentinel surveillance events such as new HIV diagnoses, each previously diagnosed but unreported case, and each person who progresses to advanced HIV disease (Figure 1). At the site level, electronic reports of new HIV diagnoses from HIV testing sites, and multiple follow-up variables from the three electronic medical record systems (EMR) are sent to SALVH. Cases are then matched and de-duplicated to allow for longitudinal patient tracking (Figure 2). The data collected through the surveillance system allows Haiti’s MoH to stay informed of HIV cases, where they are located, patient mobility, and key service gaps. Additionally, the longitudinal data are used to track clinical outcomes and monitor quality of linkage to care.
SALVH Key Components
1. Data reporting from voluntary counseling and testing (VCT) sites through EMR
2. Regular data transfer from VCT sites to SALVH via a secure, electronic reporting interface
3. Data cleaning and case matching and data quality reports to troubleshoot EMR transfer issues
Once data are cleaned and de-duplicated, they are placed in the National SALVH Database
4. Analysis and visualization platform permits users with authorized access to create custom reports and dashboards from the National SALVH Database
SALVH is an important tool in obtaining efficient and actionable data to help end the HIV epidemic in Haiti. The use of longitudinal case-based surveillance data is crucial to monitor the country’s progress toward achieving the UNAIDS 90-90-90 targets, which aim to ensure PLHIV in Haiti are aware of their status, receive treatment, and are virally suppressed. The longitudinal case-based surveillance system practice can be implemented in other countries to aid in monitoring and controlling HIV.
For information on innovative approaches to advance the national case-based longitudinal surveillance system see Appendix A.