TITLE: Rapid multiple-source HIV/AIDS data synthesis for program planning (Triangulation) in Tanzania

NEED and COMPARATIVE ADVANTAGE: This activity is part of the overall SI strategy of Tanzania to build

capacity to assemble, analyze, and better utilize existing data to answer key program questions and inform

policy decisions and program planning and implementation.

As PEPFAR-funded country programs have expanded and matured, SI systems have also evolved and

data collection has become widespread. Countries collect individual and aggregate program monitoring

data through routine monitoring systems; HIV biological and behavioral data through surveillance systems;

additional knowledge, attitude, behavior, and biomarker data through population based surveys; service

availability and provision data through facility surveys; and program evaluation and research information

through special studies.

Although countries expend a lot of effort to collect these data, they are seldom synthesized, disseminated or

used effectively to inform program planning and implementation or to make policy decisions. Fostering

evidence-based decision-making is one of the most important uses of HIV/AIDS data. When stakeholders

use this information to make decisions, they help to improve overall health care by increasing the health

system's ability to respond to the needs of those affected at all levels. Better use of this information also

promotes accountability and transparency in the decision-making process. In order to do this effectively, it is

essential to know the users, as well as their required and desired uses of the data. It is critical to identify

underutilized data sources and address the reasons why data are not being better used to meet the needs

of stakeholders.

Triangulation is synthesis and integrated analysis of data from multiple sources for program decision-

making, and a powerful tool that is used to demonstrate program impact, identify areas for improvement,

direct new programs and enhance existing programs, and help direct policy changes. It strengthens the

understanding of complex health issues, and provides support for making evidence-based public health

decisions.

ACCOMPLISHMENTS: Using FY 2007 funds (central & in-country), Tanzania will begin data synthesis

activities with assistance from UCSF and CDC HQ. Accomplishments to date include advocacy meetings

with Ministry of health (NACP and HMIS), TACAIDS and NIMR, all of which are very enthusiastic about this

project. Next steps include initial stakeholders meeting in the fall of 2007 to be facilitated by UCSF, and

formation of a task force to begin activities including the identification key questions.

ACTIVITIES: The three goals of this activity are a) to analyze single source data from routinely collected

data from HIV/AIDS intervention programs such as PMTCT or counseling and testing programs, b) to

conduct the country-driven data triangulation process to answer key questions prioritized by the country

team, and c) to build in-country capacity (individual and institutional) to synthesize, interpret, disseminate,

and use data for program improvement including evidence-based policy-change decisions. This country-

driven approach will enhance ownership and promote sustainability.

This activity will synthesize data from many sources including: a) routinely collected data from HIV/AIDS

intervention programs such as PMTCT, CT, TB/HIV, and blood donor services; b) surveillance data,

including. ANC surveys (with valid data available from 2001) and AIDS case surveillance; c) population-

based surveys such as the THIS (2003/4 and 2007) and Demographic Health Survey; and d) special

surveys and impact assessments.

This activity will be done in three phases: a) For each data source, there will be assessment, through

stakeholder meetings and discussions to determine the users of the data, and what information they need in

order to fully utilize data to inform program planning, implementation and policy modification as necessary.

The content and packaging of the synthesized information will be tailored to suit the target audience for

each data source. This may include packaging the reports into several levels and formats, e.g. reports to

National policy makers versus reports intended for service providers at facility, district or regional level. b)

For each data source, the national task force will determine what data have already been collected, the

quality of that data, and what additional data need to be collected to meet users' needs. The task force will

also develop mechanisms for accessing data from all sources. c) Once the data have been assembled,

CDC, in collaboration with UCSF and the task force, will develop an approach to analyses which will include

determining which data sources will be analyzed and disseminated individually to target groups, versus

those that will be part of the triangulation process to answer key questions. Due to varying/multiple user

needs, some data sources will be in both.

Planned funds will be used to continue activities started in FY 2007 to build in-country capacity to regularly

conduct triangulation as new data becomes available. Specifically, funds will cover external consultant

salary and travel, a local in-country coordinator/analyst to keep the process moving forward and to provide

technical assistance, materials adaptation and preparation (including workshop materials, reports, and

presentations), and any costs associated with conducting the in-country workshops funds may also be used

to conduct follow-up analytic and capacity-building activities upon request of the country team.

There will be five major activities as follows: a) formation of a country task force to guide the identification of

existing data sources and to formulate key questions that can be answered by synthesizing these data; b)

conduct stakeholder meetings to link program and policy experts with strategic information experts in order

to bridge the disconnect between the SI personnel who are charged with collecting and managing the data

and the program managers who need the information to make evidence-based decisions and plan

programs; c) conduct data compilation, analyses and report packaging workshops facilitated by UCSF data

analysts and attended by in-country data analysts from NIMR, NACP, MoHSW, TACAIDS and other USG

partners. These workshops will ensure sustainability by building long term capacity for regular data

synthesis; d) conduct task force meeting(s) to review findings and organize the report(s) for presentation at

the stakeholder meeting; e) conduct stakeholder meetings to disseminate findings, develop strategies for

further dissemination, develop recommendations for data use and identify gaps in knowledge that could be

filled by future data synthesis work.

LINKAGES: This activity will bridge the gap that often exists between the SI personnel who are charged

with collecting and managing the data and the program managers who need the information to make

Activity Narrative: evidence-based decisions and plan programs. Stakeholder meetings will see the two groups working

closely together with the program managers identifying key program questions that they see as useful in

informing their decisions, and SI personnel formulating data analyses to answer these questions. Program

managers incorporated into the task force will review the findings, reports and presentations, and provide

feedback as to whether data are presented in a format that answers the key questions. Additionally,

triangulation of data from different HIV/AIDS program areas and evidence of the inter-relationships between

these interventions will provide an opportunity for personnel to share ideas on how to strengthen referral

and other linkages between programs.

CHECK BOXES: This is an SI activity which will build capacity.

SUSTAINAIBLITY: The approaches used in this activity ensure ownership and promotes sustainability.

These include a country-driven data synthesis that brings together SI personnel with program managers

and policy makers to: a) jointly understand the functions and needs of data users; b) determine the

information that each group needs to perform functions appropriately; c) understand what data have already

been collected, the quality of that data, and what additional data need to be collected to meet users needs;

d) develop content and packaging information in a format and language suitable for the intended audience;

e) make the information available through appropriate channels and as rapidly as possible; and f) build

individual and institutional capacity to interpret, disseminate and use information.