Assessment of facility-based tuberculosis data quality in an integrated HIV/TB database in three South African districts

Joshua P Murphy; Sharon Kgowedi; Lezanie Coetzee; Vongani Maluleke; Daniel Letswalo; Constance Mongwenyana; Pria Subrayen; Salome Charalambous; Lindiwe Mvusi; Sicelo Dlamini; Neil Martinson; Aneesa Moolla; Jacqui Miot; Denise Evans

doi:10.1371/journal.pgph.0000312

Assessment of facility-based tuberculosis data quality in an integrated HIV/TB database in three South African districts

PLOS Glob Public Health. 2022 Sep 28;2(9):e0000312. doi: 10.1371/journal.pgph.0000312. eCollection 2022.

Authors

Affiliations

¹ Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, Johannesburg, South Africa.
² The Aurum Institute, Parktown, Johannesburg, South Africa.
³ School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
⁴ South African National Department of Health, Pretoria, South Africa.
⁵ Perinatal HIV Research Unit (PHRU), Soweto, South Africa.

Abstract

Background: Assessment of data quality is essential to successful monitoring & evaluation of tuberculosis (TB) services. South Africa uses the Three Interlinked Electronic Register (TIER.Net) to monitor TB diagnoses and treatment outcomes. We assessed the quality of routine programmatic data as captured in TIER.Net.

Methods: We reviewed 277 records from routine data collected for adults who had started TB treatment for drug-sensitive (DS-) TB between 10/2018-12/2019 from 15 facilities across three South African districts using three sources and three approaches to link these (i.e., two approaches compared TIER.NET with the TB Treatment Record while the third approach compared all three sources of TB data: the TB treatment record or patient medical file; the TB Identification Register; and the TB module in TIER.Net). We report agreement and completeness of demographic information and key TB-related variables across all three data sources.

Results: In our first approach we selected 150 patient records from TIER.Net and found all but one corresponding TB Treatment Record (99%). In our second approach we were also able to find a corresponding TIER.Net record from a starting point of the paper-based, TB Treatment Record for 73/75 (97%) records. We found fewer records 55/75 (73%) in TIER.Net when we used as a starting point records from the TB Identification Register. Demographic information (name, surname, date of birth, and gender) was accurately reported across all three data sources (matching 90% or more). The reporting of key TB-related variables was similar across both the TB Treatment Record and the TB module in TIER.Net (p>0.05). We observed differences in completeness and moderate agreement (Kappa 0.41-0.60) for site of disease, TB treatment outcome and smear microscopy or X-ray as a diagnostic test (p<0.05). We observed more missing items for the TB Treatment record compared to TIER.Net; TB treatment outcome date and site of disease specifically. In comparison, TB treatment start dates as well as HIV-status recording had higher concordance. HIV status and lab results appeared to be more complete in the TB module in TIER.Net than in the TB Treatment Records, and there was "good/substantial" agreement (Kappa 0.61-0.80) for HIV status.

Discussion and conclusion: Our key finding was that the TB Module in TIER.Net was more complete in some key variables including TB treatment outcome. Most TB patient records we reviewed were found on TIER.Net but there was a noticeable gap of TB Identification patient records from the paper register as compared to TIER.Net, including those who tested TB-negative or HIV-negative. There is evidence of complete and "good/substantial" data quality for key TB-related variables, such as "First GeneXpert test result" and "HIV status." Improvements in data completeness of TIER.Net compared to the TB Treatment Record are the most urgent area for improvement, especially recording of TB treatment outcomes.

Copyright: © 2022 Murphy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This study was funded by the Bill and Melinda Gates Foundation (OPP 1173131) under through the South African National TB Think Tank and Aurum Institute. https://www.gatesfoundation.org/ The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National TB Think Tank or its funders. This work has also been made possible by the generous support of the American People and the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID under the terms of Cooperative Agreements 72067419CA00004 to HE2RO. The contents are the responsibility of the authors and do not necessarily reflect the views of PEPFAR, USAID or the United States Government. https://www.state.gov/pepfar/ Research reported in this publication was also supported by the Fogarty International Center and National Institute of Mental Health, of the National Institutes of Health under Award Number D43 TW010543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. https://sites.sph.harvard.edu/global-health-research-partnership/ The funders had no role in the study design, collection, analysis and interpretation of the data, in manuscript preparation or the decision to publish.