AHRI.Tier.Net.Release 2020-09
South Africa, 2004 - 2020
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AHRI.Tier.Net.202009.v3
AHRI.Tier.Net.Release 2020-09
| Name | Country code |
|---|---|
| South Africa | ZA |
TIER.net is an electronic patient management system that is used for monitoring and evaluation of HIV care and treatment programmes in government health facilities throughout South Africa. The system was designed as part of a 3-tier approach to implementing a full electronic medical records (EMR) system. This approach provides a flexible solution that allows facilities to transition towards EMR in stages, as their infrastructure improves, and resources become available. TIER.net forms the second tier, whereby patient's paper clinical records are entered into a non-networked computer at the health facility and transferred periodically to a central database.
The TIER.net database contains information on clinic visit attendance, laboratory results and ART dispensing records for all patients on ART. The system was implemented in uMkhanyakude district in 2013; patient records from all visits before 2013 were back-captured into the system. AHRI has a memorandum of agreement with the Department of Health to receive the TIER.net data for the 17 clinics in the Hlabisa health sub-district and Hlabisa hospital. A dedicated data entry clerk based in each clinic enters information from patients' paper clinical records into the TIER.net system after each patient visit. Laboratory results are manually entered into TIER.net after they have been received by the clinic (i.e. are not imported electronically from the National Health Laboratory Service (NHLS) system).
Currently, pre-ART visits are not recorded in TIER.net, although modules to capture HIV testing and pre-ART care may be implemented in the future.
AHRI's new clinical database - ACCDB (Africa Centre Clinical Database)
TIER.net has been integrated with AHRI's previous HIV care clinical database (ARTemis), which contains records for HIV positive patients in care at 7 clinics in the sub-district, to create a new combined clinical database, ACCDB. The ACCDB contains clinical records for all HIV positive patients on ART since 2004, when the Hlabisa HIV treatment and Care programme was implemented. Linkage between the two databases is based on personal identifiers, using algorithms developed at AHRI.
The patient records in ARTemis were captured prospectively by AHRI clinical staff from 2004 until 2012, whereas records from this period were back-captured into TIER.net. Therefore, the information in ARTemis pre-2013 was used to fill in missing data in TIER.net, with the following decision rules:
Patients who had records in TIER.net and not in ARTemis: All information retained
Patients who had records in ARTemis but not in TIER.net: No pre-ART records retained (TIER.net only contains records after ART initiation, whereas ARTemis also captured pre-ART information). Retained in new database if the patient started ART and died, transferred out, or was lost to follow-up before 2013.
Patients on ART with records in ARTemis from 2013 onwards, but no record in TIER, were assumed to be a result of a linkage mismatch and were not retained.
Patients who had records in both TIER.net and ARTemis: Visit records from TIER.net only (i.e. visits records from ARTemis are not combined with those in TIER). Laboratory results from ARTemis up to 2013 are combined with results in TIER
The new clinical database has been linked with the AHRI population surveillance database (ACDIS) and the Hlabisa hospital admissions database (HIS). A longitudinal analysis of the HIV care cascade (Haber et al. From HIV infection to therapeutic response: a population-based longitudinal HIV cascade-of-care study in KwaZulu-Natal, South Africa. Lancet HIV 2017; 4(5):e223-e230) has been rerun on the new combined TIER.net and ARTemis data, and results are consistent with those obtained from the ARTemis data alone (although the pre-ART stages must be excluded).
TIER.net data are transferred to AHRI from the central Department of Health on a monthly basis and integrated into ACCDB bi-annually, and the linkages with ACDIS and HIS are updated. (The linkage with the ARTemis database is not re-run since this database is no longer active).
In April 2017, there were >47,000 individuals on ART in the TIER database, of whom approximately 12,000 were linked to ACDIS and 6500 were linked to HIS.
Although TIER.Net data has been included up to July 2017, the current dataset should be analysed only up to end 2016, because it has been linked to the Dec 2016 analytical database. The updated ACCDB data for 2017 will be available towards the end of the first quarter of 2018, linked to the end of 2017 analytical database relase.
Individual
Version
v3.0.0
Scope
| Topic | Vocabulary | URI |
|---|---|---|
| Tier.Net | Africa Health Research Institute | www.ahri.org |
Producers and sponsors
| Name | Affiliation |
|---|---|
| Kobus Herbst | Africa Health Research Institute; South African Population Research Infrastructure Network |
| Sweetness Dube | Africa Health Research Institute |
| Kathy Baisley | Africa Health Research Institute |
| Dickman Gareta | Africa Health Research Institute |
| Name |
|---|
| Africa Health Research Institute |
| Name |
|---|
| KZN Department Of Health |
Data collection
| Start | End |
|---|---|
| 2004-01-01 | 2020-03-31 |
Data Access
The representative of the Receiving Organization agrees to comply with the following conditions:
- Access to the restricted data will be limited to the Lead Researcher and other members of the research team listed in this request.
- Copies of the restricted data or any data created on the basis of the original data will not be copied or made available to anyone other than those mentioned in this Data Access Agreement, unless formally authorized by the Data Archive.
- The data will only be processed for the stated statistical and research purpose. They will be used for solely for reporting of aggregated information, and not for investigation of specific individuals or organizations. Data will not in any way be used for any administrative, proprietary or law enforcement purposes.
- The Lead Researcher must state if it is their intention to match the restricted microdata with any other micro-dataset. If any matching is to take place, details must be provided of the datasets to be matched and of the reasons for the matching. Any datasets created as a result of matching will be considered to be restricted and must comply with the terms of this Data Access Agreement.
- The Lead Researcher undertakes that no attempt will be made to identify any individual person, family, business, enterprise or organization. If such a unique disclosure is made inadvertently, no use will be made of the identity of any person or establishment discovered and full details will be reported to the Data Archive. The identification will not be revealed to any other person not included in the Data Access Agreement.
- The Lead Researcher will implement security measures to prevent unauthorized access to licensed microdata acquired from the Data Archive. The microdata must be destroyed upon the completion of this research, unless the Data Archive obtains satisfactory guarantee that the data can be secured and provides written authorization to the Receiving Organization to retain them. Destruction of the microdata will be confirmed in writing by the Lead Researcher to the Data Archive.
- Any books, articles, conference papers, theses, dissertations, reports, or other publications that employ data obtained from the Data Archive will cite the source of data in accordance with the citation requirement provided with the dataset.
- An electronic copy of all reports and publications based on the requested data will be sent to the Data Archive.
- The original collector of the data, the Data Archive, and the relevant funding agencies bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
- This agreement will come into force on the date that approval is given for access to the restricted dataset and remain in force until the completion date of the project or an earlier date if the project is completed ahead of time.
- If there are any changes to the project specification, security arrangements, personnel or organization detailed in this application form, it is the responsibility of the Lead Researcher to seek the agreement of the Data Archive to these changes. Where there is a change to the employer organization of the Lead Researcher this will involve a new application being made and termination of the original project.
- Breaches of the agreement will be taken seriously and the Data Archive will take action against those responsible for the lapse if willful or accidental. Failure to comply with the directions of the Data Archive will be deemed to be a major breach of the agreement and may involve recourse to legal proceedings. The Data Archive will maintain and share with partner data archives a register of those individuals and organizations which are responsible for breaching the terms of the Data Access Agreement and will impose sanctions on release of future data to these parties.
Metadata production
DDI.Tier.Net.202009.v3
| Name |
|---|
| Africa Health Research Institute |