Triangulating orphans and vulnerable children program and health facility data to improve HIV treatment outcomes for children and adolescents living with HIV

BACKGROUND: COVida (2016'2022) is a PEPFAR/USAID-funded orphans and vulnerable children (OVC) project implemented in 30 districts in seven provinces in Mozambique by FHI 360 and local partners. A project priority is to help children and adolescents living with HIV (CALHIV) achieve viral load (VL) suppression, but lack of accurate data on their treatment status prevented COVida from providing appropriate support at the community level. To address this challenge, COVIDA introduced a data-triangulation approach in October 2019.
DESCRIPTION: The data-triangulation approach compares self-reported OVC program data with data in the health facility (HF) patient information system to identify data gaps and discrepancies and inform corrective actions. This approach was piloted during October'December 2019 in 14 HFs in five districts in Inhambane province in collaboration with the PEPFAR HIV clinical partner.
LESSONS LEARNED: Of the1,555 CALHIV self-reported as on ART in OVC program data, HFs confirmed only 1,473 as on ART. Among those confirmed, only 767 (52%) had VL data, of whom only 462 (60%) were virally suppressed. These results led to improvement actions such as finding defaulters, referring CALHIV to VL testing, and providing enhanced adherence counseling to those with high VL loads. In September 2020, the number of CALHIV on ART had increased to 1,647, those with known VL to 1,183, and those virally suppressed to 552, a 12%, 54%, and 19% increase, respectively. Given these results, data triangulation was scaled up to all 203 HFs in COVida's program sites during the remainder of 2020.
Data triangulation has contributed to improve treatment outcomes among CALHIV in all project sites. The project's overall VL coverage rate increased from 50% in 2020 to 91% in 2021, and VL suppression from 61% to 82%.
CONCLUSIONS: Data triangulation helps OVC and clinical partners work together to improve treatment outcomes for CALHIV. It also allows OVC programs to access real-time clinical data to meet the needs of CALHIV at the community level. This approach is critical to reduce the pediatric and adolescent HIV treatment gap and should be used by all OVC and HIV clinical partners working in the same geographic areas.

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