Background: There is currently a need to strengthen health information systems so as to improve health services and health outcomes. This is especially important for HIV management in South Africa where attrition is high both pre- and post-ART initiation. Due to the scale-up of ART, care givers are currently unable to easily and timeously track HIV-positive individuals as they move through the HIV (treatment and care) cascade. Routine data related to the HIV cascade is captured in multiple disparate clinical, laboratory, pharmacy and mortality databases. Harmonising these databases is a necessary intervention for tracking, linking and retaining HIV-positive individuals in services. However, there is currently limited evidence on opportunities, procedures and capacities for, and outcomes of efforts to harmonise routine electronic HIV-cascade-related databases into health-information management tools.
Objectives: The objective was to examine the processes, promises and challenges of electronically harmonising HIV-cascade-related databases so as to strengthen monitoring and evaluation, and support service improvements in terms of the performance of the HIV cascade.
Methods: We qualitatively evaluated the processes, promises and challenges of electronically harmonising HIV-cascade-related databases through the design and execution of a retrospective cohort study of adult men and women who entered the HIV cascade in a health sub-district of the Western Cape Province and were enrolled between 2012 and 2013.
Results: We learnt, by using the retrospective cohort study as a data-harmonisation exercise, that several ethical, technical and organisational factors play a role in accessing and harmonising multiple disparate city (local government) and provincial HIV-cascade-related databases, particularly for research purposes.
Conclusions:These findings of the qualitative evaluation of the retrospective cohort study are useful for the development of a real-world health-information management intervention, that can provide the informational support needed by care givers to track, link and retain HIV-positive individuals in services.