Module 2: Assessment of HIV testing services data systems

Assessing the HIV testing services (HTS) data system is a critical first step in data quality assessment and monitoring activities, as it helps identify how data are collected, managed, and reported, and highlights potential issues with accuracy, completeness, and confidentiality. Before any type of external data quality assessment or monitoring activity is carried out at a health facility, informed consent must be obtained from the health care works and personnel engaged in the process for which the informed consent form can be used and adapted. In addition, all personnel carrying out the assessment should complete a confidentiality agreement templateensure they understand their responsibilities to maintain confidentiality.

The primary goal of an HTS data quality assessment is to gain a comprehensive understanding of the existing facility data systems and reporting procedures for testing. This involves identifying gaps and areas for improvement in data collection, management, and reporting processes. The WHO HTS site level questionnaire can be adapted and used by countries for this purpose, and should be completed by site staff familiar with HTS data collection and reporting, to better understand the facility procedures.

Specifically, the following areas are assessed by the HTS site level questionnaire:

• General information: basic information about the site, including the start date of testing services.
• Unique identifiers: determines if the site uses unique identifiers for HTS clients and the types of identifiers used.
• Data systems and confidentiality: assesses the types of data collection systems in use (electronic, paper-based, or other) and the usage, frequency of data entry, and data security measures such as password protection and paper backups.
• Use of paper-based tools: evaluates the routine updating and security of paper-based registers and tools.
• Reporting to the ministry of health and partners: examines the methods of submitting routine (monthly/quarterly) reports to health ministries and implementing partners, including the formats used (electronic or paper).
• Human resource capacity for data management and reporting: identifies the staff responsible for data entry, calculation of HTS indicators, and completion of reports. Additionally, it assesses the processes in place to ensure data compilation and reporting in the absence of designated staff and the training provided to staff.
• Data quality: reviews the quality control procedures for data entry, the existence of data quality standard operating procedures, tools for internal data quality checks, and feedback mechanisms for data systems and reporting procedures.

Mapping client and data flow

Mapping client and data flow helps programmes strengthen HTS data quality by clearly visualising how data are generated, recorded, and reported, enabling identification of bottlenecks and weaknesses in site‑level data management. It describes the flow of data as the client proceeds through the HIV testing service visit and provides insights into the strengths and weaknesses of data management at the site by reviewing documentation practices at each point of data collection throughout the care cascade. Client and data flow mapping captures the data flow process as it currently exists rather than the ideal. The WHO client and data flow mapping tool can be adapted to visualise data flow for HTS from collection to reporting and enables the capabilities summarised below.