Evaluation of antiretroviral treatment programme monitoring in Eastern Cape, South Africa

The provision of antiretroviral treatment (ART) for HIV infection is a key strategy in addressing the high burden of HIV/AIDS in South Africa and improving the quality and length of life for those infected. Information produced from routine monitoring is essential for evidence-based decision-making within ART programmes. An evaluation of the ART programme data system in Eastern Cape, South Africa was conducted to determine the causes of irregular reporting and to make recommendations to improve data quality. Data audits and semi-structured interviews were performed in facilities that initiate and provide ART. Thirty-two facilities in three sub-districts were audited. The number of adults receiving ART was over-reported by 36.6% (P < 0.05) on the District Health Information System. The interviews of nurses and administrators revealed various factors that contributed to the inaccuracy of the data including training, staffing levels, use of registers, data verification processes, and standardization with programme partners. Recommendations to address the inaccuracy of ART programme data include improving knowledge translation during training of ART programme staff, ensuring the implementation of established data verification policies and procedures, rethinking the design of the programme to reduce the burden on health facilities and personnel, and standardizing information management procedures amongst the various governmental and non-governmental stakeholders. The challenges with reporting in the Eastern Cape may be shared by other South African provinces as well as other low-middle income countries that require high quality data to inform well-designed and well-implemented interventions in the fight against HIV/AIDS.