Improving Integration of Tuberculosis and HIV Electronic Data to Inform Programmatic Decision Making in Nigeria, Uganda, and Zimbabwe, 2022-2024 (Preprint)

BACKGROUND Tuberculosis (TB) is the leading cause of mortality among people living with HIV (PLHIV); however, data on TB screening, diagnoses, or outcomes are frequently incomplete or absent from HIV clinics’ electronic medical record (EMR) systems in some high-burden countries. Integrating TB and HIV data into EMRs creates opportunities to assess factors relevant to TB prevention, detection, and treatment among PLHIV, such as through the PROTECT (Preventing the Occurrence of TB by Expanding the Coverage of TB Preventive Treatment [TPT] in PLHIV) study, which evaluated the impact of TPT on TB incidence and mortality. We aimed to integrate TB and HIV data systems, while ensuring data integrity, from March 2022 to March 2024 as preparation for the PROTECT study at selected sites in Nigeria, Uganda, and Zimbabwe. OBJECTIVE To integrate TB and HIV electronic data systems and improve the completeness, accuracy, and accessibility of TB-related data within HIV electronic medical record systems at selected sites in Nigeria, Uganda, and Zimbabwe in preparation for the PROTECT study. METHODS To integrate TB and HIV data and improve completeness and quality, project teams in the three countries: assessed EMR functionality and baseline data quality, facilitated integration of electronic TB-related modules into EMRs, performed rigorous data quality checks to identify gaps and internal inconsistencies, addressed erroneous records systematically through country-specific interventions, and compared integrated, cleaned datasets for each country to baseline datasets to assess improvements. RESULTS HIV EMRs were upgraded to integrate TB-specific variables, enabling the capture of TB-specific data at HIV clinics and leading to qualitative improvements such as increased data access, enhanced user interfaces, and automation of data extraction. Clinical records from 123,523 PLHIV at 125 health facilities across the three countries were reviewed. Post-intervention data completeness improved for multiple indicators including TPT start date, which increased from 61% to 86% in Nigeria, from 46% to 60% in Uganda, and from 33% to 60% in Zimbabwe. Despite extensive cleaning, gaps remained across all three countries. CONCLUSIONS Integrating and cleaning TB and HIV data in EMR systems was largely successful and provides longer-term utility than paper records for comprehensive clinical care and public health interventions. High-quality, integrated data are critical for effective disease surveillance, program monitoring, and guiding policy decisions. Integrating data systems may serve as a starting point for broader integration of HIV, TB, and other disease services and programs – key components of sustainability.