# Evaluation of the HIV Case‐Based Surveillance System in Dire Dawa City Administration, Ethiopia. A Descriptive Cross‐Sectional Study

## TL;DR

This study evaluates the HIV case-based surveillance system in Dire Dawa, Ethiopia, finding it timely and acceptable but underutilized due to training and coordination issues.

## Contribution

The study provides a descriptive evaluation of the HIV CBS system's performance and identifies barriers to its effective implementation in a specific Ethiopian city.

## Key findings

- Only 5 out of 14 health facilities reported HIV cases through the CBS system, compared to 314 in DHIS-2.
- Health workers cited lack of guidelines, limited coordination, and REDCap competency as major barriers.
- CBS data showed high timeliness (89%) and validity (99%) but poor representativeness (49%).

## Abstract

Ethiopia started the human immunodeficiency virus (HIV) case‐based surveillance (CBS) system along with Research Electronic Data Capture (REDCap) in June 2021. From January to June 2022, only five out of 14 CBS implementing health facilities in Dire Dawa City, Ethiopia, reported 35 newly diagnosed HIV patients through the REDCap Database compared to 314 in the District Health Information System (DHIS‐2). This study aimed to evaluate the CBS system, its usefulness, and reasons for underreporting in Dire Dawa City, Ethiopia.

We used a descriptive cross‐sectional study design. We customized the data collection tools from the Centers for Disease Control and Prevention (CDC), a guideline for evaluating public health surveillance systems. Questionnaires were administered to 36 healthcare workers involved in supporting CBS. Completed HIV CBS case reporting forms were also assessed for completeness. EPI Info software was used for data entry and analysis. Descriptive statistics, such as frequencies and proportions, were used to describe the findings.

Interviews were successfully conducted with 34 health workers. The lack of CBS reporting guidelines for healthcare facilities was 22 (61%). Limited coordination between technical staff and health facilities 19 (53%) and limited competency in REDCap 23 (64%) were also observed. CBS data timeliness, completeness, and validity were 89%, 87%, and 99%, respectively, in the REDCap. There is a lack of standard operating procedures during system interruption. The overall health facility representativeness was 368 of 757 (49%). Acceptability was 100%, mainly due to reduced paperwork and the ability to generate simple reports.

and Recommendations: The HIV CBS system was timely and acceptable. However, its representativeness was poor owing to limited competency in the REDCap. We recommend that health workers receive further training for case‐based HIV surveillance.