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Contact Tracing: To follow up with a person over the phone or in the community with the intention of bringing the person into care or provide them with a service they need.
In Malawi Core, there will be two tracing registers
Phone Tracing: This register will contain patients who have been marked for tracing and have a phone number record
Home Tracing: This register contains patients who have been marked for tracing and:
Do not have a phone number record
Have been on the Phone Tracing register but (a) Have had three phone tracing attempts but are still on the tracing register,or (b) Have had one phone tracing attempt and the tracing outcome is 'number does not exist' or 'number is not the patient's'
A patient can be on the tracing register for various reasons:
Linkage: Newly diagnosed clients who have not started treatment after 14 days of their diagnosis (Activated by not completing the TB History, Regimen and Next Appointment questionnaire on the day of registration)
High Viral Load: ART clients with a high viral load result (entered through the Viral Load Results questionnaire)
Detectable Viral Load: ART clients with a detectable viral load result (entered through the Viral Load Results questionnaire)
Missing Viral Load: ART clients with a missing viral load result (entered through the Viral Load Results questionnaire)
Invalid Viral Load: ART clients with an invalid viral load result (entered through the Viral Load Results questionnaire)
Interrupted Treatment: ART clients who have missed their appointment (set in TB History, Regimen and Next Appointment questionnaire) by 28 days or more
Missed Appointment: ART clients who have missed their appointment (set in TB History, Regimen and Next Appointment), by 7 – 27 days
Dual Referral (DR): ART clients who have agreed to bring their partner to the clinic or asked the CHW to come to their home during the contacts registration process. They will appear at the top of the list when the day is due.( Set in the Child Contact Registration and Sexual Contact Registration questionnaires)
Contract Referral (CR): ART clients who have agreed to bring their partner to the clinic during the contacts registration process. They will appear at the top of the list when the day is due. ( Set in the Child Contact Registration and Sexual Contact Registration questionnaires)
Provider Referral (PR): Child and Sexual Contacts who were identified through the ART client. They must appear on the tracing list immediately after being registered if PR is the preferred referral choice. ( Set in the Child Contact Registration and Sexual Contact Registration questionnaires)
Missed Clinic Appointment: Sexual contacts and persons Who is Reactive at community who missed the appointment date agreed on in the HIV test and Next Appointment questionnaire
Family Referral Services (FRS): ART clients who have agreed to bring their children to the clinic or asked the CHW to come to their home during the contacts registration process. They will appear at the top of the list when the day is due. (Set in the Child Contact Registration and Sexual Contact Registration questionnaires): There are two FRS: FRS No STK and FRS STK
Dry Blood Sample Positive Result: Exposed Infant with a positive DBS result (entered through the HIV test and Results questionnaire)
Dry Blood Sample Result Missing: Exposed Infants with a missing DBS result (entered through the HIV Test and Results questionnaire)
Dry Blood Sample Result Invalid: Exposed Infants with a missing DBS result (entered through the HIV Test and Results questionnaire)
Missed Milestone Visit: Exposed Infants who have missed their milestone appointment (one with Milestone HIV test questionnaire), set in Medicine and Next Appointment questionnaire, by 1 or more days
Missed Routine Appointment: Exposed Infants who have missed their appointment (one without Milestone HIV test questionnaire), set in Medicine and Next Appointment questionnaire
FHIR Resource to track patient enrollment for Tracing
The following aspects of contact tracing for Malawi Core will need to be represented in FHIR:
Representing enrollment of patients for tracing
Tracking of Phone tracing and Home tracing patients
Representing the Tracing start date
Representing the reason for contact tracing
Representing when the patient is removed from the tracing register either by
Positive outcome of the tracing encounter
The patient is removed from tracing because (a) they have opted out of care provision (b) they have transferred to a different catchment area (c) they have died
The health workers were not able to reach the patient
Representing when patient agrees to an appointment from the tracing encounter.
The proposed resource to track enrollment for contact tracing is the Task Resource
The table below outlines the adopted elements of the Task Resource:
Element
Description/Example
resourceType
Task
id
logical identifier for the resource (UUID)
meta
a tag entry identifying whether the Patient ihas been enrolled to the Phone Tracing or the Home Tracing register. value for Phone Tracing: {"tag": [{"system": "https://d-tree.org","code": "phone-tracing","display": "Phone Tracing"}]} value for Home Tracing: {"tag": [{"system": "https://d-tree.org","code": "home-tracing","display": "Home Tracing"}]}
identifier
official business identifier. denoted as the FHIR identifier data type including use (official) and value (UUID). example value: [{"use": "official","value": "e04d015e-3a67-4a37-8633-b3eabad41f47"}]
partOf
Reference to the parent Task. When a patient agrees to an appointment during the tracing encounter, the initial Task's status is update to 'in-progress' and a new Task due on the appointment date is created and linked to the initial Task through this field. example value: {"reference": "Task/01469d46-1cc0-4e82-a140-e27902b0df4d"}
status
one of the TaskStatus codes as outlined in the TaskStatus section below
CodeableConcept to identify the Task Type. We will utilize the SNOMED CT code for the contact tracing procedure. The value will be: {"coding": [{"system": "http://snomed.info/sct","code": "225368008","display": "Contact tracing (procedure)"}],"text" : "Contact Tracing"}
description
Description of task. For Home tracing the description will be HIV Contact Tracing via home visit and for Phone tracing, the description will be HIV Contact Tracing via phone
for
Reference to the Patient to be Traced. example value: {"reference": "Patient/01466d46-1cc0-4e82-a140-e27982b0df4d"}
executionPeriod
Period indicating the start and end time of execution of the task. The start dateTime will denote when the Tracing will be due. This could be a future date for some of the reasons and also for the Tasks created following a Tracing encounter. The end dateTime will denote when the patient is removed from the Tracing Register. example value: {"start": "2022-10-26T00:00:00.00Z","end": "2022-11-01T00:00:00.00Z"}. Patients with Tracing Tasks that are due in the future will not appear on the Tracing Register
authoredOn
Task Creation Date and Time
owner
Reference to the practitioner to whom the Patient is assigned. example value: {"reference": "Practitioner/01466d46-1cc0-4e82-a140-e27582b0df4d"}
reasonCode
Custom CodeableConcept to identify the Tracing Reason as outlined in the tracing reason section below. example value: {"coding": [{"system": "https://d-tree.org","code": "linkage","display": "Linkage"}],"text" : "Linkage"}
reasonReference
Reference to the Tracing Outcome Questionnaire. example value: {"reference": "Questionnaire/1bdf21ef-d31a-446e-aaa6-cec516eceab1"}
TaskStatus
The following are the TaskStatus codes that will be utilized to represent Tracing from the posible value set defined by the FHIR project.
Code
Definition
ready
The default code for any Tracing Task that is being created denoting that it is ready to be performed.
in-progress
During a Tracing encounter, if the patient agrees to visit the clinic and sets a date for the visit, the current Tracing Task is marked as in-progress and a new Task will be created. The new task is linked to the current Task through the partOfelement and its executionPeriodstart date set as the date when the visit is due
completed
The Tracing Task is marked as completed when the Patient is to be removed from a patient register after a tracing encounter and a successful clinic visit based on the tracing reason
cancelled
The Tracing Task is marked as cancelled when the Patient is to be removed from the patient register for any reason other than a succefful clinic visit following a tracing encounter
Tracing Reason Codes
The following are the custom codes that will be utilized to reprent the different tracing reasons in the reasonCode element of the Tracing Task .
Tracing Reason
system
code
display
text
Linkage
https://d-tree.org
linkage
Linkage
Linkage
High Viral Load
https://d-tree.org
hvl
High Viral Load
HVL
Detectable Viral Load
https://d-tree.org
detectable-vl
Missing Viral Load
Detectable VL
Missing Viral Load
https://d-tree.org
missing-vl
Missing Viral Load
Missing VL
Invalid Viral Load
https://d-tree.org
invalid-vl
Invalid Viral Load
Invalid VL
Interrupted Treatment
https://d-tree.org
interrupt-treat
Interrupted Treatment
Interrupt Treat
Missed Appointment
https://d-tree.org
miss-appt
Missed Appointment
Miss Appt
Dual Referral
https://d-tree.org
dual-referral
Dual Referral
Dual Referral
Contract Referral
https://d-tree.org
contact-referral
Contact Referral
Contact Referral
Provider Referral
https://d-tree.org
provider-referral
Provider Referral
Provider Referral
Missed Clinic Appointment
https://d-tree.org
miss-clinic-appt
Missed Clinic Appointment
Miss Clinic Appt
Family Referral Services Self Test Kit
https://d-tree.org
frs-stk
Family Referral Services Self Test Kit
FRS STK
Family Referral Services No Self Test Kit
https://d-tree.org
frs-no-stk
Family Referral Services No Self Test Kit
FRS no STK
Dry Blood Sample Positive Result
https://d-tree.org
dbs-positive
Dry Blood Sample Positive Result
DBS Positive
Dry Blood Sample Result Missing
https://d-tree.org
dbs-missing
Dry Blood Sample Result Missing
DBS Missing
Dry Blood Sample Invalid
https://d-tree.org
dbs-invalid
Dry Blood Sample Invalid
DBS Invalid
Missed Milestone Visit
https://d-tree.org
miss-milestone
Missed Milestone Visit
Miss Milestone
Missed Routine Visit
https://d-tree.org
miss-routine
Missed Routine Visit
Miss Routine
Tracing Event
The tracing event and its outcome is recorded through the Tracing Outcome Questionnaire. Two FHIR Resources are proposed for extraction from the Questionnaire to represent this event.
A Coding representing the ActEncounterCode classification of the patient encounter. For Phone Tracing the value will be {"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode","code": "VR"} and for Home Tracing, the value will be {"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode","code": "HH"}
type
CodeableConcept to identify the Encounter Type. We will utilize the SNOMED CT code for the contact tracing procedure. The value will be: {"coding": [{"system": "http://snomed.info/sct","code": "225368008","display": "Contact tracing (procedure)"}],"text" : "Contact Tracing"}
priority
CodeableConcept to indicate the urgency of the encounter. ActPriority codes will be utilised. The value will be: {"coding": [{"system": "http://terminology.hl7.org/ValueSet/v3-ActPriority","code": "EL","display": "elective"}],"text" : "elective"}
subject
Reference to the Patient being Traced. example value: {"reference": "Patient/01466d46-1cc0-4e82-a140-e27982b0df4d"}
participant
BackboneElement containing Reference to the Practitioner performing the Tracing. example value: [{"individual":{"reference":"Practitioner/1bdf21ef-d30a-446e-aaa6-cec516eceab1"}}]
period
Period indicating the start and end time of execution of the task. example value: {"start": "2022-10-26T00:00:00.00Z","end": "2022-11-01T00:00:00.00Z"}
reasonCode
Custom CodeableConcept to identify the Tracing Reason as outlined in the tracing reason section above. example value: {"coding": [{"system": "https://d-tree.org","code": "linkage","display": "Linkage"}],"text" : "Linkage"}
serviceProvider
Reference to the Organization responsible for this encounter i.e. The organization that the practitioner belongs to
CodeableConcept to identify the Category of the type of Observation. We will utilize the SNOMED CT code for the contact tracing procedure. The value will be: {"coding": [{"system": "http://snomed.info/sct","code": "225368008","display": "Contact tracing (procedure)"}],"text" : "Contact Tracing"}
code
Custom CodeableConcept to identify the Type of Tracing outcome as outlined in the Tracing Outome Type section below. example value: {"coding": [{"system": "https://d-tree.org","code": "not-spoken","display": "Not Spoken To Client"}],"text" : "Not Spoken To Client"}
subject
Reference to the Patient being Traced. example value: {"reference": "Patient/01466d46-1cc0-4e82-a140-e27982b0df4d"}
BackboneElement containing Reference to the Practitioner performing the Tracing. example value: [{"individual":{"reference":"Practitioner/1bdf21ef-d30a-446e-aaa6-cec516eceab1"}}]
valueCodeableConcept
Custom CodeableConcept to identify the Tracing outcome as outlined in the Tracing Outome section below. example value: {"coding": [{"system": "https://d-tree.org","code": "not-spoken","display": "Not Spoken To Client"}],"text" : "Not Spoken To Client"}
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Context
Contact Tracing: To follow up with a person over the phone or in the community with the intention of bringing the person into care or provide them with a service they need.
In Malawi Core, there will be two tracing registers
'number does not exist'
or'number is not the patient's'
A patient can be on the tracing register for various reasons:
FHIR Resource to track patient enrollment for Tracing
The following aspects of contact tracing for Malawi Core will need to be represented in FHIR:
Task Resource
The proposed resource to track enrollment for contact tracing is the Task Resource
The table below outlines the adopted elements of the Task Resource:
resourceType
id
meta
{"tag": [{"system": "https://d-tree.org","code": "phone-tracing","display": "Phone Tracing"}]}
value for Home Tracing:{"tag": [{"system": "https://d-tree.org","code": "home-tracing","display": "Home Tracing"}]}
identifier
use
(official) andvalue
(UUID). example value:[{"use": "official","value": "e04d015e-3a67-4a37-8633-b3eabad41f47"}]
partOf
{"reference": "Task/01469d46-1cc0-4e82-a140-e27902b0df4d"}
status
intent
plan
priority
routine
code
{"coding": [{"system": "http://snomed.info/sct","code": "225368008","display": "Contact tracing (procedure)"}],"text" : "Contact Tracing"}
description
HIV Contact Tracing via home visit
and for Phone tracing, the description will beHIV Contact Tracing via phone
for
{"reference": "Patient/01466d46-1cc0-4e82-a140-e27982b0df4d"}
executionPeriod
start
dateTime will denote when the Tracing will be due. This could be a future date for some of the reasons and also for the Tasks created following a Tracing encounter. Theend
dateTime will denote when the patient is removed from the Tracing Register. example value:{"start": "2022-10-26T00:00:00.00Z","end": "2022-11-01T00:00:00.00Z"}
. Patients with Tracing Tasks that are due in the future will not appear on the Tracing RegisterauthoredOn
owner
{"reference": "Practitioner/01466d46-1cc0-4e82-a140-e27582b0df4d"}
reasonCode
{"coding": [{"system": "https://d-tree.org","code": "linkage","display": "Linkage"}],"text" : "Linkage"}
reasonReference
{"reference": "Questionnaire/1bdf21ef-d31a-446e-aaa6-cec516eceab1"}
TaskStatus
The following are the TaskStatus codes that will be utilized to represent Tracing from the posible value set defined by the FHIR project.
ready
in-progress
in-progress
and a new Task will be created. The new task is linked to the current Task through thepartOf
element and itsexecutionPeriod
start
date set as the date when the visit is duecompleted
completed
when the Patient is to be removed from a patient register after a tracing encounter and a successful clinic visit based on the tracing reasoncancelled
cancelled
when the Patient is to be removed from the patient register for any reason other than a succefful clinic visit following a tracing encounterTracing Reason Codes
The following are the custom codes that will be utilized to reprent the different tracing reasons in the
reasonCode
element of the Tracing Task .https://d-tree.org
linkage
Linkage
Linkage
https://d-tree.org
hvl
High Viral Load
HVL
https://d-tree.org
detectable-vl
Missing Viral Load
Detectable VL
https://d-tree.org
missing-vl
Missing Viral Load
Missing VL
https://d-tree.org
invalid-vl
Invalid Viral Load
Invalid VL
https://d-tree.org
interrupt-treat
Interrupted Treatment
Interrupt Treat
https://d-tree.org
miss-appt
Missed Appointment
Miss Appt
https://d-tree.org
dual-referral
Dual Referral
Dual Referral
https://d-tree.org
contact-referral
Contact Referral
Contact Referral
https://d-tree.org
provider-referral
Provider Referral
Provider Referral
https://d-tree.org
miss-clinic-appt
Missed Clinic Appointment
Miss Clinic Appt
https://d-tree.org
frs-stk
Family Referral Services Self Test Kit
FRS STK
https://d-tree.org
frs-no-stk
Family Referral Services No Self Test Kit
FRS no STK
https://d-tree.org
dbs-positive
Dry Blood Sample Positive Result
DBS Positive
https://d-tree.org
dbs-missing
Dry Blood Sample Result Missing
DBS Missing
https://d-tree.org
dbs-invalid
Dry Blood Sample Invalid
DBS Invalid
https://d-tree.org
miss-milestone
Missed Milestone Visit
Miss Milestone
https://d-tree.org
miss-routine
Missed Routine Visit
Miss Routine
Tracing Event
The tracing event and its outcome is recorded through the Tracing Outcome Questionnaire. Two FHIR Resources are proposed for extraction from the Questionnaire to represent this event.
Encounter Resource
The table below outlines the adopted elements of the Encounter Resource:
resourceType
id
status
finished
class
{"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode","code": "VR"}
and for Home Tracing, the value will be{"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode","code": "HH"}
type
{"coding": [{"system": "http://snomed.info/sct","code": "225368008","display": "Contact tracing (procedure)"}],"text" : "Contact Tracing"}
priority
{"coding": [{"system": "http://terminology.hl7.org/ValueSet/v3-ActPriority","code": "EL","display": "elective"}],"text" : "elective"}
subject
{"reference": "Patient/01466d46-1cc0-4e82-a140-e27982b0df4d"}
participant
[{"individual":{"reference":"Practitioner/1bdf21ef-d30a-446e-aaa6-cec516eceab1"}}]
period
{"start": "2022-10-26T00:00:00.00Z","end": "2022-11-01T00:00:00.00Z"}
reasonCode
{"coding": [{"system": "https://d-tree.org","code": "linkage","display": "Linkage"}],"text" : "Linkage"}
serviceProvider
Observation Resource
The table below outlines the adopted elements of the Observation Resource:
resourceType
id
status
finished
category
{"coding": [{"system": "http://snomed.info/sct","code": "225368008","display": "Contact tracing (procedure)"}],"text" : "Contact Tracing"}
code
{"coding": [{"system": "https://d-tree.org","code": "not-spoken","display": "Not Spoken To Client"}],"text" : "Not Spoken To Client"}
subject
{"reference": "Patient/01466d46-1cc0-4e82-a140-e27982b0df4d"}
encounter
performer
[{"individual":{"reference":"Practitioner/1bdf21ef-d30a-446e-aaa6-cec516eceab1"}}]
valueCodeableConcept
{"coding": [{"system": "https://d-tree.org","code": "not-spoken","display": "Not Spoken To Client"}],"text" : "Not Spoken To Client"}
Tracing Oucome Types
Tracing Oucomes
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