Abstract
INTRODUCTION Accurate collection of sexual orientation
and gender identity (SOGI) data is essential to identify and
address disparities in the HIV treatment cascade. In many
countries, routine health information management systems
(RHIMS) record gender using limited categories such
as ‘male’, ‘female’, or ‘unknown’, which fail to adequately
capture the diversity of gender identities of transgender and
gender-diverse populations. This study aimed to analyze
the structure and content of the routine HIV program
dataset within the South African routine health information
management system for the inclusion of key population
unique identifier codes.
METHODS A retrospective, exploratory analysis was
conducted using routinely collected HIV program data from
Limpopo Province. The dataset comprised 37934 records
of individuals who underwent HIV testing between April
and June 2023. A cohort extract was obtained from the
national standard TIER.Net system and analyzed to describe
the structure and content of routine HIV data and to assess
how the system supports cascade reporting. The analysis,
performed in STATA 17, included descriptive statistical
procedures such as frequencies, proportions, and crosstabulations
to examine HIV testing outcomes, ART initiation,
retention, and viral load monitoring.
RESULTS The RHIMS comprised 37 934 records and 95 HIVrelated
variables. The overall HIV positivity rate was 2.3%,
with ART initiation at 94.6%, viral load testing at 93.9%,
viral suppression at 85.1%, and 12-month retention at
61.2%. When comparing male and female outcomes, HIV
positivity was 2.8% and 2.2%, ART initiation (94.5% and
96.2%), retention (59.3% and 60.0%), and viral suppression
(79.8% and 88.2%), respectively. Disaggregation by sexual
orientations could not be done as there were no unique
identifiers for them.
CONCLUSIONS The RHIMS allows only male–female
disaggregation, which is limiting. Integrating key
populations' unique identifier codes and gender identity
would enable KP-specific data, supporting more targeted
interventions, effective resource allocation, and stronger
monitoring and evaluation for an inclusive HIV response.