Optimizing use of data and evidence-related tools to complement routine surveillance systems for tuberculosis program planning Running head: Optimizing use of tuberculosis data tools

Rachel M Fiorillo^1*Eveline Klinkenberg²Christina Braccio³Daniel Chin⁴Stavia Turyahabwe⁵Moses Arinaitwe⁶Razia Fatima⁷Taye Janfa⁸Binh Hoa Nguyen⁹Aiban Ronoh¹⁰Charalambos Sismanidis¹¹Nnamdi B Nwaneri¹²Kenneth Castro^13,14,15Kathy Fiekert⁶Fukushi Morishita¹⁶Suvanand Sahu¹⁷Sevim Ahmedov¹⁴Harry Hausler^18,19Anand Date³Jennifer Harris³

• ¹Infectious Disease Department, CDC Foundation, Atlanta, United States
• ²Connect TB, The Hague, Netherlands
• ³Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, United States
• ⁴Global Health, Gates Foundation, Seattle, United States
• ⁵Tuberculosis/Leprosy Control Division, Ministry of Health, Kampala, Uganda
• ⁶KNCV TB Plus, The Hague, Netherlands
• ⁷United Nations Office for Project Services, Copenhagen, Denmark
• ⁸National Tuberculosis, Leprosy, and Other Lung Disease Prevention and Control Program, Ethiopian Ministry of Health, Addis Ababa, Ethiopia
• ⁹Vietnam National Tuberculosis Control Program, Ministry of Health, Hanoi, Vietnam
• ¹⁰Division of Tuberculosis and Lung Health, Ministry of Health, Nairobi, Kenya
• ¹¹Global TB Programme, World Health Organization, Geneva, Switzerland
• ¹²The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
• ¹³Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, United States
• ¹⁴United States Agency for International Development, Washington DC, United States
• ¹⁵Department of Medicine, Emory University School of Medicine, Atlanta, United States
• ¹⁶End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
• ¹⁷Stop TB Partnership, Geneva, Switzerland
• ¹⁸TB HIV Care, Cape Town, South Africa
• ¹⁹Department of Family Medicine, University of Pretoria, Pretoria, South Africa

Background: Challenges and gaps with routine tuberculosis (TB) data and surveillance systems are well known. To address them, numerous TB data and evidence-related tools (e.g. surveys, assessments) have been developed to help countries collect, analyze, and use TB-related data. The “TB Data Optimization Project” aimed to assess the use and usefulness of these tools and propose best practices. Methods: Phase one of this mixed-methods project included structured key informant interviews (KIIs) with TB data experts, literature review, and mapping tools’ indicators and metrics. Phase two consisted of case studies in five countries (Ethiopia, Kenya, Pakistan, Uganda, Vietnam). Structured KIIs and a use case discussion were conducted with TB program staff and partners in each country, and TB-related documents were reviewed. Phase three was an online survey for national TB programs. Qualitative data were recorded, transcribed, coded, and inductively analyzed. Quantitative data were analyzed descriptively. Findings were triangulated and summarized into key themes. Results: Seventy-two KIIs were conducted, 42 countries completed surveys, and 212 documents were reviewed. Six key themes emerged: usefulness, opportunities and challenges with planning and implementation, technical assistance and financial support, timing and coordination, motivating factors for implementation, and the role of tools in relation to routine data systems. The tools provide critical information and most were considered worth the investment. Challenges include suboptimal implementation of the recommendations from the tools, poor timing and coordination of implementation, and insufficient capacity building. A set of best practices was developed. Conclusion: While the long-term goal is to strengthen and integrate routine data systems, TB data tools currently play an important role in filling gaps. Findings from this project provide considerations for optimal use of TB data tools; however, there is still need for further guidance on selecting the most critical tools to fill gaps during TB programmatic and strategic planning.