Box 1. The 3‐Tier ART Monitoring and Evaluation System

Implementation of the 3‐Tier System began in South Africa in 2010. Standardized HIV stationery is used for recording HIV‐infected patient related information including demographic, ART and laboratory information, at each care encounter. This information is captured into one of the tiers of the 3‐Tier System. The first tier comprises paper‐based registers. The second tier is a non‐networked electronic monitoring system that captures information identical to the paper‐based registers but with additional functionality to generate reports for programme monitoring and enhanced patient care and facility management. The third tier is a fully networked online patient management system that produces the same data as tiers one and two but with further functionality for real‐time co‐ordinated patient care across facilities. Data flows according to a standardized schedule from the facility level up to districts, provinces and finally to the National Monitoring and Evaluation Directorate. The 3‐Tier System has been implemented in 96% of healthcare facilities in South Africa with 91% on tier 2 or tier 3 and 90% having completed back capture of patient data to 2004. Records of approximately 3.5 million HIV‐infected South Africans currently in care and on ART are captured within the system. The 3‐Tier System is being expanded with implementation projects in Zimbabwe, Mozambique, Malawi, Guinea and Democratic Republic of Congo.