Unique Identifier code for Key Population Programmes in Kenya Introduction The need for a unique, nationally standardized algorithm that enables identification of individuals enrolled into key populations programs arises from the general inability of current implementer/ funder based - systems to uniquely identify individuals, which is vital for record keeping and individualized tracking. By having a unique code associated with each individual enrolled into the key populations program, it resolves cross-referencing problems and establishes a single view of individuals in the database. Thus, a unique identifier code (UIC) reduces the possibility of duplicate entries for the same individual. This is particularly important in the era of 90-90-90, by ensuring an individual is tracked throughout the healthcare continuum, as well as in longitudinal analysis, by measuring behavior change. Purpose of a unique identifier There are various purposes of a Unique Identifier: Register each KP in the project with a unique identity to provide coverage estimates without duplications. Single out and track each KP across the cascade of services: prevention to care. Provides anonymity and confidential services to KPs. Ensures availability of individual-level data for understanding service uptake of the individual across the project period. Used to link data of the KP collected by different systems/organizations e.g. if the IP refers the KP for ART to another service. Elements of the unique identifier The unique identifier is comprised of four attributes: geographic, demographic and incremental variables. The codes for each one of the variables will be obtained from and will be consistent with the data captured on either the peer educator contact form or the clinic enrollment form. Once the enrollment form is completed, a unique identifier code will be generated for the individual. 1. Geographic variables: This includes the variables of county, sub-county, ward, implementing partner code and hot spot code. The geographic variables come alive in data exchange between participating organizations and capture the mobility of KP members. These variables directly link an individual to the organization that enrolled them into the program. 2. Demographic variables: There are three main demographic variables incorporated into the UIC; including, key population type, first two letters of the first, middle and surname name of the KP and month of birth in 2 digits. These variables facilitate matching KP members to their respective unique identifier code between successive visits, if the incremental variable is unknown. 3. Demographic data, which is provided by key populations, is pivotal in reducing duplication and ensuring data quality during the enrollment process, as well as throughout service provision both at clinic and outreach level. Trust building between service providers and key populations as well as raising awareness regarding the importance of correct, current demographic information is vital. 4. Incremental variables: This variable is an increasing numeric value that is reflective of the total number of individuals enrolled at the implementing partner level. It gives uniqueness to an individual within the program, and this serial number should be shared to KP member for memorization immediately after enrollment. In the likely event a KP forgets this number, demographic and geographic variables should be invoked to assist in retrieval. The serial will be generated from the position of entry into the project as reflected in the Master KP register. Variable Instruction County code This is a two-digit alphanumeric code that identifies a specific county. The already existing GOK county numeric characters will be used. Sub-county This is a three-digit alphanumeric code that identifies the sub-county. The already existing GOK sub county numeric characters will be used. Ward This is a three-digit alphanumeric code that identifies the ward. The already existing GOK ward numeric characters will be used. Implementing partner code This is a three-character code that represents an implementing partner participating in data exchange. For example, ADT and KAS to refer to Akukurunat Development Trust and KASH implementing partners respectively. Hot Spot This is a three-digit number that represents a hotspot where the KP reported as the favourite/where one mostly operates/conducts sex work/meet clients/inject drugs during enrolment. This digit should be available from the Hotspot List, a master list of hotspots covered by an implementing partner. If a KP member operates at multiple hotspots, the most frequented spot will be utilized for this variable. Key population type Indicate “01” for female sex workers, “02” for Men having sex with men and “03” for people who inject drugs First two letters of first, middle and last name For example, a KP called Josephine Atieno Omondi, indicate JOATOM. “JO” to capture the first two letters of Josephine, “AT” to capture the first two letters of Atieno (Middle name) and “OM” for Omondi, which is the Surname (family) name. If a KP does not provide/have a middle name, use code “00” for that case. The name provided by the KP member does not have to be official name as captured in the National identity card(ID) or other government documents, but rather names that they are comfortable with and will be used consistently throughout the program life cycle. Month of birth This is a two-digit number which indicates the month the individual was born on. For example, the code for a KP member born on July would be “07.” Incremental/serial number This is a numeric value that increases in respect to the number of key populations enrolled in the program. The number of digits used is dependent on the key population estimates within the geographic area of implementation. It is extracted from the serial number of the KP in the Master KP register and it should be 4 digits: 0001 Sample unique identifier code Figure 1.1 Josephine Atieno Omondi is from Busia county, Teso South sub county, Chakol North ward. She is registered at ADT as a female sex worker with a serial number 0001, and her hotspot is Stanbradox. She was born in October. Procedure of generating UIC To reiterate, a UIC will be generated once the entire registration of a KP member is complete and the peer educator contact form or the enrollment form is filled. As the variable of the UIC is generated from the information available in the registration format, completion of the registration is important. Unique identifier management should be centralized to avoid duplicate issuance of an ID and ensure standardization of the process. Thus, UIC management is the responsibility of the monitoring and evaluation (M&E) department or the M&E point person within the organization. Once the appropriate registration form is filled - either by a peer outreach worker or clinician, depending on the first point of contact with KP - the form should be handed over to the M&E officer who will allocate a UIC. If the KP is registered during outreach, the M&E Officer provides the UIC for the KP to the peer educator (PE) to populate in the contact form and outreach calendar and subsequently share with the peer in the next interaction. This PE then utilizes the UIC to track and plan relevant HIV prevention, intervention, and treatment services for the KP through the peer calendar. If the registration of the KP is done at the clinic, the M&E Officer provides the UIC to the clinic for recording and tracking purposes. However, in this case, the UIC is also provided to the PE from hotspot from where the KP came for follow-up and tracking. It is only demographic and incremental variable that will appear on paper form of the data collection tools as components of UIC. Case scenarios of handling UIC: Enrollment at outreach When a PE makes the first contact with a peer, a peer educator contact form is completed, and it captures geographic and demographic variables. Afterward, the PE hands over the dully completed contact form to the M&E officer who generates the UIC code and shares it with the PE who then transfers it to the outreach calendar for subsequent tracking. The M&E officer should request the PE to inform the peer of his/her serial/incremental number and emphasize the importance of remembering it when receiving a clinical service. Enrollment at clinic level The first time a KP member visits the projects clinic without having made a contact with a PE, the service provider will complete a Clinic Enrollment Form which captures geographic and demographic variables. After liaising with the M&E department for generation of UIC, the service provider should share the incremental/serial number with the KP member before the individual leaves the clinic. The service provider should introduce the aspect of a PE working within the individual’s respective hotspot for outreach services and request consent of sharing the individual’s information with the PE. Once the KP member agrees, the M&E department provides the details of the KP including the UIC to the PE of the hotspot where the KP frequents. The PE will transfer the demographic variables as well as the incremental variable in the UIC (initials of KP names, month of birth and serial number) to the outreach calendar for further follow up. Linkage with referral sites In the event a KP visits a referral clinic for additional services such as ART, the facility generates an ART number to identify the KP uniquely. The KP member is advised to share this number directly with the program and not via PE for confidentiality purposes. Further, riding on the working relationship between the project and the referral site, the outreach coordinator should verify the number from the ART registers and update the KP’s file accordingly.