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Tuberculosis (DHIS)

This page documents how tuberculosis case-management data is represented as FHIR resources.

Overview

​The DHIS tuberculosis module captures the registration, diagnosis, laboratory work-up and treatment course of tuberculosis (TB) patients. The data originates from the DHIS tuberculosis information system and is added to the DHP as individual, atomic FHIR resources. Resources conform to the DHIS profiles linked in each section, and to UZ Core or standard FHIR profiles otherwise.

Wherever a concept has a standard equivalent, resources carry the standard code directly - SNOMED CT for diagnoses, specimen types, identified species and processing states, LOINC for diagnostic tests and drug-susceptibility agents. The source system records this data with its own local codes; every local code is kept in its DHIS CodeSystem and mapped to its nearest standard concept by a ConceptMap, so an integrator can always look up the standard code for a code they hold. In resources, use the standard code wherever an exact (equivalent) match exists - the value set bound to each field offers the standard code for those concepts and keeps a local code only where no exact standard equivalent exists (for example culture-medium variants, smear/culture grades and drug-susceptibility bands). Each section below gives the governing profile, a concrete example resource, and a table of the value set and an example code for every field that carries a code.

A typical record links together: a patient, one or more TB diagnoses, an episode of care that groups the treatment course, the specimens collected, and the diagnostic test results produced from them.

Registering a patient (Patient)

The subject of every TB record. There is no DHIS-specific Patient profile; use UZ Core directly.

Profile: UZCorePatient

Example: example-patient-john

Information to record	Stored in
National identifier	identifier (national ID slice)
Name, gender, birth date	name, gender, birthDate
Address	address (UZ address slice)
Responsible facility	managingOrganization → Organization

Recording a TB diagnosis (Condition)

Set Condition.code to the TB diagnosis (or a relevant comorbidity). Most diagnoses use SNOMED CT directly; a few that have no 1:1 SNOMED CT match use local codes.

Profile: DHISCondition

Example: example-tbc-diagnosis

Information to record	Value set	Example code	Stored in
Diagnosis	DHISConditionCodeVS	SNOMED CT#88356006 (Primary tuberculous complex)	Condition.code
Clinical status	condition-clinical	condition-clinical#active (Active)	clinicalStatus
Verification status	condition-ver-status	condition-ver-status#confirmed (Confirmed)	verificationStatus
Category	condition-category	condition-category#encounter-diagnosis (Encounter Diagnosis)	category
When it started	-	2025-06-03	onsetDateTime
Subject	-	reference to Patient	subject

Use the SNOMED CT code wherever an exact match exists; only the few diagnoses without a 1:1 SNOMED CT match (e.g. fibro-cavitary TB and the non-TB comorbidities) keep a local code. The dhis-tuberculosis-to-snomed ConceptMap maps every DHIS diagnosis code to its SNOMED CT concept, so an integrator can find the standard code for any local code they hold.

Grouping the treatment course (EpisodeOfCare)

An episode of care groups a patient's TB diagnosis, treatment and follow-up over the whole course of care, and names the care manager.

Profile: DHISEpisodeOfCare

Example: example-dhis-episode-of-care

Information to record	Value set	Example code	Stored in
Episode type	episode-of-care-type-cs	episode-of-care-type-cs#mserv-0001-00004 (Treatment services)	type
Status	EpisodeOfCareStatus	active	status
Care period	-	2025-03-12 to 2025-09-12	period.start / period.end
Diagnosis being treated	-	reference to DHISCondition	diagnosis.condition
Patient	-	reference to Patient	patient
Care manager	-	reference to PractitionerRole	careManager

Collecting a specimen (Specimen)

Each sample collected for laboratory testing. Specimen.type records what kind of sample it is; Specimen.feature.type records its processing state (primary sample, sediment, culture isolate).

Profile: DHISSpecimen

Example: example-dhis-specimen

Information to record	Value set	Example code	Stored in
Specimen type	SpecimenTypeVS	SNOMED CT#119334006 (Sputum specimen)	Specimen.type
Processing state	SpecimenFeatureTypeVS	specimen-feature-type-cs#Spec002-0001 (Primary sample)	feature.type
Status	specimen-status	available	status
Subject	-	reference to Patient	subject
Derived from	-	reference to a parent Specimen	parent

Use the SNOMED CT code wherever an exact match exists; only the site groupings and culture media without a 1:1 SNOMED CT match keep a local code. The specimen-type-conceptmap ConceptMap maps every DHIS specimen type to its SNOMED CT concept, and the specimen-feature-type-to-snomed ConceptMap does the same for the processing states (the culture isolate uses a SNOMED CT code; primary sample and sediment keep a local code).

Recording diagnostic test results (Observation)

Every laboratory or imaging result is its own Observation. In all four profiles below, Observation.code identifies the test, drawn from DHISObservationCodeVS - LOINC where an exact code exists, otherwise a local code for culture-medium and assay variants. The observation-tuberculosis-code ConceptMap maps every DHIS test code to its LOINC concept. What differs is how the result is carried:

• coded results use DHISObservationCodeableConceptVS (SNOMED CT for identified species, local codes for smear/culture grades, plus HL7 interpretation codes such as POS/NEG),
• result components (for example, one row per drug in a susceptibility panel) are labelled with DHISObservationComponentCodeVS,
• yes/no findings use a boolean.

Choose the profile that matches the test:

Test	Profile	Result is carried as
Sputum smear microscopy	DHISObservationMicroscopy	coded AFB grade in a component
Culture, species identification, drug-susceptibility testing (DST), line-probe assay	DHISObservation	coded value and/or per-agent components
Chest X-ray	DHISObservationXray	boolean (finding present/absent)
HIV test	DHISObservationHIV	boolean

Sputum smear microscopy

Records the acid-fast bacilli (AFB) load found on a stained smear. The grade is stored in a component.

Profile: DHISObservationMicroscopy

Example: example-microscopy

Information to record	Value set	Example code	Stored in
Test code	DHISObservationCodeVS	LOINC#53904-9 (Sputum smear microscopy, fluorescent)	Observation.code
What the component reports	DHISObservationComponentCodeVS	observation-component-code-cs#Tub004-0032 (Grading)	component.code
AFB grade	DHISObservationCodeableConceptVS	dhis-observation-codeable-concept-cs#Tub003-0008 (3+ / 40 fields)	component.valueCodeableConcept
Specimen tested	-	reference to DHISSpecimen	specimen

Culture, identification and drug-susceptibility testing

Covers solid/liquid culture, species identification and drug-susceptibility testing (DST), including line-probe assays. The overall result goes in valueCodeableConcept; in a DST panel each drug is a component whose code is the agent and whose value is the susceptibility outcome.

Profile: DHISObservation

Example: example-tb-microscopy

Information to record	Value set	Example code	Stored in
Test code	DHISObservationCodeVS	observation-dhis-code-cs#Tub002-0007 (Phenotypic DST on MGIT)	Observation.code
Overall result	DHISObservationCodeableConceptVS	SNOMED CT#113858008 (M. tuberculosis complex)	valueCodeableConcept
Drug tested (DST)	DHISObservationComponentCodeVS	observation-component-code-cs#Tub004-0008 (Isoniazid 0.1 mg/mL)	component.code
Susceptibility outcome	ObservationCodeableConceptVS	v3-ObservationInterpretation#R (Resistant)	component.valueCodeableConcept
Specimen tested	-	reference to DHISSpecimen	specimen

Identified species and the trace and identification qualifiers use their SNOMED CT code directly; the observation-result-to-snomed ConceptMap records the DHIS result code each one replaces, while smear/culture grades and resistance-band outcomes without a standard equivalent keep a local code.

For DST components, plain drug-name agents use the LOINC <drug> [Susceptibility] code directly; concentration-bearing agents keep a local code (the critical concentration a standard code drops). The observation-component-to-loinc ConceptMap maps every DHIS drug agent to its LOINC concept.

Chest X-ray

Records whether a TB-related finding was seen on a chest X-ray.

Profile: DHISObservationXray

Example: example-observation-xray

Information to record	Value set	Example code	Stored in
Test code	DHISObservationCodeVS	LOINC#30745-4 (Chest X-ray)	Observation.code
Finding present	-	false	Observation.value (boolean)

HIV test

Records the result of an HIV test performed as part of TB/HIV co-infection screening.

Profile: DHISObservationHIV

Example: example-obs-hiv

Information to record	Value set	Example code	Stored in
Test code	DHISObservationCodeVS	LOINC#56888-1 (HIV testing)	Observation.code
Result	-	true	Observation.value (boolean)

Documenting the inpatient stay (Encounter)

An inpatient admission for TB treatment. There is no DHIS-specific Encounter profile; use UZ Core directly. diagnosis.condition links the admission to the TB diagnosis.

Profile: UZCoreEncounter

Example: example-dhis-encounter

Information to record	Value set	Example code	Stored in
Class	v3-ActCode	v3-ActCode#IMP (inpatient encounter)	class
Status	EncounterStatus	completed	status
Admission period	-	2026-02-12 to 2026-02-18	actualPeriod
Diagnosis	-	reference to DHISCondition	diagnosis.condition
Diagnosis role	encounter-diagnosis-use	encounter-diagnosis-use#final (Final)	diagnosis.use

Supporting resources

These resources are referenced by the records above and use UZ Core profiles directly.

Resource	Profile	Example	Role
Organization	UZCoreOrganization	example-organization	The TB treatment facility
Practitioner	UZCorePractitioner	example-practitioner	A clinician involved in care
PractitionerRole	UZCorePractitionerRole	practitionerrole-001	Links a clinician to a facility