HIV Care and Treatment: Benefits of Electronic Medical Records

Phyllis Kanki1, Seema Meloni1,Beth Chaplin1, Bolanle Banigbe2, Prosper Okonkwo2

1 Harvard School of Public Health, Boston, MA USA2AIDS Prevention Initiative Nigeria, Ltd./Gte., Abuja, Nigeria

AIDS 2012 - Turning the Tide Together

ART to 79,584 AIDS patients

HIV care to 95,389and ART to 61,891

Master Trainer Corps:Trainers treated 13,578 AIDS patients

Harvard PEPFAR Nigeria

• Through Bill & Melinda Gates Foundation funding, Harvard has been working with multiple hospitals and prevention programs in Nigeria since 2000

• Started PEPFAR ART activities at 6 tertiary hospitals in 2004 and expanded to a total of 26 ART sites and 64 PMTCT sites.

2005 2006 2007 2008 2009 2010 2011

Cumulative in Palliative Care

Adults 6,151 18,518

36,504

59,051

75,512 113,567 128,895

Pediatrics 449 1,132 2,167 3,060 5121 6037

Cumulative on ART

Adults 2,760 12,165

23,108

38,050

55,793 72,906 78,931

Pediatrics 97 485 1,284 1,951 3,260 3,897

Organization of Electronic Data System

Paper Records

Daily, on-site data entry

by (multiple) locally-hired

& trained personnel

Regular transfer to

data managers’ computers

for cleaning, merging,

management and use.

Physician views patient data in clinical

rooms

APIN

Feedback to sites

Harvard provides TA to APIN SI

team

Electronic Medical Records System

Pre-

assessment

Entry

ARV naïve

ARV experienced

ART eligible

ART ineligible Palliative

Care

Visit

Lab

Pharmacy

ART eligible

Discontinue ToxicityFailure

VCT

PMTCT Program Databases/Forms

Antenatal

CareLab

Pharmacy

Delivery LabLab

LabExposed

Infant

Follow-up

PharmacyPharmacy

PharmacyPharmacy

Pharmacy

LabLab

LabLab

LabLabIf infant becomes

HIV+, switched to pediatric HIV

program

* Some women enter PMTCT through VCT or adult program

Antenatal

CareAntenatal

CareAntenatal

CareAntenatal

Care

CD4

Each green triangle indicates one pickup of antiretroviral medications.Orange triangles indicate a changein regimen.

Log of Viral Load

Laboratory Values

Pharmacy Pickups

Identifying patients failing ART

tested for HIV‐1 drug resistance;subsequently switched to second

line therapy

Patient Monitoring: Pharmacy Database Adherence Utility

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•Assess adherence to treatment based on timeliness of drug pick-ups

•Use calculation of average percent adherence

•Setting up networks so that pharmacists can cross-check prescriptions

Site Assessment Indicators• Continuity of care• ART initiation• CTX coverage• TB screening coverage• Lab data

– % Charts missing values• Toxicity

– % patients with panic values

– % patients with appropriate clinical response(s)

• CD4 and Viral Load– % patients with values at

baseline, 3, 6, and 12 months

– % patients with >50 cell/mL CD4 increase and/or suppressing viral load at 6 and 12 months

• Treatment failure– % patients in failure at 6

and 12 months– % patients with

appropriate clinical response(s)

Electronic Record Systems

• Patient Monitoring– Treatment response– Adherence monitoring– Loss to Follow-Up– Toxicity monitoring

• Program Monitoring– Reports– Quality Assessment

• Drug usage and projections

• Program evaluations

Electronic Record Systems – Summary

• In clinics with large patient burdens – electronic record systems can optimize patient care.

• Data systems can promote patient care with automated utilities

• Program reporting and evaluations can be readily performed in real-time and is cost-efficient.

Acknowledgements

This work was funded, in part, by the U.S. Department of Health and Human Services, Health Resources and Services Administration.

P. Kanki (PI) S. MeloniE. EkongB. ChaplinH. RawizzaJ-L. SankaléA. Dieng-SarrG. EisenD. HamelN. UlengaL. DinicJ. HosseiniC.Smith

R. MurphyK. ScarsiK. HurtB. TaiwoC.Achenbach

P. OkonkwoT. JolayemiB. AlukoS. OchigboR. OlaitanJ. SamuelsP. AkandeT. OyebodeB. AkinyemiO. EberenduC. O’Martins

I. AdewoleD. OlaleyeJ. IdokoS. SagayO. AgbajiO. IdigbeD. OnwujekweC. OkanyR. NkadoW. GashauH. MuktarJ. AbahC. ChukwukaS. AkanmuF. Ogunsola

All our colleagues at the APIN PEPFAR sites in NigeriaMost of all, our patients