Viewpoint: A Pragmatic Approach to Constructing a Minimum Data Set for Care of Patients with HIV in Developing Countries

Providing quality health care requires access to continuous patient data that developing countries often lack. A panel of medical informatics specialists, clinical human immunodeficiency virus (HIV) specialists, and program managers suggests a minimum data set for supporting the management and monitoring of patients with HIV and their care programs in developing countries. The proposed minimum data set consists of data for registration and scheduling, monitoring and improving practice management, and describing clinical encounters and clinical care. Data should be numeric or coded using standard definitions and minimal free text. To enhance accuracy, efficiency, and availability, data should be recorded electronically by those generating them. Data elements must be sufficiently detailed to support clinical algorithms/guidelines and aggregation into broader categories for consumption by higher level users (e.g., national and international health care agencies). The proposed minimum data set will evolve over time as funding increases, care protocols change, and additional tests and treatments become available for HIV-infected patients in developing countrie

A Review of ICT Systems for HIV/AIDS and Anti-Retroviral Treatment Management in South Africa

HIV/AIDS is a major global health problem. In South Africa, it is estimated that 5.4 million people are infected by HIV, out of a population of nearly 48 million, giving a prevalence rate of about 11%. About 600,000 individuals are infected with AIDS. Furthermore, the estimates show that, by mid-2006, some 711,000 people were in need of anti-retroviral treatment (ART), while 225,000 were actually receiving it

Using Touchscreen Electronic Medical Record Systems to Support and Monitor National Scale-Up of Antiretroviral Therapy in Malawi

Gerry Douglas and colleagues describe the rationale and their experience with scaling up electronic health records in six antiretroviral treatment sites in Malawi

J Registry Manag

ObjectivesValid deduplication of human immunodeficiency virus (HIV) case reports is critical to the utility of these data to inform HIV programs. The Haitian Ministry of Health (MSPP) and partners operate a case-based, national HIV/AIDS surveillance system (HASS), using deterministic and probabilistic procedures to identify duplicate records. These procedures are described and validated based on expert classifications.MethodsTwo samples of HASS records identified as duplicates were selected: 100 pairs from deterministic and 100 pairs from probabilistic matching procedures (total: 200 pairs, 400 case reports). Clinical data from the national electronic medical record (iSant\ue9) were reviewed and consensus gold-standard determinations on the status of duplications were made. False positive rates (FPR) were estimated by reviewing these records, while false negative rates were calculated (FNR) by using LinkPlus\u2122 probabilistic linkage software. The effect of deduplication on total HIV case counts was demonstrated.ResultsReview of deterministic matches yielded 99 true positives and 1 false positive (FPR, 1 per 100; 95% CI, 0.71\u20135.4). Review of probabilistic matches yielded a FPR of 6 per 100 (95% CI, 2.7\u201312.4). LinkPlus identified 1,491 probable matches among 68,393 records, representing a FNR of 2 per 100 (95% CI, 0.55\u20137.0). After adjustment, the estimated unique count of reported HIV patients in HASS was 211,885 (95% CI, 207,293\u2013213,232) as of December 2013.ConclusionsBased on application of the established procedures, HASS conforms to the duplication performance standard recommended by the Centers for Disease Control and Prevention for HIV surveillance.20162017-04-01T00:00:00ZCC999999/Intramural CDC HHS/United States27195993PMC522299

Shared Learning in an Interconnected World: Innovations to Advance Global Health Equity

The notion of reverse innovation --that some insights from low-income countries might offer transferable lessons for wealthier contexts--is increasingly common in the global health and business strategy literature. Yet the perspectives of researchers and policymakers in settings where these innovations are developed have been largely absent from the discussion to date. In this Commentary, we present examples of programmatic, technological, and research-based innovations from Rwanda, and offer reflections on how the global health community might leverage innovative partnerships for shared learning and improved health outcomes in all countries

Jefferson Digital Commons quarterly report: January-March 2020

This quarterly report includes: New Look for the Jefferson Digital Commons Articles COVID-19 Working Papers Educational Materials From the Archives Grand Rounds and Lectures JeffMD Scholarly Inquiry Abstracts Journals and Newsletters Master of Public Health Capstones Oral Histories Posters and Conference Presentations What People are Saying About the Jefferson the Digital Common

J Acquir Immune Defic Syndr

BackgroundThe World Health Organization (WHO) recommends universal antiretroviral therapy (ART) for people living with HIV (PLWH), but evidence about effects of expanded ART access on ART retention in low-resource settings is limited.SettingHaiti\u2019s Ministry of Health endorsed universal ART for pregnant women in March 2013 (Option B+) and for all PLWH in July 2016. This study included 51,579 ART patients from 2011\u201317 at 94 hospitals and clinics in Haiti.MethodsThis observational, retrospective cohort study described time trends in 6-month ART retention using secondary data, and compared results during three time periods using an interrupted time series (ITS) model: pre-Option B+ (period 1: 1/11\u20132/13), Option B+ (period 2: 3/13\u20136/16), and Test and Start (T&S, period 3: 7/16\u20139/17).ResultsFrom the pre-Option B+ to the T&S period, the monthly count of new ART patients increased from 366/month to 877/month, and the proportion with same-day ART increased from 6.3% to 42.1% (p30 days after HIV diagnosis (aIRR=0.86; 95% CI: 0.84\u20130.89, p<0.001).ConclusionAchieving targets for HIV epidemic control will require increasing ART retention and reducing the disparity in retention for those with same-day ART.P30 AI027757/AI/NIAID NIH HHS/United StatesU2G GH001130/GH/CGH CDC HHS/United States2021-06-01T00:00:00Z32084052PMC72288517696vault:3548

Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

Background: Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Partners In Health (PIH) has been supporting the Rwanda Ministry of Health (MOH) in two rural districts in Rwanda since 2005. Since 2009, the MOH and PIH have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions, and address health care access, cost, and quality. The PHIT Partnership represents a collaboration between the MOH and PIH, with support from the National University of Rwanda School of Public Health, the National Institute of Statistics, Harvard Medical School, and Brigham and Women’s Hospital. Description of intervention The PHIT Partnership’s health systems support aligns with the World Health Organization’s six health systems building blocks. HSS activities focus across all levels of the health system — community, health center, hospital, and district leadership — to improve health care access, quality, delivery, and health outcomes. Interventions are concentrated on three main areas: targeted support for health facilities, quality improvement initiatives, and a strengthened network of community health workers. Evaluation design The impact of activities will be assessed using population-level outcomes data collected through oversampling of the demographic and health survey (DHS) in the intervention districts. The overall impact evaluation is complemented by an analysis of trends in facility health care utilization. A comprehensive costing project captures the total expenditures and financial inputs of the health care system to determine the cost of systems improvement. Targeted evaluations and operational research pieces focus on specific programmatic components, supported by partnership-supported work to build in-country research capacity. Discussion Building on early successes, the work of the Rwanda PHIT Partnership approach to HSS has already seen noticeable increases in facility capacity and quality of care. The rigorous planned evaluation of the Partnership’s HSS activities will contribute to global knowledge about intervention methodology, cost, and population health impact