OpenMRS Implementers Network

The article reviews Open Medical Record System (OpenMRS), a collaborative open-source project for development of software that supports health care delivery in developing countries. The aim is to develop an open Implementers Network to provide regional support for the growing number of OpenMRS implementations and to include African developers in future growth of OpenMRS. The South African OpenMRS Implementer group successfully configured, installed and maintained an integrated HIV/TB OpenMRS application without significant programming support. Since then, this model has been replicated in other African sites. The OpenMRS Implementers NetworkWiki and listserv have proven to be effective in providing implementation support

OpenMRS Implementers Network

OpenMRS (www.openmrs.org) is a highly configurable open source electronic medical record system focused on developing countries. An international collaboration of individuals and institutions is contributing to developing and extending the core application and a network of implementers is configuring specific implementations of OpenMRS for treating and managing care for patients with HIV/AIDS and tuberculosis at sites in Eastern and Southern Africa. Support is critical for successful implementation and an OpenMRS implementers group has been formed driven by developers of OpenMRS with initial implementers from Kenya, Rwanda and South Africa and pilot implementers in Lesotho, Malawi, Tanzania, Uganda, and Zambia. The OpenMRS implementers group not only provides a first line of support to other implementers, but also performs functional testing and documentation. Support for local customizations is mainly provided through the OpenMRS Wiki, forum, and two e-mail mailing lists. The mailing lists are fairly active and responsive to issues arising during implementation, allowing a reasonably high level of support to be maintained for specific in country implementations, and are supplemented with regular implementer meetings. Three meetings were held during 2006, in Eldoret, Cape Town and Dar-Es-Salaam. The first meeting of 2007 will take place in Mali during the Helina 2007 conference

Comprehensive treatment of extensively drug-resistant tuberculosis

BACKGROUND: Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru. METHODS: A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant. RESULTS: Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [+/-SD] number of regimens, 4.2+/-1.9 vs. 3.2+/-1.6; P\u3c0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4+/-1.1 vs. 5.3+/-1.5; P\u3c0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3+/-1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36). CONCLUSIONS: Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis