HIV Care and Treatment: Benefits of Electronic Medical Records

Phyllis Kanki 1 , Seema Meloni 1 ,Beth Chaplin 1 , Bolanle Banigbe 2, Prosper Okonkwo 2 1 Harvard School of Public Health, Boston, MA USA 2 AIDS Prevention Initiative Nigeria, Ltd./Gte., Abuja, Nigeria

AIDS 2012 - Turning the Tide Together

Master Trainer Corps: Trainers treated 13,578 AIDS patients ART to 79,584 AIDS patients HIV care to 95,389 and ART to 61,891

Harvard PEPFAR Nigeria

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

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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 Cumulative in Palliative Care Adults Pediatrics 6,151 18,518 449 2007 36,504 1,132 2008 59,051 2,167 2009 75,512 3,060 2010 113,567 5121 Cumulative on ART Adults Pediatrics 2,760 12,165 97 23,108 485 38,050 1,284 55,793 1,951 72,906 3,260 2011 128,895 6037 78,931 3,897

Paper Records

Organization of Electronic Data System

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

Harvard provides TA to APIN SI team Feedback to sites

Electronic Medical Records System

VCT

ARV naïve

Pre assessment

ART ineligible ART eligibl e Palliative Care ART eligibl e ARV experienced

Entry Visit Lab Pharmacy Discontinue Failure Toxicity

PMTCT Program Databases/Forms

Antenatal Antenatal Care Care Care Care Care Delivery Lab Lab Exposed Lab Infant Follow-up Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Pharmacy Lab Lab Lab Lab Lab Lab

If infant becomes HIV+, switched to pediatric HIV program

* Some women enter PMTCT through VCT or adult program

Laboratory Values Pharmacy Pickups CD4 Log of Viral Load Each green triangle indicates one pickup of antiretroviral medications.

Orange triangles indicate a change in regimen.

Identifying patients failing ART tested for HIV

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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

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Use calculation of average percent adherence

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Setting up networks so that pharmacists can cross-check prescriptions

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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

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Patient Monitoring

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Treatment response

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Adherence monitoring

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Loss to Follow-Up Toxicity monitoring

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Program Monitoring

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Reports

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Quality Assessment

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Drug usage and projections

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Program evaluations

Electronic Record Systems – Summary

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

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Data systems can promote patient care with automated utilities

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

Acknowledgements

P. Kanki (PI) S. Meloni E. Ekong B. Chaplin H. Rawizza J-L. Sankalé A. Dieng-Sarr G. Eisen D. Hamel N. Ulenga L. Dinic J. Hosseini C.Smith

R. Murphy K. Scarsi K. Hurt B. Taiwo C.Achenbach

P. Okonkwo T. Jolayemi B. Aluko S. Ochigbo R. Olaitan J. Samuels P. Akande T. Oyebode B. Akinyemi O. Eberendu C. O ’ Martins I. Adewole D. Olaleye J. Idoko S. Sagay O. Agbaji O. Idigbe D. Onwujekwe C. Okany R. Nkado W. Gashau H. Muktar J. Abah C. Chukwuka S. Akanmu F. Ogunsola

All our colleagues at the APIN PEPFAR sites in Nigeria Most of all, our patients This work was funded, in part, by the U.S. Department of Health and Human Services, Health Resources and Services Administration.