Cte dIvoires Experience With a Nationscale Longitudinal PatientMonitoring System for HIV Treatment a

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• Côte dIvoires Experience With a Nation-scale
  Longitudinal Patient-Monitoring System for HIV
  Treatment and Care

Abdou Salam Gueye, MD, PhD CDC Cote
dIvoireCatherine Seyler, MD, PhD ISPED
FranceStrategies for Building National-scale
Longitudinal Electronic Patient Monitoring
Systems for HIV Treatment and Care in PEPFAR
Countries Lusaka/Zambia Oct 2nd Oct 5th
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Background

• November 1997 UNAIDS Universal Access to
  HIV/AIDS Treatment initiative 7 ARV centers
  opened, 674 treated patients
• June 2004 launched of PEPFAR and GFATM
  decentralized HIV initiative
• Actually,106 ART centers, 40,000 patients on ART
  at 2 USD per month

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A Nationwide System in Progress Lessons Learned

• Revision of national care and treatment
  indicators in 2003 with testing of paper forms in
  four clinics in 2005.
• However, use of these tools was limited by
• Lack of longitudinal patient-management capacity
  with the paper forms
• Lack of motivation among providers to use the
  tools, which they perceived as increasing their
  workload.
• Cote dIvoire government chose the WHO HIV/AIDS
  patient-monitoring guidelines to develop a new
  system

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New Approaches in Creating a Harmonized
Nationwide System

• Adapting the WHO ART patient-monitoring tools to
  the Côte dIvoire
• Developing Paper Tools to Collect the Country
  Minimum Data Set
• Finally, a formal scale-up implementation plan
  was developed and shared with all partners
  involved in HIV/AIDS activities

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Developing a National Electronic System to Manage
Collected Data

• End 2006, the MOH decided to develop a national
  electronic tool to follow HIV-infected patients
• ACONDA-VS CI, an Ivorian NGO and its technical
  partner
• Institut de Santé Publique, dEpidémiologie et du
  Développement, Bordeaux 2 University, France
  (ISPED)
• Were chosen based on their 10 years experiense
  developing and implementing research data
  management systems.

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Electronic Tool Development Processes

• Between December 2006 and June 2007, the
  ACONDA/ISPED ME team developed a comprehensive
  and field-sensitive electronic tool.
• In June 2007, a CDC consultant in Abidjan
  conducted a preliminary evaluation of this
  electronic tool and found that the development
  has respected the specification requirement guide.

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Tools Background

• This tool is based on an individualized
  longitudinal electronic system developed on
  pre-existing operational and research records.
• In July 2007, ACONDA ME system included in more
  than 20 sites rural and urban 33,393 HIV infected
  patients (5,597 children). Among them 15,305
  initiated HAART.

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System Specificities (1)

• Individual longitudinal follow-up of HIV infected
  adults and children without and with ART.
• Management of all pharmacy aspects drugs order,
  drugs stock-out, medical material comsumption.
• Activities report of all programmatic aspects
  (patients in active follow-up, pharmacy needs)
  automaticaly accessible on site.

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System Specificities (2)

• The ID Number is a combination of type of
  Facility Code, letter identifying provinces, year
  of entry in the program and sequential number.
• Very few restriction to data capture validation
  to avoid lose of data.
• Linkage between individual patient longitudinal
  clinical, biological and pharmacy data.

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System Specificities (3)

• Respect health facilities workflow
• A new function AMD (data clerk) is created. They
  enter data and provide information to physicians
  prior to consultations and physicians are happy
• The application is an open source

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WORKFLOW
REGULAR HIV PATIENT TREATMENT AND CARE
AMD
Reception Chart Retrieval Paper and/or
Electronic
Consultation Physical exam TTT OIs /-
CTX Patient chart
PHYSICIAN
Other Intervention Results Lab x-Ray
Specialized Interv
PHARMACIST
Drug Provision Data entry Pharmacy module
electronic
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Data Capture of Paper Tools
Capture of a new patient number
Roll out menu
Validate the capture
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Permanent Quality Control of Captured Data
Alerts in red to inform of missing data
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Capture of All Prescriptions Both ART and OI Drugs
Standardised capture of drugs delivered
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Follow-up of all Pharmacy Activities (order,
drugs reception, stock-out)
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Permanent Pharmacy Reports
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View of Patient Clinical Form
Latest HAART regimen with date of prescription
Click here to view last 6 months CD4
Figures of CD4 and Weight evolution since
inclusion
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Automatic Standardized Reports for MOH, PEPFAR,
Other Partners
PEPFAR Monthly report
Print the document
Export the document to computer desk
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Automatic Standardized Follow-up Activities
Figures of active follow-up with aggregated
number of patients who are deceased or lost to
follow-up
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Automatic Request to Sort Patients Lists
List of late to treatment patients with delay
between date of ART drugs delivery and the date
of the day
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Where we are, Where we go !

• A pilot phase of the electronic tool took place
  at selected ACONDA facilities successfully in
  August 2007.
• Homogenisation between electronic and paper tools
  should occur in October 2007.
• Starting in November 2007, an improved version of
  these tools will be deployed all over the country
  according to a formal scale-up plan.

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MOH Vision 2008
TIMS
MONISTAC
MLS WebSite
ETR
OVC Database
SIMPLE
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MOH Vision 2009
TIMS
MONISTAC
MLS WebSite
ETR
OVC Database
SIMPLE
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RESEARCHERS
POPULATION
MANAGERS
INTERNET
BIOLOGISTS
CLINICIANS
PHARMACISTS
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Conclusion

• The biggest strength of this system is its
  acceptance by all stakeholders.
• New guidelines and procedures of care are needed
  to assure the success of this innovative tool.
• Data quality control follow-up are essential.