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 Turning the Tide Together

ART to 79,584 AIDS patients HIV care to 95,389 and 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 Cumulative in Palliative Care Adults6,15118,51836,50459,05175,512113,567128,895 Pediatrics4491,1322,1673, Cumulative on ART Adults2,76012,16523,10838,05055,79372,90678,931 Pediatrics974851,2841,9513,2603,897

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 eligibl e ART ineligible Palliative Care Visit Lab Pharmacy ART eligibl e Discontinue ToxicityFailure VCT

PMTCT Program Databases/Forms Antenatal Care Lab Pharmacy DeliveryLab Exposed Infant Follow-up Pharmacy Lab If infant becomes HIV+, switched to pediatric HIV program *Some women enter PMTCT through VCT or adult program Antenatal Care Antenatal Care Antenatal Care Antenatal Care

CD4 Each green triangle indicates one pickup of antiretroviral medications. Orange triangles indicate a change in 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 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. 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