Background
Depression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings.

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Validity/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV/AIDS in western Kenya.

Partnerships between academic medical center (AMCs) in North America and the developing world are uniquely capable of fulfilling the tripartite needs of care, training, and research required to address health care crises in the developing world Moreover, the institutional resources and credibility of AMCs can provide the foundation to build systems of care with long-term sustainability, even in resource-poor settings

https://www.ghdonline.org/uploads/Einterz_AcadMed_AMPATHpartnership_2007_MrCEveu.pdf

Responding to the HIV pandemic: the power of an academic medical partnership.

The developing world faces a series of health crises including HIV/AIDS and tuberculosis that threaten the lives of millions of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. In this paper we explain why information systems are important in many healthcare projects in the developing world. We discuss pilot projects demonstrating that such systems are possible and can expand to manage hundreds of thousands of patients. We also pass on the most important practical lessons in design and implementation from our experience in doing this work. Finally, we discuss the importance of collaboration between projects in the development of electronic medical record systems rather than reinventing systems in isolation, and the use of open standards and open source software.

/pdf/implementing-electronic-medical-record-systems-in-developing-2s9osn54qj.pdf

Implementing electronic medical record systems in developing countries.

Objectives: To determine the clinical and immunological outcomes of a cohort of HIV infected patients receiving antiretroviral therapy. Design: Retrospective study of prospectively collected data from consecutively enrolled adult HIV-infected patients in eight HIV clinics in western Kenya. Methods: CD4 cell counts weight mortality loss to follow-up and adherence to antiretroviral therapy were collected for the 2059 HIV-positive non-pregnant adult patients treated with antiretroviral drugs between November 2001 and February 2005. Median duration of follow-up after initiation of antiretroviral therapy was 40 weeks (95% confidence interval 38-43); 111 patients (5.4%) were documented as deceased and 505 (24.5%) were lost to follow-up. Among 1766 (86%) evaluated for adherence to their antiretroviral regimen 78% reported perfect adherence at every visit. Although patients with and without perfect adherence gained weight patients with less than perfect adherence gained 1.04 kg less weight than those reporting perfect adherence (P = 0.059). CD4 cell counts increased by a mean of 109 cells/ml during the first 6 weeks of therapy and increased more slowly thereafter resulting in overall CD4 cell count increases of 160 225 and 297 cells/ml at 12 24 and 36 months respectively. At 1 year a mean increase of 170 cells/ml was seen among patients reporting perfect adherence compared with 123 cells/ml among those reporting some missed doses (P < 0.001). Antiretroviral treatment of adult Kenyans in this cohort resulted in significant and persistent clinical and immunological benefit. These findings document the viability and effectiveness of large-scale HIV treatment initiatives in resource-limited settings. (authors)

Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya.

OBJECTIVES: To assess whether community-based care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV care. DESIGN: Prospective cluster randomized controlled clinical trial. SETTING: Villages surrounding 1 rural clinic in western Kenya. SUBJECTS: HIV-infected adults clinically stable on antiretroviral therapy (ART). INTERVENTION: The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of care monthly clinic visits. MAIN OUTCOMES MEASURED: Viral load CD4 count Karnofsky score stability of ART regimen opportunistic infections pregnancies and number of clinic visits. RESULTS: After 1 year there were no significant intervention-control differences with regard to detectable viral load mean CD4 count decline in Karnofsky score change in ART regimen new opportunistic infection or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001). CONCLUSIONS: Community-based care by PLWAs resulted in similar clinical outcomes as usual care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs expediting ART rollout and increasing access to treatment while expanding the capacity of health care institutions in resource-constrained environments.

Task-shifting of antiretroviral delivery from health care workers to persons living with HIV/AIDS: Clinical outcomes of a community-based program in Kenya

https://www.ghdonline.org/uploads/An_electronic_medical_record_system_for_HIV_Kenya.pdf

An electronic medical record system for ambulatory care of HIV-infected patients in Kenya.

Providing high-quality HIV/AIDS care requires high-quality, accessible data on individual patients and visits. These data can also drive strategic decision-making by health systems, national programs, and funding agencies. One major obstacle to HIV/AIDS care in developing countries is lack of electronic medical record systems (EMRs) to collect, manage, and report clinical data. In 2001, we implemented a simple primary care EMR at a rural health centre in western Kenya. This EMR evolved into a comprehensive, scalable system serving 19 urban and rural health centres. To date, the AMPATH Medical Record System contains 10 million observations from 400,000 visit records on 45,000 patients. Critical components include paper encounter forms for adults and children, technicians entering/managing data, and modules for patient registration, scheduling, encounters, clinical observations, setting user privileges, and a concept dictionary. Key outputs include patient summaries, care reminders, and reports for program management, operating ancillary services (e.g., tracing patients who fail to return for appointments), strategic planning (e.g., hiring health care providers and staff), reports to national AIDS programs and funding agencies, and research.

Erica M. Kigotho

Papers

An electronic medical record system for ambulatory care of HIV-infected patients in Kenya.

The AMPATH medical record system: Creating, implementing, and sustaining an electronic medical record system to support Hiv/AIDS care in western Kenya