Mathieu Forster

Bio: Mathieu Forster is an academic researcher from University of Bern. The author has contributed to research in topics: Health care & Tuberculosis. The author has an hindex of 2, co-authored 4 publications receiving 221 citations.

Electronic medical record systems data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings.

Abstract: OBJECTIVE: To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. METHODS: In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. FINDINGS: Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72-19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0-18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37-0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90-0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2-19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15-0.20). CONCLUSION: The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.

Tuberculosis in HIV programmes in lower-income countries: practices and risk factors.

Abstract: BACKGROUND: Tuberculosis (TB) is a common diagnosis in human immunodeficiency virus (HIV) infected patients on antiretroviral treatment (ART). OBJECTIVE: To describe TB-related practices in ART programmes in lower-income countries and identify risk factors for TB in the first year of ART. METHODS: Programme characteristics were assessed using standardised electronic questionnaire. Patient data from 2003 to 2008 were analysed and incidence rate ratios (IRRs) calculated using Poisson regression models. RESULTS: Fifteen ART programmes in 12 countries in Africa, South America and Asia were included. Chest X-ray, sputum microscopy and culture were available free of charge in respectively 13 (86.7%), 14 (93.3%) and eight (53.3%) programmes. Eight sites (53.3%) used directly observed treatment and five (33.3%) routinely administered isoniazid preventive treatment (IPT). A total of 19 413 patients aged ≥16 years contributed 13 227 person-years of follow-up; 1081 new TB events were diagnosed. Risk factors included CD4 cell count (>350 cells/μl vs. <25 cells/μl, adjusted IRR 0.46, 95%CI 0.33–0.64, P < 0.0001), sex (women vs. men, adjusted IRR 0.77, 95%CI 0.68–0.88, P = 0.0001) and use of IPT (IRR 0.24, 95%CI 0.19–0.31, P < 0.0001). CONCLUSIONS: Diagnostic capacity and practices vary widely across ART programmes. IPT prevented TB, but was used in few programmes. More efforts are needed to reduce the burden of TB in HIV co-infected patients in lower income countries.

Electronic Medical Record Systems, Data Quality and Loss to Follow-Up: Survey of Antiretroviral Therapy Programmes in Resource-Limited settings/Systemes D'enregistrement Electronique Des Donnees Medicales, Qualite Des Donnees et Nombre De Perdus De Vue : Enquete Sur Les Programmes De Traitement Antiretroviral Dans Les Pays a Ressources limitees/Sistemas De Historias Clinicas Electronicas, Calidad De Los Datos Y Perdidas De Seguimiento

Abstract: Introduction Access to antiretroviral therapy (ART) has improved in lower-income countries over the past 4 years as a result of an exceptional commitment by the international community and donor agencies WHO estimates that about 3 million people were receiving ART in low- and middle-income countries at the end of 2007, a figure representing a 75-fold increase over the previous 4 years (1) The number of patients starting ART has increased exponentially since 2003 and must continue to do so if the goal of universal access to ART is to be achieved (2) In the absence of curative treatments, lifelong follow-up of patients on ART is required to monitor adherence, treatment response and adverse effects A growing amount of increasingly complex information needs to be reviewed at each visit, and new data must be added to the record An important aspect is retention in care: a recent analysis of treatment programmes showed that losses to follow-up have become more common with the scale-up of ART (3) Programmes find it increasingly difficult to follow the growing population of patients and to trace those who do not return to the clinic Electronic Medical Record (EMR) systems can improve health care by increasing adherence to therapeutic guidelines and protocols, informing clinical decisions and decreasing medication errors (4,5) EMR systems allow early identification of patients who miss appointments, thereby facilitating their timely tracing, and provide a platform for operational research (6) Little is known about the role of EMR systems in the context of the scale-up of ART in resource-limited settings A recent review identified the need for studies on the best ways of using information systems to support the expansion of HIV care in such settings (7) The objective of this study was to describe the electronic medical databases used in ART programmes in lower-income countries and to assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up Methods Workshop and subsequent survey In June 2006, representatives of 21 ART programmes from 15 countries (Benin, Brazil, Burundi, Cote d'Ivoire, the Gambia, India, Kenya, Malawi, Mall, Nigeria, South Africa, Thailand, Uganda, Zambia and Zimbabwe) attended a workshop on the use of EMR systems in ART programmes in resource-limited settings Ten of the 21 programmes participated in the Antiretroviral Treatment in Lower Income Countries (ART-LINC) collaboration, a network of treatment sites of the International Epidemiological Databases to Evaluate AIDS (IeDEA, http://www iedea-hivorg) (8-10) The workshop was jointly organized by IeDEA and the Knowledge Communities and Strategies (KCS) unit at WHO and hosted by the Centers for Disease Control and Prevention (CDC, United States Department of Health and Human Services) offices in Entebbe, Uganda Based on the workshop, an online questionnaire covering the EMR systems in place, human and electronic resources, reporting systems, data storage, quality control measures and the tracing of patients lost to follow-up was written in English, translated into French and revised after pilot testing in Bern and Bordeaux The questionnaire is available from biblio@ispmunibech ART treatment programmes that participated in the Entebbe workshop were invited to complete the questionnaire All sites (n = 21) agreed to participate in the survey WHO's web-based Data Collector system (11) was used The questionnaire was uploaded 20 December 2006, and all sites had responded by 12 February 2007 Data quality in ART-LINC Questions from the Entebbe survey were used to create indicators of data quality First, for each programme, a computation was made of the number of hours dedicated to data entry per week divided by the number of ART patients enrolled This was done separately for data entry clerks and medical staff …

E-Health Technologies Show Promise In Developing Countries

Abstract: Is there any evidence that e-health—using information technology to manage patient care—can have a positive impact in developing countries? Our systematic review of evaluations of e-health implementations in developing countries found that systems that improve communication between institutions, assist in ordering and managing medications, and help monitor and detect patients who might abandon care show promise. Evaluations of personal digital assistants and mobile devices convincingly demonstrate that such devices can be very effective in improving data collection time and quality. Donors and funders should require and sponsor outside evaluations to ensure that future e-health investments are well-targeted.

Sterile-Insect Methods for Control of Mosquito-Borne Diseases: An Analysis

Abstract: Effective vector control, and more specifically mosquito control, is a complex and difficult problem, as illustrated by the continuing prevalence (and spread) of mosquito-transmitted diseases. The sterile insect technique and similar methods control certain agricultural insect pest populations in a species-specific, environmentally sound, and effective manner; there is increased interest in applying this approach to vector control. Such an approach, like all others in use and development, is not a one-size-fits-all solution, and will be more appropriate in some situations than others. In addition, the proposed release of pest insects, and more so genetically modified pest insects, is bound to raise questions in the general public and the scientific community as to such a method's efficacy, safety, and sustainability. This article attempts to address these concerns and indicate where sterile-insect methods are likely to be useful for vector control.

Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis

Abstract: Background The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes. Methods and Findings We searched the PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Indian Medlars Centre (IndMed) and African Index Medicus (AIM) databases and the abstracts of three conferences for studies that traced patients lost to follow up to ascertain their vital status. Main outcomes were the proportion of patients traced, the proportion found to be alive and the proportion that had died. Where available, we also examined the reasons why some patients could not be traced, why patients found to be alive did not return to the clinic, and the causes of death. We combined mortality data from several studies using random-effects meta-analysis. Seventeen studies were eligible. All were from sub-Saharan Africa, except one study from India, and none were conducted in children. A total of 6420 patients (range 44 to 1343 patients) were included. Patients were traced using telephone calls, home visits and through social networks. Overall the vital status of 4021 patients could be ascertained (63%, range across studies: 45% to 86%); 1602 patients had died. The combined mortality was 40% (95% confidence interval 33%–48%), with substantial heterogeneity between studies (P<0.0001). Mortality in African programmes ranged from 12% to 87% of patients lost to follow-up. Mortality was inversely associated with the rate of loss to follow up in the programme: it declined from around 60% to 20% as the percentage of patients lost to the programme increased from 5% to 50%. Among patients not found, telephone numbers and addresses were frequently incorrect or missing. Common reasons for not returning to the clinic were transfer to another programme, financial problems and improving or deteriorating health. Causes of death were available for 47 deaths: 29 (62%) died of an AIDS defining illness. Conclusions In ART programmes in resource-limited settings a substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died. Our findings have implications both for patient care and the monitoring and evaluation of programmes.

Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health

Abstract: Cardiovascular disease (CVD), once thought to be confined primarily to industrialized nations, has emerged as a major health threat in developing countries. Cardiovascular disease now accounts for nearly 30 percent of deaths in low and middle income countries each year, and is accompanied by significant economic repercussions. Yet most governments, global health institutions, and development agencies have largely overlooked CVD as they have invested in health in developing countries. Recognizing the gap between the compelling evidence of the global CVD burden and the investment needed to prevent and control CVD, the National Heart, Lung, and Blood Institute (NHLBI) turned to the IOM for advice on how to catalyze change. In this report, the IOM recommends that the NHLBI, development agencies, nongovernmental organizations, and governments work toward two essential goals: * creating environments that promote heart healthy lifestyle choices and help reduce the risk of chronic diseases, and * building public health infrastructure and health systems with the capacity to implement programs that will effectively detect and reduce risk and manage CVD. To meet these goals, the IOM recommends several steps, including improving cooperation and collaboration; implementing effective and feasible strategies; and informing efforts through research and health surveillance. Without better efforts to promote cardiovascular health, global health as a whole will be undermined.