Background

1. Côte d’Ivoire’s Experience With a Nation-scale Longitudinal Patient-Monitoring System for HIV Treatment and Care Abdou Salam Gueye, MD, PhD; CDC Cote d’IvoireCatherine 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

2. 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

3. 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 d’Ivoire government chose the WHO HIV/AIDS patient-monitoring guidelines to develop a new system

4. New Approaches in Creating a Harmonized Nationwide System Adapting the WHO ART patient-monitoring tools to the Côte d’Ivoire 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

5. 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, d’Epidémiologie et du Développement, Bordeaux 2 University, France (ISPED) Were chosen based on their 10 years experiense developing and implementing research data management systems.

6. Electronic Tool Development Processes Between December 2006 and June 2007, the ACONDA/ISPED M&E 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.

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

8. 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.

9. 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. System Specificities (2)

10. 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 System Specificities (3)

11. 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

12. Data Capture of Paper Tools Capture of a new patient number Roll out menu Validate the capture

13. Permanent Quality Control of Captured Data Alerts in red to inform of missing data

14. Capture of All Prescriptions Both ART and OI Drugs Standardised capture of drugs delivered

15. Follow-up of all Pharmacy Activities (order, drugs reception, stock-out…)

16. Permanent Pharmacy Reports

17. 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

18. Automatic Standardized Reports for MOH, PEPFAR, Other Partners PEPFAR Monthly report Print the document Export the document to computer desk

19. Automatic Standardized Follow-up Activities Figures of active follow-up with aggregated number of patients who are deceased or lost to follow-up

20. 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

21. 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.

22. MOH Vision 2008 TIMS MONISTAC MLS WebSite ETR OVC Database SIMPLE

23. MOH Vision 2009 TIMS MONISTAC MLS WebSite ETR OVC Database SIMPLE

24. National HIV Data Repository RESEARCHERS POPULATION MANAGERS INTERNET CLINICIANS BIOLOGISTS PHARMACISTS

25. 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.