TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda

Abstract

Background Delays in testing HIV-exposed infants and obtaining results in resource-limited settings contribute to delays for initiating antiretroviral therapy(ART) in infants. To overcome this challenge, Rwanda expanded its national mobile and internet-based HIV/AIDS informatics system, called TRACnet, to include HIV PCR results in 2010. This study was performed to evaluate the impact of TRACnet technology on the time to delivery of test results and the subsequent initiation of ART in HIV-infected infants. Methods A retrospective cohort study was conducted on 380 infants who initiated ART in 190 health facilities in Rwanda from March 2010 to June 2013. Program data collected by the TRACnet system was extracted and analyzed. Results Since the introduction of TRACnet for processing PCR results, the time to receive results has significantly decreased from a median of 144 days[IQR 121-197] to 23 days[IQR 17-43]. The number of days between PCR sampling and health facility receipt of results decreased substantially from a median of 90 days[IQR 83-158] to 5 days[IQR 2-8]. After receiving PCR results at a health facility, it takes a median of 44 days[IQR 32-77] before ART initiation. Result turnaround time was significantly associated with time to initiating ART(P<0.001). An increased number of staff trained for HIV care and treatment was also significantly associated with decreased time to ART initiation(P=0.004). Conclusions The use of mobile technology for communication of HIV PCR results, coupled with well-trained and skilled personnel, can reduce delays in communicating results to providers. Such reductions may improve timely ART initiation in resource-limited settings.

User Perceptions and Use of an Enhanced Electronic Health Record in Rwanda With and Without Clinical Alerts: Cross-sectional Survey

“…From the beginning of the HIV treatment scale-up, the Government of Rwanda has emphasized care and prevention in rural areas as well as in urban settings; recruitment, training, and supervision of community health workers; and the use of health information systems. These information systems included national-level surveillance systems for HIV care [ 8 , 9 ], mobile health systems to support antenatal and primary care, and patient information or EHR systems mainly for supporting HIV care in health centers and hospitals. The 3 main EHR systems used have been OpenMRS (OpenMRS Inc) in health centers and 36 district hospitals offering HIV services, IQcare (International Quality Care, Palladium Inc) [ 10 ] in some health centers (now replaced by OpenMRS), and OpenClinic (OpenClinic GA) [ 11 ] in some hospitals.…”

Melhores práticas de gestão no cuidado ao HIV: scoping review

“…O segundo grupo que recebeu maior destaque foi o de mulheres com quatro estudos, em que dois apresentaram enfoque no período puerperal 19,28 , um no período gestacional 24 , e outro direcionado a mulheres trabalhadoras do sexo 12 . Dois estudos tiveram como participantes profissionais da saúde 14, 21 , dois estavam direcionados a serviços de saúde que prestam cuidados direcionados às PVHIV 23,30 , e os demais estudos contaram com a participação de idosos 20 , estudantes de enfermagem 15 , crianças 25 e lactentes 26 .…”

“…O perfil das organizações executoras das melhores práticas variou entre os estudos; no entanto, serviços e programas de saúde receberam destaque em sete manuscritos, em que a iniciativa Avahan -India Aids esteve presente em dois artigos Os estudos apresentaram diferentes populações para as quais as melhores práticas foram destinadas. Para as PVHIV, sobressaíram os estudos acerca a saúde materno-infantil, envolvendo gestantes e puérperas com HIV 14 , recém-nascidos de mães com HIV 14,28 , mulheres grávidas com seguimento para o puerpério e recém-nascidos 24 , e recém-nascidos que iniciaram a Terapia Antirretroviral (Tarv) 26 . Outros estudos envolveram crianças 25 , PVHIV no geral 16,18,21 , pessoas sem seguro saúde 29 , pessoas adultas que fazem uso da Tarv 23 , pessoas não tratadas com Tarv 27 , e parturientes e recém--nascidos sem status de HIV documentado 19 .…”

An Unstructured Supplementary Service Data System for Daily Tracking of Patient Samples and Diagnostic Results in a Diagnostic Network in Malawi: System Development and Field Trial

“…For example, an analysis of archival 2017-2018 courier data in Malawi revealed that 30.08% (24,256/80,648) of the courier visits to clinics were empty trips. This not only results in inefficient use of limited resources but also contributes to delays in receiving critical test results [ 5 ], which in turn leads to poor health-seeking behavior among the population [ 6 ] and can contribute to increased mortality rates [ 7 ].…”