For nearly a decade, iSanté has allowed providers to share information among care team members and health professionals.

For nearly a decade, iSanté has allowed providers to share information among care team members and health professionals.

Over the past several years, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has invested heavily in health systems and clinical data analyses in low-income countries around the world, in its efforts to support the care and treatment of those affected by HIV and AIDS.

With the support of PEPFAR, through the Health Resources and Services Administration (HRSA), in 2005, the International Training and Education Center for Health (I-TECH), together with Haiti’s Ministère de la Santé Publique et de la Population (MSPP) and the U.S. Centers for Disease Control and Prevention (CDC), developed and implemented iSanté — an electronic medical record system to capture and report information on patients living with HIV and AIDS.

For nearly a decade, this system has allowed providers to document HIV patient care, look up patient care histories, and share information between care team members and health professionals.

The MSPP has been particularly concerned with patient adherence to antiretroviral therapy (ART) and treatment failure due to a number of factors, including the 2010 Haiti earthquake. While iSanté has gotten kudos in Haiti for storing and linking patient data, three recent papers, lead-authored by I-TECH Research and Evaluation Advisor Nancy Puttkammer, have illustrated the potential of using this data source to identify and help solve the challenges of adherence and patient attrition.

  • Before and After the Earthquake: A Case Study of Attrition from the HIV Antiretroviral Therapy Program in Haiti,” published in Global Health Action in August 2014, compared attrition from the national HIV ART program at two large public-sector hospitals where I-TECH works. One site was less than 30 km from the epicenter of the devastating earthquake of January 2010, while the other site was outside of the area strongly affected by the earthquake. Surprisingly, the paper showed that attrition improved after the earthquake in the site closest to the epicenter. This finding underscores the resilience of patients and providers, and contributes evidence that it is possible to maintain continuity of HIV services even in the context of a complex humanitarian emergency.
  • “Patient Attrition from the HIV Antiretroviral Therapy Program at Two Hospitals in Haiti,” currently in press at the Pan American Journal of Public Health, examines ART attrition at the same two hospitals, during the period 2005-2011. The study found higher risk of attrition among patients who lived farther away from the hospital, who started on non-standard ART regimens, who did not receive ART adherence counseling before initiating ART, and who rapidly started ART following their enrollment in HIV care and treatment. The findings suggest opportunities for several quality improvement interventions at the two hospitals.

“This research has provided a valuable contribution in documenting health outcomes and encouraging improvement in the ART program in Haiti,” says Dr. Scott Barnhart, Professor of General Internal Medicine and Global Health at the University of Washington. “We are at the dawn of translating large investments in EMRs into useful data for improving the care of patients, as well as supporting important public health functions such as surveillance. This work is at the forefront of these activities.”

Data gathered by iSanté is used for improvement of HIV care and treatment services at three levels: the individual patient, the group or facility, and the national or system level.

Data gathered by iSanté is used for improvement of HIV care and treatment services at three levels: the individual patient, the group or facility, and the national or system level.

In fact, it was during the review process for “Patient Attrition” that the CDC and MSPP took note of the potential of iSanté to provide timely, efficient answers to questions of public health importance. In early 2014, the MSPP was concerned about retention of women in the Option B+ program for prevention of mother-to-child transmission of HIV (the program administers lifelong ART for all pregnant or breastfeeding women regardless of their clinical stage or CD4 count).

I-TECH was called upon to compare attrition rates among women enrolled on ART under Option B+ versus other new ART enrollees. Using data from iSanté’s consolidated server, which contains data from more than 100 health facilities, it was possible to complete a preliminary analysis within three weeks, rather than sending data collection teams to multiple facilities. A poster on the findings was recently accepted for presentation at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI).

“These publications will bring real added value to the use of iSanté in Haiti, as well as help improve patient care,” says Dr. Jean Guy Honoré, I-TECH Haiti Country Director. “This work shows the usefulness of data collected in iSanté and will be a stimulus for health care providers, as well as our mentors who provide technical assistance to them. This will encourage a better use of iSanté and more involvement in research and publication activities.”

On that score, I-TECH is also joining a new analysis working group within the MSPP, which will support the Ministry in prioritizing and addressing its key research and evaluation questions using patient data from Haiti’s three EMR systems.

“I have been involved with iSanté since 2004, when we first began working with HIV clinical experts in Haiti to define the standardized content for HIV patient visits,” says Dr. Puttkammer. “At that time, we talked about a key goal of iSanté: to facilitate research on patient health and quality of care. It has been incredibly satisfying, after so much hard work at sites all over Haiti, to show that we could actually reach this goal.”

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