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Developing a Network of Providers to Support AIDS Patients
by Cynthia Young, Senior Writer

Providing quality healthcare to people living with HIV and AIDS can be a tremendous challenge to health systems in developing counties, which often lack the capacity and resources to address increasing numbers of HIV/AIDS patients suffering from opportunistic infections and other chronic diseases.

The USAID Quality Assurance and Workforce Development project is examining strategies to address these growing caseloads of AIDS patients, where a small number of expert AIDS clinicians will be supporting a much larger group of regular healthcare providers. A presentation on Expert Systems and AIDS-related Health Care was held recently at USAID in Washington to study information technology currently being implemented in developing countries. This technology shows great promise in solving this potential bottleneck.

Dr. Ian Sanne, Director of the Clinical HIV Research Unit of Wits University, South Africa, spoke about the TherapyEdge software to support general providers caring for AIDS patients. The software package is currently being used in South Africa to monitor people living with HIV/AIDS (PLWHA) who are on Highly Active Antiretroviral Therapy (HAART).

Dr. Neeraj Kak, PhD, Senior Technical Advisor for the Quality Assurance Project, discussed QAP’s plans to develop an integrated case management system to improve the quality of care for people living with HIV/AIDS, particularly those on HAART.

He spoke about setting up an integrated case management model for a large number of PLWHA who potentially could be put on HAART over the next several years in many countries. To standardize quality of care irrespective of a patient’s location, the model would ensure high quality treatment and patient follow-up.

“Our objective for the network is to provide support for patient screening, treatment, and follow-up, and ensure provider and patient compliance with treatment,” said Dr. Kak. “There is a need to standardize care at all levels with limited human resources, lack of adequate physical infrastructure, equipment, supplies, and record-keeping, and the need to ensure patient compliance to drug therapies.”

The central element in the system will be a centralized Expert System linking multiple relational databases holding clinical algorithms, patient records, and reports. It will be linked to health centers and laboratories via WAN/LAN systems or the Internet. 

 “This Expert System will allow treatment and follow-up of patients, analysis, and raising of red flags concerning patient-specific health problems,” said Dr. Kak. “Community-based workers will be linked to the system with hand-held electronic devices to upload patient information. The expert system will be linked to a central call center hosting experts and case managers, who can screen, diagnose, and treat patients.” 

At the central call center, experts will review case information, attend patients, write prescriptions, and inform individuals about HIV/AIDS concerns. The call center will update the local and centralized databases, ensure case management, patient follow-up, and provide medication.

Local case managers will prescribe medications, update databases with patient information, analyze health status, and inform the calling center or local health center when urgent action or follow-up is required. Laboratories will be electronically linked to the expert system, will provide screening and diagnostic support, prevention, patient follow-up, and data transmission to local health centers or the central expert system.

This system will also be an information source for individuals to learn more about their HIV status, learn about HIV/AIDS and related opportunistic infections, and provide advice on HIV/AIDS issues to those who want to maintain confidentiality. An automated system will call patients regularly for progress, ensure compliance to treatment, and convey medication reminders. 

A number of USAID staff including Jeff Cochrane, of the EGAT Information Technology group, spoke about the need as well as challenges of successfully implementing IT technologies in developing countries.

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development
(USAID) under Contract Number GPH-C-00-02-00004-00.