An Evaluation of Electronic Data Systems for Antiretroviral Therapy in Four Facilities in Malawi

 

Antiretroviral therapy (ART) is rapidly scaling-up in Malawi. Between December 2004 and September 2008, the number of patients ever started on ART grew from 13,183 to 204,440 respectively.  As the number of patients on treatment increases, the current paper-based system will become increasingly burdensome and prone to errors.

 

In response, an Electronic Data Systems (EDS) task force was formed to develop system requirements for national EDS for ART monitoring and to facilitate a pilot of EDS for expanded use.

 

Based on the system specifications, two developers independently developed and piloted EDS for ART at four government clinics. Key EDS features supporting clinical management, reporting and higher-level analyses include:

• Point-of-care data entry
• Unique patient identifiers on standard patient documents
  
• Interactive clinical staging
• Primary and secondary outcomes
• Graphical display of weight trends
• Calculation of drug adherence and next appointment
• Identification of defaulters for active follow-up
• Remote access for reporting

 

Over 18,000 patients (15% of the national cohort) are currently managed and monitored using EDS in Malawi.

 

Valuable insights were gained from the pilot phase:

• Point-of-care EDS help to enforce standard protocol.
• High turnover of staff requires regular re-trainings at EDS clinics.
• Implementation of EDS requires long-term technical support for data management, to rectify user errors and to fix hardware.
• Remote system monitoring is a powerful tool to reduce system down-time and to provide pro-active user support. This requires network connectivity.

 

Throughout the pilot, the developers identified ways to strengthen EDS for national scale-up, including program management priorities, establishing a system to procure reliable and timely equipment, and developing standard protocol for data migration.

 

While the ART EDS system has proved feasible and successful, challenges around connectivity, interoperability, training and support will need to be managed for a successful national roll-out.