Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting.

Publication Date:

12 Nov 2014

Citation:

Puttkammer N, Zeliadt S, Balan JG, Baseman J, Destiné R, Domerçant JW, France G, Hyppolite N, Pelletier V, Raphael NA, Sherr K, Yuhas K, Barnhart S (2014) Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting. PLOS

 

Abstract

Background
The adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients’ adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk.

Methods
Among adult patients enrolled on ART from 2005–2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6–12 months on treatment, based on the World Health Organization’s immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves.

Results
Among 923 patients with CD4 results available during the period 6–12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation. Conclusions Pharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs.  

Read the Full Article

 

Stand with HAI

Stand with HAI

Donate

When you support Health Alliance International, you take a stand for a more equitable and respectful model of global health. Your donation not only helps us expand our reach, it is an investment in our shared values of health equity and solidarity. 

Join the Alliance

Our alliance is made up of supporters, partners, staff, and volunteers who share our commitment to universal access to quality health care. Just like a health system, every person plays a role in keeping us working toward this ultimate goal. Will you join us? 

Get Engaged

The kind of change we seek requires sustained action.  Whether you want to engage in HAI's advocacy work or help spread HAI's mission and model, we rely on our friends and supporters to stand beside us when we stand up for equity in global health.

Didn't find what you were looking for?

Didn't find what you were looking for?