The Use of Electronic Medical Records and Clinical Decision Support Tools to Evaluate and Strengthen HIV Care in Haiti and Ukraine

Abstract

Use of electronic medical records (EMRs) and clinical decision support (CDS) tools to support HIV care has been growing in low- and middle-income countries. Data from these systems can inform incidence surveillance, index partner tracing, HIV program evaluation, and individual patient care. However, there are several barriers to the use of this data for decision making, including negative perceptions of the usefulness and trustworthiness of routine data, data quality issues, and limitations of observational data for causal inference in program and policy evaluation. Our objective was to better understand how EMRs and CDS tools could be leveraged to strengthen and support HIV care in Haiti and Ukraine, including understanding barriers and facilitators to tool use, associations between EMR data quality and patient outcomes, and use of quasi-experimental methodology to evaluate public health interventions (here, index testing and partner services). Related to each of these questions, we found that: 1) providers had generally positive views of EMR-informed CDS tools, particularly their potential to improve decision-making and patient outcomes; 2) that EMR data missingness is associated with poorer retention in care, particularly among children living with HIV, suggesting that data quality is a crucial element of clinical case management and quality of care; 3) and that EMR data can enable large-scale analyses of effectiveness of public health interventions, and specifically in this case example, showing evidence of index testing program effectiveness at brining named partners into HIV care and treatment at earlier stages of HIV disease progression.