Page History

Christina White and Piotr Mankowski of DIGI ITECH-UW shared about the Client Registry work in Haiti to improve the ability to provide high quality care to patients to move between services, facilities and networks. Brett Onions from Luke International shared about the Demographics Data Exchange (DDE), the Master Patient Index (MPI) for Malawi, currently being developed by EGPAF in Malawi. Both presentations provided an overview of the current implementations and the attendees had the opportunity to ask questions that ranged from details on the technology and matching process. 

• Recording
• Slides
  • DUC Intro / Next Steps
  • Haiti: DIGI ITECH-UW Slides
  • Malawi: Master Patient Index
•  Collaborative Notes
• Meeting Summary

• Lighthouse Trust’s Innovations for Client-Centered Care: Community-based ART Retention and Suppression (CARES) App in Malawi. Lighthouse Trust clinics in Lilongwe, Malawi, use EMRs in static sites.  But Lighthouse’s differentiated service delivery (DSD) programs, like its nurse-led community-based ART program (NCAP), do not benefit from EMRs. Lighthouse Trust, ITECH, and Medic, with support from the National Institutes for Health, will share their experience with their Community-based ART Retention and Suppression (CARES) App. CARES aims to provide a high-quality, point-of-care EMRs app in NCAP settings, enabling improved patient care and program-level M&E while reducing workload. 
• • Slides
  • View on the TIF
Differentiated Service Delivery Models in UgandaEMR to decongest facilities. Samuel Lubwama and Edward Bichetero in Uganda will share their experience functionalizing the guidelines for Differentiated Service Delivery Models in UgandaEMR as a method for decongesting facilities. 
• • View on TIF

• Recording
• Slides
  • DUC Intro / Next Steps
  • Lighthouse Trust’s Innovations for Client-Centered Care: Community-based ART Retention and Suppression (CARES) App in Malawi
• Collaborative Notes

This 90 minute virtual workshop was designed to take a deeper look at the metrics calculation and reporting processes with the goals of supporting and strengthening countries as they work toward using patient-level data for generating metrics for program planning, patient care and decision making. 

Goals of the session included:

1. Understanding the different goals and needs for metrics reporting
2. Sharing experiences and learning from others on calculation and metrics reporting processes
3. Opportunities to build relationships and linkages between teams working on reporting challenges 
4. Gathering common challenges and practices
5. Identifying ways the DUC can facilitate the teams in collectively moving forward

• Recording
• Jamboard
• Summary & Findings
• Introduction Slides
• Collaborative Notes

Unique Patient Identification (UPI) in Kenya. Presented by Dr. Joseph Sitienei, MoH Kenya

Uniquely identifying patients is a critical component of Kenya’s efforts to deliver Universal Health Coverage (UHC) to everyone living within the country.  Dr. Sitienei shared the strategy and the steps that the Kenyan government took to help ensure the implementation and acceptability of a UPI system to uniquely identify patients and deliver optimum health care. These steps included leveraging the country’s national person identification system and involving the community to “own” the process. Dr. Sitienei also shared various challenges faced throughout this process and solutions.  As a next step the government and MOH will work to implement the UPI policy country-wide and eventually expand it include biometric identifiers. 

• Recording
• UPI in Kenya Slides
• Kenya MOH Patient identity National Policy
• DUC Introduction Slides
• Collaborative Notes

• Meeting Recording
• Meeting Slides
  • DUC
  • Jembi
• Collaborative Notes Page

Community Meeting

• Meeting Recording
• Collaborative Notes Page
• Meeting Slides

• DUAL Team Slides

• Meeting Recording
• Meeting Slides
  • DUC Introduction and Next Steps

• Malawi Team Slides
• Uganda Team Slides

• Meeting recording
• Meeting slides
  • DUC Introduction and Next Steps

The call consisted of community members sharing information and experiences regarding using Biometrics for identity management. 

• Alexandra Grigore, CPO with Simprints shared a general overview of biometrics use for Patient Identity Management. They addressed drawbacks (ex. duplicates and unreliable data), examples of types of biometric data (ex. fingerprints, facial recognition), how they are used, and a couple specific case studies regarding biometric use. Link to slides shared.
• Nicolas de Kerorguen a Contractor for CDC/CGH/DGHT/HIDMSB/Health Informatics Team and Franck Aghan a Software engineer SEJEN based in Côte d’Ivoire shared lessons learned from the use of fingerprint biometric technology in Côte d’Ivoire. They discussed background information, challenges associated with fingerprint use, and direct observations from their work.Link to slides shared.

• Event Summary
• Meeting Recording
• Meeting Slides
  
  • • DUC Introduction and Next Steps
    • Simprints Team Slides
    • Côte d'Ivoire Team Slides
• Meeting Notes Page

• Meeting Recording
• Meeting Slides
  
• Meeting Notes Page

• Meeting Recording
• Meeting Slides
• Collaborative Meeting Summary
• Session Jamboard

• Meeting Recording
• Meeting Slides
• Session Jamboard
• Toolkit Draft Proposal

• Meeting Recording
• Meeting Slides
• Mentimeter

The following is a summary of the current identity practices that were shared:  

• The group first established an overview of the current state of HIV identity practices: 
• Although most countries have a national ID, there are challenges with using it for HIV care
• Countries are using or looking at solutions for a client registry (CR) / enterprise master patient index (EMPI)
• Countries are using or planning to use human adjudication and algorithmic matching.  

• Meeting Recording 
• Collaborative Meeting Summary
• Meeting Slides -
  • Jamboard: 2022-03 DUC: Identity Management Workshop 
  • Slides: 2022-03 DUC Identity Workshop

8 February 2022

Data Integration Across Facilities: Determining a Patient's Real Treatment Continuity 

This meeting focused on the topic of "Data Integration Across Facilities: Determining a Patient’s Real Treatment Continuity." The community participated in a conversation on identified patterns used to integrate patient-level data across facilities to better discern true HIV retention for an individual.

• Morrison Idiasirue, CiHEB Regional Software Developer, and Stephen Ohakanu, CiHEB Director of Health Informatics, with CiHEB Nigeria shared the Nigeria National Data Repository as the unified data storage and analysis facility that houses de-identified patient level data for HIV tx data.
• Kemar Celestin, HIS Coordinator with CHARESS Haiti, shared on secondary use of data from Haiti's iSantéPlus National Electronic Medical Record system to reduce loss-to-follow-up via alerts, routine data to analyze implementation and site-level performance, as well as by carrying out national-level program and policy evaluations.

Following these presentations was a Q&A to dive deeper into the details shared and the speakers also spoke to more technical-level processes from their experience.  

• Meeting Recording
• Meeting Summary
• Meeting Slides
  • Slides: Secondary Use of Data from Haiti's iSantéPlus National Electronic Medical Record System to Reduce Lost to Follow-up
  • Slides: Nigeria National Data Repository

This meeting focused on the topic of "From Patient-Level Data to Indicator Reporting: Exploring Country Patterns." The community took a look at the state of metrics reporting, promoted learning across contexts by hearing from individual country experiences on reporting patterns and data flows. We also heard some emerging work that impact reporting standards and processes.

Community members Jennifer Shivers and Jason Knueppel lead this call. Jason shared more on the PEPFAR and Ministry of Health Data Alignment Activity as an example to help understand the full HIV landscape and better define targeted interventions. We were then introduced to community members who shared more about the approaches they are involved in for indicator reporting on this call:

• Dominique Vite with PEPFAR in Mozambique
• Victor Kabwe with PEPFAR in Zambia
• Jason shared about Namibia's processes with information provided by Michael De Klerk.

• • Recording
  • Summary
  • Slides
• DUC Debrief Recording

This meeting synthesized conversations from previous meetings that dug deeper into the working model which was first introduced in the March 2021 community meeting. The October meeting focus was on sharing an overview of the interventions that have been shared with the community to date. The meeting was also designed to get feedback and input from community members on additional needs and topics that the community would like to see addressed.

Paul Biondich, a community lead for the Data Use Community,started the presentation by sharing background on the formation of this community along with its mission, purpose, and the progress we've made to date. Paul then shared how we've organized this through the field experiences that have been shared on this call by creating a framework/working model now titled, "Technical Interventions Framework (TIF): HIV Treatment Continuity". The TIF was made to start creating common understanding of implementer approaches through agreeing on a common way to talk about / look at HIV treatment continuity. Next, Olivia shared about a project to create canvases across interventions in the TIF. The Touchpoint Canvas is a visual framework for understanding different components of an intervention. Following this presentation, Kasey Upchurch, led a feedback session for input on how community members have felt about this community so far and the direction they would like to see for the future of the DUC. 

• Recording
• Summary
• Slides

Touchpoint Interventions: Proactive Adherence Counseling

Teams presented on the following:

• Palindrome is a data science implementer specializing in machine learning, predictive analytics and alternative data services. Alongside their partner, Right to Care, the two teams shared how they are using AI to create a model that can predict whether a patient will miss their next scheduled appointment and become LTFU. The machine learning work was tested in six facilities in one district in South Africa, using paper adherence scorecards and digital adherence scorecards.
• DataFi, Data for Implementation, is a consortium of partners. The team shared their work in Mozambique to deploy a predictive model as part of a software solution connected to OpenMRS, the EMR used at ECHO-supported facilities. They will be creating a software plugin to generate patient risk scores through the EMR. The project work can be described in four stages 1) data collection, 2) machine learning, 3) systems integration design and implementation (the current project stage), and 4) assessment and scale up.  One of the project partners, Macro-Eyes, developed the OpenMRS module that will be deployed at facilities.

• • Recording
  • Summary
  • Slides
• DUC Debrief Recording

Using Patient Record Systems to Generate
M&E Reports for HIV Treatment Continuity

These two presentations shared on the following:

• Clement Marcel from CiHEB Tanzania shared on the "Care and Treatment Analytics Tool" and how it is used to provide additional deep dive analytics to ensure that HIV care and treatment data informs and supports the programs and the National EMR. This tool is able to link with different tools for triangular data and allows cross-monitoring analysis. The data elements in this tool are deidentified patient-level data, such as visit date. Currently this tool is used in 31 regions and 1,300 facilities where three million clients and 155 million records were tested. 
• Kagiso Sebina from CiHEB Botswana shared their presentation on "Data Based Community: Do we have the Data to use?" and how they addressed challenges with unique ID use, high mobility with patient populations, and matching and de-duplicating records. 

• • Recording
  • Summary
  • Slides
  • Presenter Slides- CiHEB Tanzania Presentation, CiHEB Botswana Presentation
• DUC Debrief Recording

Touchpoint Interventions: Missed Appointment Reminders

These three presentations shared on the following:

• Santiana Munezero from the Rwanda Biomedical Center shared their appointment management strategy. This team utilizes an EMR system structure through OpenMRS to maintain patient information from registration through follow-ups and retention practices. The appointment management for HIV patients includes a model for scheduling and the process following a missed appointment: 1) Identification, 2) contact tracing, and 3) updating records. A few challenges were also noted; the appointment module is not ideal in meeting requirements for HIV appointments, only paper tools are used by providers for A.R.T. pickup, and local servers at facilities have not been easy to use.
• Evelyn Too from AMPATH - Kenya shared they have found that clients miss appointments due to forgetting the appointment, self-transferring, transit-related challenges, and a busy work schedule. There are also times where a patient is deceased and it is not noted in their management system. A team of experts planned how they could automate their processes including developing reports, automating the defaulter tracing registers that were formerly paper-based, and training retention staff on accessing AMRS and generating missed appointments daily. Evelyn also shared the missed appointment management process.
• Jacob Mutale and Komba Sikombe from CIDRZ - Zambia presented on a project called "Leveraging Person-Centered Public Health for HIV Treatment in Zambia (PCPH)". In facility interviews, the team found that those who had missed appointments were related often related to clinic-based barriers and structural barriers. Through other survey data, there were other reasons for missed appointments they dug deeper into like patient's experience with staff.

• • Recording
  • Summary
  • Slides
  • Presenter Slides- AMPATH
• DUC Debrief Recording

Touchpoint Interventions: Pre-Appointment Support

These three presentations shared on the following:

• Desalegn Bekedami from iCAP-Ethiopia shared the EMR-ART system and how it traces clients who have missed their appointment. This list is shared with adherence counselors and clinicians who use color coded displays to identify patients to call with reminders. 
• Ashley Sorgi from EGPAF shared the digital solutions for quality improvement (QI) and pre-appointment strategies. There was a QI evaluation on HIV care in South Africa. The QI-PM application is both a mobile and web based tool that enables EGPAF staff to track site-level QI projects overtime.
• David Mukungi and Esther Kanyang'onda from IntelliSOFT presented on eHospital, a client management module project in Kenya that ran from June 2019 to September 2019. This is an adaptation of Bahmni, is powered by OpenMRS to track patients, support clinical decisions, report and document management, support an entire facility, and is interoperable. They also shared on SSEMR, a project in South Sudan. This system connect Bahmni and syncs offline to register patients, view records, and enter patient data. This system also identifies missed appointments and viral loads as well as flag patients for the physician until they are enrolled. 

• • Recording
  • Summary
  • Slides
  • Presenter Slides: IntelliSOFT and EGPAF
• DUC Debrief Recording

TIF

• QI-PM Pre Appointment Support

• Pre-Appointment Support (South Sudan)

Touchpoint Intervention: Reactive Adherence Counseling

Three presentations were featured on this call to share experiences with this touchpoint.

• Nancy Puttkammer from I-TECH at the University of Washington presented about experience from the InfoPlus Adherence Project in Haiti. This goal was to develop an EMR based alert to signal patients at high risk of HIV treatment failure and to incorporate the story-telling culture by enacting a provider-led brief counseling approach called “My Adherence Stories”.

• Pinto Shukuru from LVCT Health in Kenya presented on the STEPS Project. This project aims to increase the availability and demand for comprehensive quality HIV prevention services to priority populations in high HIV-burdened counties of Western Kenya. One solution that was explored was the use of flags in the EMR. When a service provider accesses a patient’s chart, key items are flagged on the patient’s dashboard; missed appointment, due for viral load, pending viral load results, high viral load, and instability. The EMR also allows a facility to see the number of clients expected and those with an unsuppressed viral load as well as a list of clients with missed appointments for tracing.

• Limbani Thengo from Partners in Health presented on Electronic Tracking Retention and Client Enrollment (TRACE) in the Neno District of Malawi. This project includes community health workers and staff members to make home visits to patients who have missed visits and those who are enrolled in programs that identify patients at-risk of falling out of care due to location and other programs.

• • Recording
  • Summary
  • Slides
  • Presenter Slides - coming soon
• DUC Debrief Recording

• • Recording
  • Summary
  • Slides
  • Interactive Visual Learning Framework is posted on the community forum
• DUC Debrief Recording

This meeting featured short presentations from national EMR implementers discussing how these tools are used in the continuity of treatment (retention):

• KenyaEMR was presented by Otieno Benard of Palladium’s KenyaHMIS II Project. The system is implemented in over 800 facilities. They identified four categories of features that support retention: clinically oriented features, such as appointment management; reports and line-lists; support for clinical appointment keeping; and custom reporting. The data is shared into a national cohort dataset allowing decision-makers to identify gaps in retention and where to support interventions.

• UgandaEMR was presented by Stephen Senkomago Musoke with the METS program. The system has been implemented in over 1000 sites with the flexibility to do point-of-care, retrospective, or hybrid data entry. Point-of-care queueing allows for tracking of patients during care so patients are not lost. Dashboards are used to support clinical decision making and give an overview of lab tests and results. The EMR integrates with a mobile app that allows CHWs to assess those who have missed appointments and those that need follow-up to do assessments in the community.

• iSantéPlus (Haiti) was presented by Kemar Celestin of Centre Haïtien pour le Renforcement du Système de Santé (CHARESS). The EMR supports a number of reporting tools that allows providers to see lists of patients that have missed appointments, if they are due for viral load testing, or need medications. The Continuum of Care document provides a summary of all the care the patient has received and allows the data to be transferred to between iSantéPlus sites.

• NigeriaMRS presented by Gibril Gomez of Jhpiego and implemented in 1000 hospitals. The system supports custom notifications for appointments, medication pick up, and lab reminders. The community pharmacy allows patients who are stable and receiving care to pick up medications and nearby pharmacies.

• Lafiya Management Information System (LAMIS Nigeria) presented by Alexander Alozie of Data.FI. LAMIS has been implemented in over 700 facilities. The system supports a number of treatment continuation features including: SMS Reminders for clinic visits, drug refills, and viral load investigations; case management; client status notifications; and LAMISLite which works on a mobile device and supports CHWs in the community.

• PIHMalawiEMR presented by Limbani Thengo. Patient’s identified in the appointment report as being missing for two or six weeks are then put into the Tracking Retention and Client Enrollment (TRACE) process. First they will verify the missed appointment is not due to missed data entry, then they signal CHWs via a mobile app to conduct outreach to bring the patients back to care.

• eSwatini CMS presented by Mzawandile Viakati. The system integrates with the national system allowing registered patients demographics to be accessed from any facility. The system provides 92% of the data needed for monitoring the 95-95-95 goals.

Slide presentations are being shared by presenters here.

• • Meeting Recording
  • Meeting Summary
  • Meeting Slides
• DUC Debrief (formerly Office Hours) Recording

TIF

• Pre-appointment reminders (Nigeria)

The meeting featured three presentations of solutions for patient reminders and tracking:

• Unified Data System: Project HOPE and Dimagi presented their tool, which is being used in Ethiopia to standardize data capture and case management systems for all PEPFAR and USAID-funded community HIV activities. The tool allows Community Engagement Facilitators (CEFs) to document and share tracing efforts and outcomes. This has resulted in improved retention in care through re-engagement and reduced attrition.
• Ushauri: Family AIDS Care & Education Services (FACES) and mHealth Kenya presented the Ushauri project, a mobile and web-based platform for improving health outcomes of people living with HIV by providing timely and reliable messages including appointment reminders, treatment adherence, and wellness.Additionally, it includes an appointment diary for providers and a defaulter tracing module for managing patient’s appointments at the facility level. The application can be used as a standalone tool or integrated into an EMR. The use of the tool has resulted in improved retention rates. As part of the COVID-19 response, they were also able to adapt the tool to ensure patients, whose travel had been limited, had adequate ARTs.
• Two-way texting (2WT): This project was implemented by I-TECH and Medic Mobile in Zimbabwe and Malawi to improve retention efforts and reduce wasted effort related to poor retention data quality. 2WT provides motivational adherence messages to patients, appointment reminders, and missed appointment alerts and also records responses indicating that the patient has transferred care or if they need to change a visit date. The tool is also used to support follow-up for Voluntary Medical Male Circumcision (VMMC) patients to help identify those who require follow-up visits.

The slides for each of the presentations can be accessed from the DUC Discourse page.

• Meeting Summary
• Meeting Slides

Richard Stanley of IntraHealth gave a presentation on identity linking. Richard explained that tools to link patients across systems will make it easier to use clinical data for care coordination, reporting, monitoring, surveillance, and research. For example, being able to determine that a patient is receiving care in another facility without having to rely on direct outreach efforts. Dr. Stanley described a client registry, or enterprise master patient index (eMPI), which is an authoritative, standardized, and up-to-date list of patients that uses matching methods that compare demographic identifiers to link patient identities.

• Meeting Summary
• Meeting Slides

During this month’s meeting several members shared their experiences:

• Edwin Mulwa of the FACES (Family AIDS Care and Education Services) program in Kenya discussed the frequency of missed appointments and the lack of concordance between paper systems and the EMR. They made use of Ushauri, a digital appointment reminder system developed by mHealth Kenya. The automatic messaging has helped reduce the burden of sending reminders but there is a need for additional analytics to be built into the system. This would allow them to examine how many patients are being booked and what is the rate they are keeping appointments. They noted that the early adoption process was challenging, but worth the effort, particularly through adaptations made to ensure the patients do not run out of medication during the COVID19 pandemic.
• Sara Van Rompaey of Friends in Global Health in Mozambique noted similar challenges that Edwin had. Most health facilities have OpenMRS and they are implementing this with iDART (Intelligent Dispensing of Antiretroviral Treatment) at dispensaries as a means of tracking medication compliance. While the program was successful so far with long term retention, those new to ART needed additional follow-up for retention. This is challenging in Mozambique where cell phone penetration is low, particularly in rural areas making contact tracing intensive. However, she noted these efforts resulted in both improved retention rates and increased viral suppression.
• Nicky Kimaina of AMPATH Kenya uses a point-of-care system built on top of OpenMRS. The system allows them to verify if a patient has moved between facilities (150 facilities total, 46 are using MRS, about 80 using KenyaEMR), so they are not incorrectly counted as LTFU. The system allows for improved appointment management, which has decreased wait times and crowding at the clinics. There are processes to make that data available for report consumption in real-time so users can distribute the load between facilities of when appointments will be.
• Elizabeth Wetzel and Alex Kabwinja shared the experiences of Baylor College of Medicine Children’s Foundation in Malawi, which supports 120 facilities. There is a point of care EMR used by providers and a back-end system, eMastercard, used for retrospective data entry. They noted that gaps in data make it difficult to quantify true LTFU.
• Osoti Osoti of the Afya Nyota ya Bonde project in Kenya noted that almost half of their 65 sites are using KenyaEMR. He noted that having a POS system improves data use giving access to real-time data though they are not able to share data with non-KenyaEMR systems.
• Steven Wanyee of Kenya developed a proof of concept for the implementation of a digital health solution focused on HIV/TB/Family planning programs, specifically targeting cross-border health service delivery. This is an issue not only for interoperability but legal ramifications of sharing data between countries.

• Meeting Summary
• Meeting Slides

Introduced a new collaboration tool, Discourse. This tool will allow us to archive discussions that take place during meetings and serve as a forum to continue conversations after the end of the meetings. You may access the DUC Discourse Tool at https://discourse.duc.ohie.org/.

During the meeting we noted three areas related to LTFU/retention to stimulate conversation:

1. Appointment Management – The ability to know which patients are supposed to return and when they are supposed to return.
2. "Missed Appointment" Identification – Identification of patients who have missed an appointment or a medication pick-up and require intervention.
3. "Missed Appointment" Resolution – The methods for documenting the status of a patient that has missed an appointment or a medication pick-up and integrating this data into appointment management and defaulter tracing strategies.

• Meeting Summary 
• Meeting Slides 

•  
• Two-way texting (2WT): This project was implemented by I-TECH and Medic Mobile in Zimbabwe and Malawi to improve retention efforts and reduce wasted effort related to poor retention data quality. 

The slides for each of the presentations can be accessed from the DUC Discourse page.

• Meeting Summary
• Meeting Slides

Richard Stanley of IntraHealth gave a presentation on identity linking. Richard explained that tools to link patients across systems will make it easier to use clinical data for care coordination, reporting, monitoring, surveillance, and research. For example, being able to determine that a patient is receiving care in another facility without having to rely on direct outreach efforts. Dr. Stanley described a client registry, or enterprise master patient index (eMPI), which is an authoritative, standardized, and up-to-date list of patients that uses matching methods that compare demographic identifiers to link patient identities.

• Meeting Summary
• Meeting Slides

During this month’s meeting several members shared their experiences:

• Edwin Mulwa of the FACES (Family AIDS Care and Education Services) program in Kenya discussed the frequency of missed appointments and the lack of concordance between paper systems and the EMR. 
• Sara Van Rompaey of Friends in Global Health in Mozambique noted similar challenges that Edwin had. Most health facilities have OpenMRS and they are implementing this with iDART (Intelligent Dispensing of Antiretroviral Treatment) at dispensaries as a means of tracking medication compliance. 
• Nicky Kimaina of AMPATH Kenya uses a point-of-care system built on top of OpenMRS. The system allows them to verify if a patient has moved between facilities (150 facilities total, 46 are using MRS, about 80 using KenyaEMR), so they are not incorrectly counted as LTFU. 
• Elizabeth Wetzel and Alex Kabwinja shared the experiences of Baylor College of Medicine Children’s Foundation in Malawi, which supports 120 facilities. There is a point of care EMR used by providers and a back-end system, eMastercard, used for retrospective data entry. They noted that gaps in data make it difficult to quantify true LTFU.
• Osoti Osoti of the Afya Nyota ya Bonde project in Kenya noted that almost half of their 65 sites are using KenyaEMR. He noted that having a POS system improves data use giving access to real-time data though they are not able to share data with non-KenyaEMR systems.
• Steven Wanyee of Kenya developed a proof of concept for the implementation of a digital health solution focused on HIV/TB/Family planning programs, specifically targeting cross-border health service delivery. This is an issue not only for interoperability but legal ramifications of sharing data between countries.

• Meeting Summary
• Meeting Slides

Introduced a new collaboration tool, Discourse. This tool will allow us to archive discussions that take place during meetings and serve as a forum to continue conversations after the end of the meetings. You may access the DUC Discourse Tool at https://discourse.duc.ohie.org/.

During the meeting we noted three areas related to LTFU/retention to stimulate conversation:

1. Appointment Management – The ability to know which patients are supposed to return and when they are supposed to return.
2. "Missed Appointment" Identification – Identification of patients who have missed an appointment or a medication pick-up and require intervention.
3. "Missed Appointment" Resolution – The methods for documenting the status of a patient that has missed an appointment or a medication pick-up and integrating this data into appointment management and defaulter tracing strategies.

• Meeting Summary 
• Meeting Slides 

HIV/AIDS Treatment Retention Outcomes: Field Perspectives on Data Use 

Speakers from Kenya and Nigeria who discussed electronic medical record (EMR) implementations where patient-level data is collected and merged into a shared health record and/or data warehouse that allows for analysis and reporting of data. 

HIV/AIDS Treatment Retention Outcomes: Field Perspectives on Data Use 

Speakers from Kenya and Nigeria who discussed electronic medical record (EMR) implementations where patient-level data is collected and merged into a shared health record and/or data warehouse that allows for analysis and reporting of data. 

The speakers explained details of how data is analyzed and used by these systems, such as:

• Determining when in the treatment process the most LTFU occurs. Note that in both cases the most LTFU occurred right after ART initiation. 
• Measuring retention treatment outcomes over years (i.e. death, silent transfer, documented transfers, LTFU, active) 
• Measuring reasons for disengagement and reasons for silent transfer
• PEPFAR indicator analysis 

• Meeting Summary 
• Meeting Slides 

Practitioners presented their experiences and research from Mozambique, Uganda, and Zambia on viral load suppression, root causes of missed appointments, understanding LTFU, and clinical mentoring to health care providers. This led to a rich discussion on the role of patient experience and satisfaction in retention in care as well as information systems investments made to improve retention, given limited resources. Several practitioners on the call noted that rudeness and poor treatment of patients are common in many facilities. These negative experiences occur from reception through provider interactions. There are little data available to practitioners about patient experience and its impact on LTFU. Further, practitioners noted that interventions to improve health workers' attitudes towards patient and patient satisfaction have not been widely disseminated.

• Meeting Summary
• Meeting Slides