title: How to improve the quality of a disease management program for HIV-infected patients using  a computerized data system. The Saint-Antoine Orchestra program.
abstract: OBJECTIVE
  The emergence of non-AIDS-related events in the HIV-infected population experiencing a longer life expectancy implies the implementation of a comprehensive approach of HIV clinical management through better access to care, prevention, and early diagnosis of co-morbidities.
  
  
  METHODS
  The Orchestra program is a computer-assisted HIV care and support tool implemented since December 2004 in the outpatient clinic of a University Hospital set in Paris, France. The intervention aims at improving access to HIV information care and support specifically targeted five areas of actions: cardiovascular risk factors; gynecological follow-up; anti-hepatitis B virus (HBV) vaccine coverage; sexuality and prevention of sexually transmitted infections; and compliance to antiretrovirals. The impact of this program was examined prospectively on a "before-after" basis after a two-year implementation.
  
  
  RESULTS
  In the two-year period, 1717 patients were regularly followed. The level of the database information significantly increased in time (low density lipoprotein (LDL) cholesterol and glycemia were informed in 74% of patients at inclusion versus 95% at two years, and 83% versus 97%, p < 0.001, respectively). The number of targeted interventions was also higher. For eligible women, papanicolaou smears and mammography were prescribed in 52% of cases after intervention, versus 44% at inclusion, p0.04 and 83% versus 50%, p < 0.001, respectively. Indicators of care eventually improved significantly. Initially 72% non-adherent patients declared to be adherent after the intervention ( p < 0.001) and 67% of patients with initial LDL-hypercholesterolemia normalized their LDL level within two years ( p < 0.001).
  
  
  CONCLUSIONS
  The Orchestra program has provided a unique opportunity to assess and improve prevention and management of co-morbidities in HIV patients.
authors.affiliation: AP-HP, Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, Paris, France. laurent.fonquernie@sat.aphp.fr
authors.forename: F
authors.initials: F
authors.lastname: Fonquernie
authors.forename: K
authors.initials: K
authors.lastname: Lacombe
authors.forename: J P
authors.initials: JP
authors.lastname: Vincensini
authors.forename: F
authors.initials: F
authors.lastname: Boccara
authors.forename: S
authors.initials: S
authors.lastname: Clozel
authors.forename: A
authors.initials: A
authors.lastname: Ayouch Boda
authors.forename: D
authors.initials: D
authors.lastname: Bollens
authors.forename: P
authors.initials: P
authors.lastname: Campa
authors.forename: J
authors.initials: J
authors.lastname: Pacanowski
authors.forename: J L
authors.initials: JL
authors.lastname: Meynard
authors.forename: M C
authors.initials: MC
authors.lastname: Meyohas
authors.forename: P M
authors.initials: PM
authors.lastname: Girard
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000517:prevention & control; D000328:Adult; D015897:Comorbidity; D003194:Computer-Assisted Instruction / Q000379:methods; D019468:Disease Management; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010297:Paris; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards*; D012306:Risk