title: Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study.
abstract: OBJECTIVE
  There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients.
  
  
  METHODS
  We conducted a retrospective, pre-post EMR study among patients enrolled in HIV care and eligible for ART at 17 rural Kenyan clinics and compared the: (1) proportion of patients eligible for ART based on CD4 count or WHO staging who initiate therapy; (2) time from eligibility for ART to ART initiation; (3) time from ART initiation to first CD4 test.
  
  
  RESULTS
  7298 patients were eligible for ART; 54.8% (n=3998) were enrolled in HIV care using a paper-based system while 45.2% (n=3300) were enrolled after the implementation of the EMR. EMR was independently associated with a 22% increase in the odds of initiating ART among eligible patients (adjusted OR (aOR) 1.22, 95% CI 1.12 to 1.33). The proportion of ART-eligible patients not receiving ART was 20.3% and 15.1% for paper and EMR, respectively (χ(2)=33.5, p<0.01). Median time from ART eligibility to ART initiation was 29.1 days (IQR: 14.1-62.1) for paper compared to 27 days (IQR: 12.9-50.1) for EMR.
  
  
  CONCLUSIONS
  EMRs can improve quality of HIV care through appropriate placement of ART-eligible patients on treatment in resource limited settings. However, other non-EMR factors influence timely initiation of ART.
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Tom
authors.initials: T
authors.lastname: Oluoch
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Abraham
authors.initials: A
authors.lastname: Katana
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya.
authors.forename: Victor
authors.initials: V
authors.lastname: Ssempijja
authors.affiliation: Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kwaro
authors.affiliation: Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Patrick
authors.initials: P
authors.lastname: Langat
authors.affiliation: Ministry of Health, National AIDS and STI Control Program, Nairobi, Kenya.
authors.forename: Davies
authors.initials: D
authors.lastname: Kimanga
authors.affiliation: Kenya Medical Research Institute, CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Nicky
authors.initials: N
authors.lastname: Okeyo
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Nicolette
authors.initials: N
authors.lastname: de Keizer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007630:Kenya; D008297:Male; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents
keywords: Developing countries; Guidelines adherence; HIV; Medical Records; Quality of healthcare