title: Better adherence to pre-antiretroviral therapy guidelines after implementing an electronic medical record system in rural Kenyan HIV clinics: a multicenter pre-post study.
abstract: BACKGROUND
  The monitoring of pre-antiretroviral therapy (pre-ART) is a key indicator of HIV quality of care. This study investigated the association of an electronic medical record system (EMR) with adherence to pre-ART guidelines in rural HIV clinics in Kenya.
  
  
  METHODS
  A retrospective study was carried out to assess the quality of pre-ART care using three indicators: (1) the performance of a baseline CD4 test, (2) time from enrollment in care to first CD4 test, and (3) time from baseline CD4 to second CD4 test. A comparison of these indicators was made pre and post the introduction of an EMR system in 17 rural HIV clinics.
  
  
  RESULTS
  A total of 18523 patients were receiving pre-ART care, of whom 38.8% in the paper group had had at least one CD4 test compared to 53.4% in the EMR group (p<0.001). The adjusted odds of performing a CD4 test in clinics using an EMR was 1.59 (95% confidence interval 1.49-1.69). The median time from enrolment into HIV care to first CD4 test was 1.40 months (interquartile range (IQR) 0.47-4.87) for paper vs. 0.93 months (IQR 0.43-3.37) for EMR. The median time from baseline to first CD4 follow-up was 7.5 months (IQR 5.97-10.73) for paper and 6.53 months (IQR 5.57-7.87) for EMR.
  
  
  CONCLUSIONS
  The use of the EMR system was associated with better compliance to HIV guidelines for pre-ART care. EMRs have a potential positive impact on quality of care for HIV patients in resource-constrained settings.
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, PO Box 606, 00621, Village Market, Nairobi, Kenya. Electronic address: toluoch@cdc.gov.
authors.forename: Tom
authors.initials: T
authors.lastname: Oluoch
authors.affiliation: Kenya Medical Research Institute - CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kwaro
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, PO Box 606, 00621, Village Market, Nairobi, Kenya.
authors.forename: Victor
authors.initials: V
authors.lastname: Ssempijja
authors.affiliation: Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, PO Box 606, 00621, Village Market, Nairobi, Kenya.
authors.forename: Abraham
authors.initials: A
authors.lastname: Katana
authors.affiliation: Kenya Medical Research Institute - CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Patrick
authors.initials: P
authors.lastname: Langat
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, Netherlands.
authors.forename: Ameen
authors.initials: A
authors.lastname: Abu-Hanna
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Nicolette
authors.initials: N
authors.lastname: de Keizer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007630:Kenya; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Developing countries; Electronic medical records; Guideline adherence; HIV; Quality of care; eHealth