title: A structured approach to recording AIDS-defining illnesses in Kenya: A SNOMED CT based solution.
abstract: BACKGROUND
  Several studies conducted in sub-Saharan Africa (SSA) have shown that routine clinical data in HIV clinics often have errors. Lack of structured and coded documentation of diagnosis of AIDS defining illnesses (ADIs) can compromise data quality and decisions made on clinical care.
  
  
  METHODS
  We used a structured framework to derive a reference set of concepts and terms used to describe ADIs. The four sources used were: (i) CDC/Accenture list of opportunistic infections, (ii) SNOMED Clinical Terms (SNOMED CT), (iii) Focus Group Discussion (FGD) among clinicians and nurses attending to patients at a referral provincial hospital in western Kenya, and (iv) chart abstraction from the Maternal Child Health (MCH) and HIV clinics at the same hospital. Using the January 2014 release of SNOMED CT, concepts were retrieved that matched terms abstracted from approach iii & iv, and the content coverage assessed. Post-coordination matching was applied when needed.
  
  
  RESULTS
  The final reference set had 1054 unique ADI concepts which were described by 1860 unique terms. Content coverage of SNOMED CT was high (99.9% with pre-coordinated concepts; 100% with post-coordination). The resulting reference set for ADIs was implemented as the interface terminology on OpenMRS data entry forms.
  
  
  CONCLUSIONS
  Different sources demonstrate complementarity in the collection of concepts and terms for an interface terminology. SNOMED CT provides a high coverage in the domain of ADIs. Further work is needed to evaluate the effect of the interface terminology on data quality and quality of care.
authors.affiliation: U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Nairobi, Kenya. Electronic address: toluoch@cdc.gov.
authors.forename: Tom
authors.initials: T
authors.lastname: Oluoch
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
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: Irene
authors.initials: I
authors.lastname: Alaska
authors.affiliation: Kenya Medical Research Institute - CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ochieng
authors.affiliation: Kenya Medical Research Institute - CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Nicky
authors.initials: N
authors.lastname: Okeyo
authors.affiliation: Kenya Medical Research Institute - CDC Collaborative Program, Kisumu, Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kwaro
authors.affiliation: Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
authors.forename: Ronald
authors.initials: R
authors.lastname: Cornet
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003625:Data Collection; D003906:Developing Countries; D017144:Focus Groups; D015658:HIV Infections / Q000150:complications; D006801:Humans; D019451:Information Management; D016247:Information Storage and Retrieval; D007630:Kenya; D016347:Medical Records Systems, Computerized / Q000145:classification*; D008501:Medical Records, Problem-Oriented; D011787:Quality of Health Care; D012016:Reference Values; D015203:Reproducibility of Results; D012984:Software; D039061:Systematized Nomenclature of Medicine; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface; D018875:Vocabulary, Controlled
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS; AIDS-related opportunistic infections; Developing countries; Quality of healthcare; SNOMED CT