title: TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda.
abstract: Delays in testing HIV-exposed infants and obtaining results in resource-limited settings contribute to delays for initiating antiretroviral therapy (ART) in infants. To overcome this challenge, Rwanda expanded its national mobile and Internet-based HIV/AIDS informatics system, called TRACnet, to include HIV polymerase chain reaction (PCR) results in 2010. This study was performed to evaluate the impact of TRACnet technology on the time to delivery of test results and the subsequent initiation of ART in HIV-infected infants.
  
  
  
  A retrospective cohort study was conducted on 380 infants who initiated ART in 190 health facilities in Rwanda from March 2010 to June 2013. Program data collected by the TRACnet system were extracted and analyzed.
  
  
  
  Since the introduction of TRACnet for processing PCR results, the time to receive results has significantly decreased from a median of 144 days [interquartile range (IQR): 121-197 days] to 23 days (IQR: 17-43 days). The number of days between PCR sampling and health facility receipt of results decreased substantially from a median of 90 days (IQR: 83-158 days) to 5 days (IQR: 2-8 days). After receiving PCR results at a health facility, it takes a median of 44 days (IQR: 32-77 days) before ART initiation. Result turnaround time was significantly associated with time to initiating ART (P < 0.001). An increased number of staff trained for HIV care and treatment was also significantly associated with decreased time to ART initiation (P = 0.004).
  
  
  
  The use of mobile technology for communication of HIV PCR results, coupled with well-trained and skilled personnel, can reduce delays in communicating results to providers. Such reductions may improve timely ART initiation in resource-limited settings.
authors.affiliation: From the *Voxiva, Rwanda SARL, Kigali, Rwanda; †Rwanda Biomedical Center, Institute of HIV Disease Prevention and Control, Kigali, Rwanda; ‡Ministry of Health, Republic of Rwanda, Kigali, Rwanda; §Harvard Medical School, Boston, Massachusetts; ¶Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; ‖US Centers for Disease Prevention and Control, Kigali, Rwanda; **University of Rwanda College of Medicine & Health Sciences, School of Public Health, Kigali, Rwanda; ††Voxiva, Inc., Washington, DC; and ‡‡Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Kizito
authors.initials: K
authors.lastname: Kayumba
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
authors.forename: Placidie
authors.initials: P
authors.lastname: Mugwaneza
authors.forename: John
authors.initials: J
authors.lastname: Rusine
authors.forename: Eric
authors.initials: E
authors.lastname: Remera
authors.forename: Jean Baptiste
authors.initials: JB
authors.lastname: Koama
authors.forename: Vedaste
authors.initials: V
authors.lastname: Ndahindwa
authors.forename: Pamela
authors.initials: P
authors.lastname: Johnson
authors.forename: David J
authors.initials: DJ
authors.lastname: Riedel
authors.forename: Jeanine
authors.initials: J
authors.lastname: Condo
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D042241:Early Diagnosis; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006268:Health Facilities; D006801:Humans; D007223:Infant; D020407:Internet; D008297:Male; D015397:Program Evaluation / Q000379:methods; D012189:Retrospective Studies; D012432:Rwanda; D060145:Text Messaging; D061665:Time-to-Treatment
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents