title: Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique.
abstract: The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system.
  
  
  
  This assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS.
  
  
  
  This baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis.
  
  
  
  Health facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use.
  
  
  
  This initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource-constrained environments seeking to improve PMS implementation.
authors.affiliation: Center for Global Health, Division of Global HIV and TB, Centers for Disease Control and Prevention, Maputo, Mozambique. Electronic address: mindyho@gmail.com.
authors.forename: Mindy
authors.initials: M
authors.lastname: Hochgesang
authors.affiliation: Division of Prevention Sciences, Department of Medicine, University of California, 550 16th Street, 3rd floor, San Francisco, CA 94158, USA. Electronic address: Sophia.Zamudio-Haas@ucsf.edu.
authors.forename: Sophia
authors.initials: S
authors.lastname: Zamudio-Haas
authors.affiliation: Division of Prevention Sciences, Department of Medicine, University of California, 550 16th Street, 3rd floor, San Francisco, CA 94158, USA. Electronic address: lissa.moran@ucsf.edu.
authors.forename: Lissa
authors.initials: L
authors.lastname: Moran
authors.affiliation: Universidade Eduardo Mondlane, Direcção do Registo Académico, Av. Julius Nyerere 3453, R/C, C.P. 257 Maputo, Mozambique. Electronic address: Jose.nhampossa@gmail.com.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Nhampossa
authors.affiliation: California HIV/AIDS Research Program, University of California Office of the President, Oakland, CA 94612, USA. Electronic address: ljpackel@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Packel
authors.affiliation: Prevention and Public Health Group, Global Health Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA. Electronic address: hleslie@hsph.harvard.edu.
authors.forename: Hannah
authors.initials: H
authors.lastname: Leslie
authors.affiliation: Center for Global Health, Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: jrichards@cdc.gov.
authors.forename: Janise
authors.initials: J
authors.lastname: Richards
authors.affiliation: Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, USA. Electronic address: Starley.Shade@ucsf.edu.
authors.forename: Starley B
authors.initials: SB
authors.lastname: Shade
mesh_terms: D003625:Data Collection; D003695:Delivery of Health Care; D015658:HIV Infections / Q000628:therapy*; D015497:HIV-1 / Q000302:isolation & purification; D006268:Health Facilities; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D009073:Mozambique; D017063:Outcome Assessment, Health Care; D019035:Rural Health Services
keywords: Electronic medical records; HIV; Health information systems; Mozambique; Patient monitoring systems; Sub-Saharan africa