ABSTRACT
Clinical, socioeconomic, and access barriers remain a critical problem to antiretroviral (ART) programs in sub-Saharan Africa. Community-based accompaniment (CBA), including daily home visits and psychosocial and socioeconomic support, has been associated with improved patient outcomes at 1 year. We conducted a prospective observational cohort study of 578 HIV-infected adults initiating ART in 2007-2008 with or without CBA in rural Rwanda. Among patients without CBA, those with advanced HIV disease, low CD4 cell counts, lower social support, and transport costs had significantly higher odds of negative outcomes at 1 year; amongst patients who received CBA, only those with low CD4 cell counts had significantly higher odds of negative outcomes at 1 year. CBA also significantly mitigated the effect of transport costs and inaccessibility of services on the likelihood of negative outcome. CBA may be one approach to mitigating known risk factors for negative outcomes for patients on ART in resource-poor settings.
Subject(s)
Anti-Retroviral Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , HIV Infections/drug therapy , HIV/drug effects , Adult , Aged , CD4 Lymphocyte Count , Female , HIV Infections/psychology , HIV Infections/virology , Health Services Accessibility , Humans , Male , Medication Adherence , Middle Aged , Prospective Studies , Rural Population , Rwanda , Social Support , Treatment Outcome , Viral LoadABSTRACT
In many developing countries, electronic medical record (EMR) systems are being implemented in resource-poor settings. Essential to such implementations are software developers with a high technical capacity, a good understanding of medical informatics and an awareness of local clinical needs. This paper describes a training program which has been run in Rwanda to enable local computer science graduates to play a significant role in that country's forthcoming implementation of a national EMR system. Such a training program is unique in that region of Africa and we discuss the challenges inherent in such an undertaking. We describe the development of the curriculum and the evolution of the teaching methodologies over the course of the year and discuss its potential integration with academic institutions in Rwanda. Finally we propose that training programs of this nature which produce local software developers who are familiar with medical informatics are a requirement for successful and sustainable eHealth implementations in the developing world.
