An e-health driven laboratory information system to support HIV treatment in Peru: E-quity for laboratory personnel, health providers and people living with HIV.

BACKGROUND: Peru has a concentrated HIV epidemic with an estimated 76,000 people living with HIV (PLHIV). Access to highly active antiretroviral therapy (HAART) expanded between 2004-2006 and the Peruvian National Institute of Health was named by the Ministry of Health as the institution responsible for carrying out testing to monitor the effectiveness of HAART. However, a national public health laboratory information system did not exist. We describe the design and implementation of an e-health driven, web-based laboratory information system--NETLAB--to communicate laboratory results for monitoring HAART to laboratory personnel, health providers and PLHIV. METHODS: We carried out a needs assessment of the existing public health laboratory system, which included the generation and subsequent review of flowcharts of laboratory testing processes to generate better, more efficient streamlined processes, improving them and eliminating duplications. Next, we designed NETLAB as a modular system, integrating key security functions. The system was implemented and evaluated. RESULTS: The three main components of the NETLAB system, registration, reporting and education, began operating in early 2007. The number of PLHIV with recorded CD4 counts and viral loads increased by 1.5 times, to reach 18,907. Publication of test results with NETLAB took an average of 1 day, compared to a pre-NETLAB average of 60 days. NETLAB reached 2,037 users, including 944 PLHIV and 1,093 health providers, during its first year and a half. The percentage of overall PLHIV and health providers who were aware of NETLAB and had a NETLAB password has also increased substantially. CONCLUSION: NETLAB is an effective laboratory management tool since it is directly integrated into the national laboratory system and streamlined existing processes at the local, regional and national levels. The system also represents the best possible source of timely laboratory information for health providers and PLHIV, allowing patients to access their own results and other helpful information about their health, extending the scope of HIV treatment beyond the health facility and providing a model for other countries to follow. The NETLAB system now includes 100 diseases of public health importance for which the Peruvian National Institute of Health and the network of public health laboratories provide testing and results.

Sistemas de información: Internet, acceso y uso por trabajadores de salud y personas viviendo con VIH/SIDA / Information systems: Internet, access and use by health workers and people living with HIV/AIDS

El Instituto Nacional de Salud desarrolló NETLAB, un sistema de información basado en la Web que aumenta la disponibilidad de los resultados de laboratorio a los trabajadores de salud y a los pacientes viviendo con VIH/SIDA (PVVS). Para asegurar su efectividad se requiere conocer aspectos como recursos y acceso a Internet. Objetivos: Describir las características del acceso a Internet y NETLAB por los usuarios (personal de salud y PVVS) y la infraestructura informática en los establecimientos en donde se administra TARGA, comparando Lima û Callao con Provincias. Materiales y métodos: Se incluyeron 48 establecimientos de salud públicos y privados que brindan TARGA, ubicados en 23 departamentos del Perú. Se elaboraron tres cuestionarios dirigidos a los trabajadores de salud, a PVVS y a técnicos de informática. Resultados: Se encuestó a 246 trabajadores sanitarios, a 201 PVVS y a 45 trabajadores de informática. El 95,5 por ciento de los trabajadores sanitarios reportaron que sabían navegar en Internet, 62,6 por ciento contaban con el servicio en sus oficinas, 85 por ciento conocía NETLAB y 36 por ciento contaba con una clave de acceso. El 50,7 por ciento de las PVVS reportaron saber navegar en Internet (85,5 por ciento en Lima y 45,7 por ciento en provincias; p<0,01), 81 por ciento accede a través de cabinas públicas y 93 por ciento está interesado en conocer sus resultados de laboratorio a través de Internet. Todos los establecimientos tienen Internet, pero la infraestructura informática y calidad de conexión a Internet es muy variada. Discusión: La elevada proporción de personal sanitario que utiliza Internet favorece la introducción y uso del NETLAB y sus herramientas de comunicación. La brecha de acceso a Internet entre PVVS residentes en Lima y provincias y la elevada proporción de uso de las cabinas públicas, plantea retos y oportunidades para promover la utilización de NETLAB en este grupo.

The National Institute of Health developed NETLAB, a Web based information system that increases the availability of laboratory results to health workers and patients living with HIV / AIDS (PLWHA) in HAART. To assure its effectiveness it is necessary to explore issues available like resources access to Internet Objectives: To describe the characteristics of Internet access and NETLAB access by potential users and the IT infrastructure in places where HAART is administered. Methods: We included 48 public and private health facilities where HAART is administered for 23 departments for Peru. 3 questionnaires were prepared, one for health professionals, another for PLWA and another for informatics specialists from each center. Results: We included in the survey 246 health workers, 201 PLWA and 45 informatics workers. 95,5 per cent of the health workers reported they know how use the Internet, 62,6 per cent had Internet connection with in his offices. 85 per cent knew about NETLAB, but only 36 per cent had an access code. 50,7 per cent of PLWA knew how to use Internet (85,5 per cent in Lima and 47,7 per cent in provinces p<0,01). 81 per cent access trough the public Internet booths (ôcabinas públicasõ) and 93 per cent are interesting accessing their lab results trough the Internet. All the health facilities have Internet access though the quality of the connection is very heterogeneous. Discussion: The high proportion of health workers who knew how and uses the Internet is encouraging and favors the introduction and the use of NETLAB and communications technology. The access gap between PLWA in Lima and regions and the high frequency of use of public Internet booths represent a challenge but also opportunities to promote the use of NETLAB in this group.

Conjuntivitis folicular por Chlamydia trachomatis: Frecuencia y pruebas diagnósticas / Follicular conjunctivitis caused by Chlamydia trachomatis: Frequency and diagnosis test

La Chlamydia trachomatis es la principal causa infecciosa de ceguera en el mundo, que empieza como conjuntivitis folicular. En el Perú se han realizado pocos estudios, debido a su dificultad diagnóstica. Se realizó un estudio en 55 pacientes de 18 a 68 años con diagnóstico de conjuntivitis folicular atendidos en el Instituto Nacional de Oftalmología (Lima, Perú) durante los años 2005 y 2006, con el objetivo de determinar la frecuencia de infección por Chlamydia trachomatis y evaluar la utilidad de la tinción de Giemsa y la inmunofluorescencia directa (IFD) para el diagnóstico de C. trachomatis en relación con el cultivo celular. La frecuencia de C. trachomatis en muestras de secreciones de conjuntivitis folicular fue de 13 por ciento (7/55) por cultivo celular, 20 por ciento (11/55) por IFD y de 9 por ciento (5/55) por Giemsa; los signos y síntomas más frecuentes fueron la presencia de secreciones y fotofobia. Todos los casos fueron varones y manifestaron no tener antecendentes de infecciones de transmisión sexual previas. Se encontró una sensibilidad de 42,9 y 85,7 por ciento y una especificidad de 98,8 y 89,6 por ciento para la tinción Giemsa e IFD respectivamente.

Chlamydia trachomatis is the principal infectious cause of blindness in the world, which begins as follicular conjunctivitis. In Peru few studies was realized by its difficulty to diagnose. A study was conducted in 55 patients 18 to 68 years with follicular conjunctivitis treated at the Instituto Nacional de Oftalmología (Lima, Peru) during the years 2005 and 2006, with the objective of determining the prevalence of Chlamydia trachomatis and evaluated the usefulness of Giemsa and direct immunofluorescence (DIF) for the diagnosis of C. trachomatis in relation to cell culture. The frequency of C. trachomatis in samples of eyes secretions was 13 per cent (7/55) for cell culture, 20 per cent (11/55) for DIF and 9 per cent (5/55) for Giemsa; the signs and symptoms more frequents were the presence of secretions and photophobia. All cases were males and reported not having had prior sexually transmitted infections. We found a sensitivity of 42,9 and 85,7 per cent, and a specificity of 98,8 and 89,6 per cent for Giemsa and DIF respectively.