Introduction
HIV case-based surveillance
As more countries implement national electronic medical records, there is increasing demand for secondary use of electronic medical record (EMR) data. Among these is the use of EMR data for HIV case-based surveillance. HIV case and mortality reporting is recommended as a core component of 2nd generation HIV surveillance. Case-based surveillance of HIV collects information on key sentinel events for each person with HIV. It seeks to monitor and describe the longitudinal progression of HIV in each person.
To support The United States President’s Emergency Plan for AIDS Relief (PEPFAR)’s focus on sustainable control of the HIV epidemic, use of information from HIV case –based surveillance would provide a better understanding of epidemic trends over time, identify epidemic hotspots, and identify sub-populations at high risk of infection, among others; in a timely manner.
The documentation that follows refers to use of HIV patient-level data from openMRS, an electronic medical record, for HIV case-based surveillance. The case reporting module in openMRS represents the case-based surveillance component of the system. Screenshots have been provided to illustrate a test patient’s HIV progression along the care cascade by generating the relevant case reports for each sentinel event being monitored.
For interoperability, the case reports are generated as Fast healthcare interoperable resources (FHIR) documents to be sent to a public health agency’s shared health repository.
1. Home Page
2. Register a patient
3.Trigger event: New HIV Case
Enter the observation for a reportable sentinel event. In this case, patient HIV test results are positive.
New HIV Case trigger is fired by the observation and entered in the case report queue
One can either submit or decline the queued case report
Submitted case reports
Case report as a FHIR document
4. Trigger event: New HIV Disease
Enter details for WHO staging based on HIV disease diagnosed
case report queue
review and submit the reports
submitted case reports
Case report as FHIR document
5. Trigger event: New HIV Treatment
case reporting queue
Review and submit report
submitted case report
case report as FHIR document
6. Trigger event: ART Therapy changed to second line
case report queue
review and submit case report
submitted case reports
case report as a FHIR document
7. Trigger event: HIV Treatment stopped
Case reporting queue
Review and submit case report
Submitted reports
Case report as FHIR document
8. Trigger event: HIV treatment failure
Case report queue
Review and submit or dismiss case report
Submitted case reports
Case report as FHIR document
9. Trigger event: Patient died
case report queue
Review and submit case report
Submitted case reports
case report as FHIR Document
References
[1] | WHO, UNAIDS, "Guidelines for second generation HIV surveillance: an update: know your epidemic," World Health Organization, Geneva, Switzerland, 2013. |
[2] | NASTAD, "Case-based surveillance toolkit," National Alliance of State and Territorial AIDS Directors, Washington, D.C, 2014. |
[3] | The Office of the U.S. Global AIDS Coordinator, "PEPFAR 3.0 controlling th epidemic: delivering on the promise of an AIDS free generation," The Office of the U.S. Global AIDS Coordinator, Washington, D.C, 2014. |
[4] | HL7, "FHIR DSTU2," HL7, Oct 2015. Accessed at https://www.hl7.org/fhir/documentation.html |