Effectiveness of real-time client tracking tools in reducing Interruption in Treatment: evidence from a low resource setting, Zimbabwe

BACKGROUND: Despite the impressive progress on achieving the UNAIDS 95-95-95 goal by 2030, Interruption in Treatment (IIT) remains one of the biggest threats in Sub-Saharan Africa especially due to COVID-19 among other challenges. UNAIDS estimates that one in five experience IIT after being on ART for at least 12 months. In Zimbabwe, IIT is equally high (estimated at 13-20%). Population Solutions for Health (PSH) with USAID funding, invested in a client-level electronic record management system (Bahmni) that generates real-time data to improve ART retention.
DESCRIPTION: Between February ' December 2021 PSH implemented a Continuous Quality Improvement (CQI) intervention utilizing Bahmni to generate real-time ART data from 5 Zimbabwean districts. A weekly electronic line-list of clients due for ART refills was generated to facilitate client follow-up through phone calls and home visits. The investigators tracked 7,903 clients; Female sex workers (FSW), Men who have sex with Men (MSM), and General Population (GP) on ART from February to December 2021 implementing the CQI strategy and recording month-on-month ITT.
LESSONS LEARNED: IIT was 7.1% ((6.1% ' 8.2%) 95% CI) at the onset of the intervention, and dropped almost monotonically to under 1% (0.4% (0.3%-0.5%) 95% CI) by December 2021. There were no differences in ITT rates by population type (illustrated in the graph) nor by age and gender. Real-time data enabled a timely client-provider interaction that resolved challenges faced by the client (including COVID-19 induced travel restrictions). The CQI strategy included differentiated service delivery to improve access to ART medication.


CONCLUSIONS: The EMR has shown to be an effective tool in tracking clients on ART to reduce IIT. Generating real-time data allows for a much more rapid and effective client-provider interaction that translates into improved ART cohort management. This innovation must be scaled up especially in low-resource settings where patients face diverse challenges that result in IIT.

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