Electronic laboratory information system and HIV data quality: time-series analyses at eight public health laboratories in Côte d'Ivoire


BACKGROUND: Laboratory services are essential to HIV programming, and lack of functional laboratory information systems (LIS) and quality data is one of the main barriers to service delivery and data-driven decision making in low- and middle-income countries (LMICs). The OpenELIS Global software is an open-source LIS tailored for LMIC public health laboratories. The Côte d''Ivoire Ministry of Health and the United States President''s Emergency Plan for AIDS Relief have been collaborating since 2009 to implement OpenELIS for HIV data management. This study aimed to quantify the initial and enduring effects of OpenELIS on HIV data quality.
METHODS: We performed interrupted time series analyses using negative binomial mixed-effects regression to estimate the effect of OpenELIS implementation on monthly CD4 testing data quality outcomes defined as timeliness, completeness, and validity. We obtained de-identified individual laboratory records from paper registries for 12 months before OpenELIS adoption and from OpenELIS servers since adoption until December 31, 2020. Data were from three reference laboratories and five district laboratories that adopted OpenELIS in 2015, 2018, and 2019 and serve approximately 38,100 people living with HIV in five regions. Each laboratory record was assessed on the primary outcomes and analyzed at the laboratory level. We estimated relative risks representing monthly outcomes compared with counterfactual outcomes had the laboratories not adopted OpenELIS.
RESULTS: There were 79,975 individual laboratory records during the study period, including 57,877 (72.3%) after OpenELIS adoption. A 28.5% increase (95% confidence interval [CI]: 1.026, 1.608) in timeliness, a 1.3% increase (95% CI: 1.001, 1.024) in completeness, and a 0.3% increase (95% CI: 1.000, 1.006) in validity were detected shortly after laboratories adopted OpenELIS. The improvements were sustained throughout implementation.
CONCLUSIONS: OpenELIS has improved HIV data quality at public health laboratories in Côte d''Ivoire, particularly in the early stage of implementation. Data in higher quality are more likely to be used and useful in HIV care and treatment. Ease of implementation, continuous technical support, and relative advantage of OpenELIS compared to paper registries have facilitated routine use of OpenELIS. The findings from this study provide evidence for future scale-up of OpenELIS in LMICs to serve HIV surveillance and disease management.