Digital health records improve survival in HIV treatment clinics

Digital health records improve survival in HIV treatment clinics

With an estimated 9.5% of the population being HIV positive in 2019, Malawi has one of the highest HIV prevalence rates in the world. While untreated HIV can lead to infection and death, antiretroviral therapy (ART) - a combination of drugs that suppresses the virus, restores immune function and reverses the progression of AIDS - is available free of charge to Malawian patients. But success depends on patients adhering to regular treatment, and tracking down patients who are leaving care is expensive and time-consuming for clinics that are already understaffed.

To address this challenge, the nonprofit Baobab Health Trust and the Malawi Ministry of Health began transitioning clinics from paper-based medical records to electronic medical records (EMRs) in 2005.

In a recent study by Wharton School Assistant Professor Leandro “Leo” Pongeluppe and colleagues, researchers examined the impact of this change on patient outcomes at 106 HIV treatment clinics between 2007 and 2019. Their findings were published inThe Review of Economics and Statisticsshow that the introduction of electromagnetic radiation resulted in an estimated 28% reduction in deaths after five years, with the largest reduction in children. Pongeluppe and co-authors Laura Derksen, a researcher at the Ragnar Frisch Center For Economic Research, and Anita M. McGahan, a professor at the University of Toronto, estimate that the introduction of EMR prevented about 5,050 AIDS deaths over time.

We use management technology to support those who are most at risk. We can save lives, especially the lives of the most vulnerable, and do so in a very cost-effective way. Hopefully this is a way for us to incentivize further implementation.”

Leandro “Leo” Pongeluppe, Assistant Professor, Wharton School

The authors estimate that the cost of EMR implementation is approximately $448 per life saved over the first five years. Pongeluppe says the use of electromagnetic radiation is limited in other sub-Saharan African countries as well as parts of Latin America, meaning there is great opportunity for non-governmental organizations to expand this system to developing countries.

The EMR system allows staff to track scheduled ART visits, identify patients who are at least two months late for an ART appointment, and request referrals to other services and screening for tuberculosis – a leading cause of illness and death for people with HIV/AIDS. In clinics without an EMR, staff must examine thousands of paper records to identify deceased patients.

Their findings suggest that these improvements in health care outcomes are the result of improvements in efficiencies rather than changes in medical care, and that the decline in deaths is due to an increase in lost patients returning for care.

“The broad efficiencies achieved by the EMR system enable clinics to manage higher patient volumes and retain patients more effectively without exceeding capacity limits,” they write. “We contribute to a broader health policy literature that goes beyond drug delivery by showing that management interventions such as EMR systems have important health impacts and can be implemented at scale in resource-poor settings.”

Looking forward, Pongeluppe plans to analyze the impact of using shipping containers converted into clinics on major roads in sub-Saharan Africa to deliver ART, an intervention aimed at reaching transient populations such as truck drivers and sex workers who often do not continue to visit the same clinic.

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