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

Abstract

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.

Figure 1

Flow diagram of process from coding of sample to publication of test result. Provides a summary of the steps that a sample follows from its reception at the laboratory until the publication of related test results in the NETLAB system.

Figure 2

Main NETLAB screen. Shows the primary NETLAB screen, including points of access for laboratory personnel, health providers and health administrators (left side) and for HAART patients (right side).

Figure 3

NETLAB access icon. Shows the NETLAB access icon, which is displayed on the main webpage of the Peruvian National Institute of Health and provides direct access to the main NETLAB screen shown in Figure 2.

Figure 4

Presentation of individual CD4 count and viral load results over time. Shows historical test results for a HAART patient, including 10 CD4 counts and 10 viral loads, which are available to the patient and the patient's health provider through the NETLAB system.

Figure 5

NETLAB educational material for people living with HIV. Shows the NETLAB screen of educational information for PLHIV, which includes an explanation of CD4 cells, CD4 counts and viral loads, as well as links to webpages that might be of interest to PLHIV.