Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response

Abstract

Since 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported implementation and maintenance of health information systems for HIV/AIDS and related diseases, such as tuberculosis, in numerous countries. As the COVID-19 pandemic emerged, several countries conducted rapid assessments and enhanced existing PEPFAR-funded HIV and national health information systems to support COVID-19 surveillance data collection, analysis, visualization, and reporting needs. We describe efforts at the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, USA, and CDC country offices that enhanced existing health information systems in support COVID-19 pandemic response. We describe CDC activities in Haiti as an illustration of efforts in PEPFAR countries. We also describe how investments used to establish and maintain standards-based health information systems in resource-constrained settings can have positive effects on health systems beyond their original scope.

Keywords: COVID-19; EMR; Haiti; PEPFAR; SARS; SARS-CoV-2; coronavirus; coronavirus disease; electronic medical record; health information exchange; health information systems; public health surveillance; respiratory infections; severe acute respiratory syndrome coronavirus 2; viruses; zoonoses.

Figure 1

Elements of the Global Informatics Collaborative of PEPFAR-supported systems leveraged for COVID-19 pandemic response. The US CDC headquarters project team coordinated work across 3 implementing partners. Partners enhanced and customized existing PEPFAR health information systems by leveraging ongoing efforts of the TAP, a central mechanism that enables PEPFAR and national health information systems stakeholders to come together as the Global Informatics Collaborative. CDC, Centers for Disease Control and Prevention; PEPFAR, US President’s Emergency Plan for AIDS Relief; TAP, Technical Assistance Platform.

Figure 2

Core pillars of the US President’s Emergency Plan for AIDS Relief–supported informatics-savvy health organizations leveraged for COVID-19 pandemic response. The 3 pillars of an information-savvy health organization are supported by Technical Assistance Platform technical areas.

Figure 3

Collaborating stakeholders and beneficiaries of US President’s Emergency Plan for AIDS Relief–supported health information systems leveraged for COVID-19 pandemic response, Haiti. Funding supported Haiti’s ministry of public health and population, Ministère de la Santé Publique et de la Population (MSPP). Dollar signs denote health information systems–specific investments. Dotted lines indicate episodic or sporadic technical assistance and other inputs into the MSPP. Solid lines indicate structured technical assistance and other inputs into the MSPP’s systems. CDC, Centers for Disease Control and Prevention; NGO, nongovernmental organization; PAHO, Pan-American Health Organization; WHO, World Health Organization.

Figure 4

US President’s Emergency Plan for AIDS Relief–supported health information suite leveraged for COVID-19 pandemic response, Haiti. The system was built on the nation’s existing monitoring and evaluation platform, MESI. Red indicates existing HIV systems; blue indicates COVID-19 systems. SISNU is a DHIS2 (https://dhis2.org) hub for aggregate case reporting by disease and geography. C19, COVID-19; EMR, electronic medical record; MESI, Monitoring, Évaluation et Surveillance Intégreé; PEPFAR, US President’s Emergency Plan for AIDS Relief; PLR, Patient Locator and Retention mobile phone application; SISNU, Systeme d’Information Sanitaire Unique.

Figure 5

Example of COVID-19 pandemic response patient management and surveillance package developed from US President’s Emergency Plan for AIDS Relief (PEPFAR)–supported systems leveraged for COVID-19 pandemic response. The open medical record system HIV reference implementation (OHRI) platform is based on requirements from some PEPFAR countries. The COVID-19 system developed at the US Centers for Disease Control and Prevention leveraged the OHRI platform, already developed and being adapted by some PEPFAR countries.

Figure 6

Dataflow of COVID-LONG system developed from US President’s Emergency Plan for AIDS Relief–supported HIV surveillance systems and used for COVID-19 pandemic response, Haiti. Testing laboratories, vaccination sites, hospitals, community, and border health facility agents uploaded data to the web-based system that was accessible by MSPP staff. COVID Lab, national dashboard of COVID-19 laboratory testing in Haiti; COVID-LONG, COVID-19 longitudinal surveillance database; MSPP, Ministère de la Santé Publique et de la Population.

Figure 7

Surveillance dashboard database built from US President’s Emergency Plan for AIDS Relief–supported systems leveraged for COVID-19 pandemic response, Haiti. A screenshot from the COVID-19 interactive dashboard from Haiti COVID-19 surveillance database shows a COVID-19 histogram tracking the number of COVID-19–positive cases per day on the top row and positivity rates of total reported COVID-19 tests on the bottom row.