Introduction

High rates of pre-treatment loss to care among persons diagnosed with HIV persist. Linkage to care can be improved through active digitally-based surveillance. Currently, record-keeping for HIV diagnoses in South Africa is paper-based. Aggregated testing data are reported routinely, and only discordant findings result in a specimen being tested at a laboratory and digitised. The Western Cape Province in South Africa has a Provincial Health Data Centre (PHDC) where person-level routine electronic data are consolidated in a single database, leveraging the existence of a unique patient identifier. To facilitate improved HIV surveillance, a pre-carbonated point-of-care test (PoCT) form was piloted, where one copy was routed to a central point and digitised for PHDC inclusion.

Methods

We evaluated the utility of the intervention using cross-sectional and retrospective cohort analyses, as well as comparisons with aggregate data. Data were linked to the Patient Master Index of the PHDC using unique identifiers. Prior evidences of HIV within the PHDC were used to differentiate newly diagnosed patients and those retesting, as well as linkage to care and treatment.

Results

From May 2017 to June 2018, 11337 digitised point-of-care HIV testing records were linked to the PHDC. Overall, 96% of records in the aggregate dataset were digitised, with 97% linked to the PHDC. Of those tested, 79% were female (median age 27 years). Linkage demonstrated that 51.3% (95% CI 48.4–54.1%) of patients testing HIV-positive were retesting. Of those newly diagnosed, 81% (95% CI 77.9–84.3%) were linked to HIV care and 25% (95% CI 21.6–28.7%) were initiated on antiretroviral therapy immediately.

Conclusion

Digitisation of PoCT results provides individuated HIV testing data to assist in linkage to care and in differentiating newly diagnosed patients from positive patients retesting. Actionable and accurate data can improve the measurement of performance towards the UNAIDS 90-90-90 targets.

中文翻译：

---

数字化护理点 HIV 检测结果的实用性，以准确衡量和提高联合国艾滋病规划署 90-90-90 目标的绩效。

介绍

在被诊断出患有艾滋病毒的人中，治疗前失去护理的比率仍然很高。可以通过基于数字的主动监控来改善与护理的联系。目前，南非艾滋病毒诊断的记录保存是基于纸质的。定期报告汇总的测试数据，只有不一致的结果才会导致样本在实验室进行测试并数字化。南非的西开普省有一个省级健康数据中心 (PHDC)，其中个人级常规电子数据被整合到一个数据库中，利用了唯一患者标识符的存在。为了促进改进 HIV 监测，试行了一种预碳酸化床旁检测 (PoCT) 表格，其中一份副本被发送到中心点并数字化以供 PHDC 纳入。

方法

我们使用横断面和回顾性队列分析以及与汇总数据的比较来评估干预的效用。使用唯一标识符将数据链接到 PHDC 的患者主索引。PHDC 内 HIV 的先前证据用于区分新诊断的患者和重新检测的患者，以及与护理和治疗的联系。

结果

从 2017 年 5 月到 2018 年 6 月，11337 份数字化即时 HIV 检测记录与 PHDC 相关联。总体而言，聚合数据集中 96% 的记录被数字化，其中 97% 与 PHDC 相关联。在接受测试的人中，79% 是女性（中位年龄 27 岁）。关联表明，51.3% (95% CI 48.4–54.1%) 的 HIV 检测呈阳性的患者正在重新检测。在新诊断的患者中，81% (95% CI 77.9–84.3%) 与 HIV 护理有关，25% (95% CI 21.6–28.7%) 立即开始接受抗逆转录病毒治疗。

结论

PoCT 结果的数字化提供了个性化的 HIV 检测数据，以帮助与护理联系并区分新诊断的患者和重新检测的阳性患者。可操作和准确的数据可以改进对联合国艾滋病规划署 90-90-90 目标的绩效衡量。