# Adherence Dashboard (Kenya)

### **Countries:** <img src="/files/71DowkKsopEpx0xcIXp4" alt="" data-size="line">Kenya

### **Intervention Description** &#x20;

Dashboard to identify patients with potential retention to support adherence in HIV care through data collection of HIV Testing services, clinical services, and key population services.&#x20;

Presenter: Peris Nasimiyu and Pinto Shukuru, LVCT Health

[DUC Meeting Recording](https://archive.org/details/2021.04.13-duc-community-meeting)

### Intervention Details

|                                                                                                           |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          |
| --------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| <img src="/files/ZnQzrtFUZBTR1t9FjJV5" alt="" data-size="line">Data Elements                              | <p>Missed HIV appointment </p><p>Due for VL </p><p>Pending VL Results </p><p>High VL </p><p>Unstable</p>                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
| <img src="/files/QxebJwCqcBiRpZ37yN1M" alt="" data-size="line">Evidence                                   | <p>Appointment keep rate increased to around 80% from around 60%.</p><p>12 month ART cohort retention around 70% with fluctuations due to migration which they are now able to track. </p><p>Viral load suppression around 92-94%.</p><p>Use of EMR from 1 clinic in 2014 to 12 care clinics in 2017.</p>                                                                                                                                                                                                                                                                                                |
| <img src="/files/RrTZsAks3vukmm5dKSYl" alt="" data-size="line">Technology Requirements / Interoperability | <p>Computer with internet and server.</p><p>Cell phone - Mobile Application with offline functionality. </p><p>Dashboard- integrated with DHIS2/National Reporting System. </p><p>Use of Ushauri (synched with EMR) for appointment reminders via text.</p><p>Interoperability layer between EMR and NASCOP and NASCOP VL website for direct sync of VL and EID data.</p>                                                                                                                                                                                                                                |
| <img src="/files/KU9EhZrpfw5twoqOs3Og" alt="" data-size="line">Calculations / Algorithms                  | <p>High viral load- client with VL copies of more than 400. </p><p>Due for VL- has been on ART for more than 6 months, then 1 year apart, identified pregnant, on EAC 3 months after reporting high VL. </p><p>Missed HIV appointment- more than 24 hrs have elapsed since the day they were to come for their clinic appointment; Defaulter- 72 hrs; LTFU- 30 days. </p><p>Pending VL results- client bled for VL testing but lab yet to dispatch results.</p><p>Unstable- new client of less than 12 months on ART, client with VL more than 1,000 copies; client with adherence of less than 95%.</p> |
| <img src="/files/SbcBa0OpnFf4xQTFDVhs" alt="" data-size="line">Factors to Scale                           | <p>Need to implement within OpenMRS-based EMR. </p><p>Unable to flag key indicators - use hybrid model of paper and electronic version. </p><p>Power outages due to location and country infrastructure. </p><p>Need to synchronize EMR to reporting systems.</p>                                                                                                                                                                                                                                                                                                                                        |
| <img src="/files/LlIOE3Kb7FWAuwFgE8QV" alt="" data-size="line">Implementation Considerations              | <p>Patients need access to mobile phones. </p><p>Power outages prevent upload of data - paper version needed to bridge gap.</p><p>Patients need to be language and technology literate to use mobile application. </p><p>System not able to flag at-risk patients so highlighted in register.</p><p>Register also track outreach attempts, final outcome recorded in EMR. </p><p>Train service providers.</p>                                                                                                                                                                                            |
| <img src="/files/jamtpgsEuuE7Fhh3MXm6" alt="" data-size="line">Governance Considerations                  | <p>Data Security - proper storage of paper version. </p><p>Potential loss of data upload and retrieval due to power outages.</p><p>Capacity of service providers including willingness and laxity.</p>                                                                                                                                                                                                                                                                                                                                                                                                   |


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