Differentiated Service Delivery Models Support in UgandaEMR
UgandaEMR (March 2023)
Countries: 
Uganda
UgandaOverview
In 2016, the Uganda National Consolidated HIV Prevention, Care and Treatment Guidelines recommended “Test and Treat” for all PLHIV regardless of clinical stage or CD4 as a critical strategy to enable Uganda to achieve the UNAIDS 90-90-90 goals. In the same guidelines, Uganda also adopted differentiated services delivery (DSD) model for HTS, HIV care, and treatment, recognizing “no size fits all” and to take care of individual’s unique needs. This led to a goal to migrate from paper-based DSD implementation to electronic to allow health workers to categorize patients as stable/unstable, enroll and track patients within DSD models, ease reporting and analysis.
This approach was embedded into UgandaEMR with community-based workflows implemented using UgandaEMR Mobile, a mobile and offline-capable solution. Technology support is tiered from facility-based support to district/implementing partner to national level support.
Plans to integrate with Medic Mobile for community-based care.
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Intervention Details
Scope
National scope with specific implementations in high-volume facilities and urban centers.
Plans to scale up the CRPDDP model to more facilities.
Tools/Technology
Uganda EMR
Uganda EMR Mobile
ARTAccess for community retail pharmacy drug distribution integrated using a FHIR API (starting out with 60 facilities supporting 42,000 clients)
Data Processes
Categorization of patients into different DSDM models based on stability and care needs:
Stable Clients (stable on first- or second-line ART regimen at least 6 months, virally suppressed, WHO stage 1 or 2, 95% or better adherence over past 6 months, no TB or TB previously treated) utilize community resources to decongest facilities:
Fast Track Drug Refill (FTDR)
Community Client Led ART Delivery (CCLADs) - client-based groups in community rotate drug pick-up
Community Drug Distribution Points (CDDPs) - clients pick up drugs and receive clinical evaluation when due, including Community Led Drug Distribution Points (CLDDP) and Community Retail Pharmacy Drug Distribution Points (CRPDDP)
Unstable/new patients utilize services within facilities:
Facility Based Individual Management (FBIM) – clients needing extra attention
Facility Based Group (FBG) - for complex or stable clients desiring peer support
Calculations and Data Sharing:
Tracking patient appointments, adherence, and viral load testing.
Data synchronization between EMR, mobile app, and At Access system.
People
Health workers, data personnel, and pharmacy staff are trained to use the EMR and mobile applications.
Implementation Considerations
Adjustments to the mobile app and EMR to suit local guidelines and patient needs.
Governance Considerations
Ensuring secure data transfer and storage, particularly with the integration of multiple systems.
Challenges
Managing data synchronization, ensuring data security, and adapting to new guidelines.
Successes
Facilities routinely seeing 1000 patients per day were reduced to 300-600 patients per day.
Impact
Significant reduction in facility congestion, improved patient management, and better adherence to care protocols.
Resources
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