Lighthouse Trust's Community-based ART Retention and Suppression (CARES) App in Malawi

I-TECH and I-TECH/Malawi, Malawi (March 2023)

Countries: Malawi

Overview

Lighthouse Trust's Community-based ART Retention and Suppression (CARES) App provides differentiated service delivery (DSD) to move patients from congested ART clinics to communities. It is based on Community Health Toolkit (CHT) Core Framework and is an offline-first, EMR-like App that mirrors Malawi’s ART EMR. The CARES App allows community healthcare workers to perform visits offline in the field, including guiding them through workflow and providing reminders to help guide care. Nurses can use the system to plan home visits and track drug inventory. Moving care into the community not only better meets clients' needs, but alsoreducese the burden on and congestion within facilities by moving aspects of care out of the facilities.

Challenges include the complexity of healthcare data, retrieving and transforming data for routine monitoring & evaluation, and dealing with connectivity limitations. Upcoming work includes optimizations, on-time VL testing, improved drugs & commodities management, deploying CARE to additional facilities, adding a hypertension module, smooth referrals, and strengthen EMR integration.

Presenter: Dr. Caryl Feldacker (I-TECH), Daniel Mwakanema (I-TECH/Malawi)

Link to presentation

Intervention Details

Scope	Initially local, with plans to scale regionally and potentially nationally. The intervention is being optimized for broader deployment beyond the flagship clinics.
Tools/Technology	Community Health Toolkit (CHT), an open-source set of tools optimized for community health workers. The app needs to integrate with Malawi's bespoke EMR system, which is a challenge due to its customized nature.
Data Processes	The app mirrors the Malawi ART EMRS fields to ensure standardized and complete HIV clinical consults. The app includes decision-making supports, adherence calculations, and real-time data usage for improved care. Data is synced between the app and the EMR, though currently, this involves manual data entry. The app performs adherence calculations and provides alerts for on-time viral load testing. Example of data elements used: Enrollment Data National ID Gender Age Regimen Viral Load Current outcome Appointment dates Tasks (reminders) Allergies Side effects TB screening questionnaire Adherence Prescriptions Reports (appointments, prescriptions, dispensing, adherence, consultations) Calculations: Adherence calculations based on drug counts Reminders (tasks) based on guideline-based care workflows Appointment recommendations
People	Nurses and community health workers are critical, with training provided on using the app and understanding its functionalities.
Implementation Considerations	In Malawi, 80% of population is rural Uses Community Health Toolkit (CHT) Core Framework Uses patient barcodes available in Malawi Based on Malawi’s bespoke data model (which is based on OpenMRS data model)
Governance Considerations	Minimizing identifiable data within the App Many countries do not want sensitive data hosted in the cloud (outside o the country)
Challenges	Integrating with a customized EMR, ensuring data security, and managing offline data syncing.
Successes	Successful development and initial deployment of the CARES app, with positive feedback from users.
Impact	Improved quality of care in community settings, better adherence to national ART guidelines, and reduced workload for providers.
Resources	Notes page Community Health Toolkit (CHT)