|Institution:||Universiteit van Amsterdam|
|Full text PDF:||http://hdl.handle.net/11245/1.473763|
HIV/AIDS remains a major public health problem; in 2013 nearly 35 million people were infected globally, with 71% living in sub-Saharan Africa (SSA). Approximately 1.5 million people died of AIDS related illnesses in 2013. Kenya is ranked fourth globally in HIV/AIDS burden. In this thesis, we have described the biological and socio-behavioral factors associated with HIV infection among adults aged 15-49 years in Kenya. The informatics studies included in the thesis focus on the use of electronic medical record (EMR) and clinical decision support systems (CDSS) to improve quality of care for HIV/AIDS patients through better adherence to WHO and national clinical guidelines. The studies provide strong evidence that EMR-based CDSS can significantly improve adherence to HIV/AIDS treatment guidelines in resource-limited countries in SSA, through appropriate initiation of life-saving of antiretroviral therapy and timely monitoring of immunological response to treatment. We also showed that a CDSS can enhance early detection and action on treatment failure among HIV patients. The thesis further describes the process of deriving a reference set for AIDS Defining Illnesses (ADIs) based on an international terminology system (SNOMED CT) and using it to standardize the recording ADIs. The reference set was implemented as an interface terminology of an EMR at a busy teaching and referral hospital in western Kenya. Overall, the thesis provides compelling evidence that EMR-based CDSS improve quality of HIV care in resource-limited settings through better adherence to clinical guidelines.