Sub-Saharan Africa could soon have medical records of people living with HIV and AIDS patients run electronically, thanks to The DREAM Project which now operates within the framework of the national health systems of several African countries. DREAM has now spread to 10 African countries: Mozambique, Malawi, Tanzania, Kenya, the Republic of Guinea, Guinea Bissau, Cameroon, Congo RDC, Angola and Nigeria and is being used by thousands of professionals in 31 centres and 18 molecular biology laboratories that are already operational and by now has reached its fourth version.
The Dream Project aims to introduce the essential components of an integrated strategy for the prevention and treatment of HIV/AIDS and will provide efficient management of the clinical data regarding the treatment of the patients and epidemiological analyses. The project is intended to serve as a model for a wide-ranging scale-up in the response to the epidemic in a unified manner of gathering data by different centres in different countries, monitoring of centres and for the refining of therapies.
DREAM was launched in Mozambique in March 2002, following two years of groundwork. However, the idea for the project was born in 1998 when the Community of Sant’Egidio– a Christian movement founded in Rome in the late 1960s that has a strong base in Africa – decided to fight the devastating impact of HIV/AIDS.
The medical files of over 73,000 assisted patients are managed by this software and the data collected with it have become essential for the epidemiological research that is carried out to improve the effectiveness of the therapy.
Specific software for the management of the patients’ EMR has been created within the DREAM programme in order to deal with the challenges deriving from the context in which DREAM operates. Setting up a computer infrastructure in health centres, providing a power supply, as well as managing the data and the project resources efficiently and reliably, are some of the challenges the project aims to solve.
As for Internet connections, especially regarding bandwidths that are not always adequate, the matter is tackled in different ways. Careful enquiries made to local Internet service providers (ISP) have allowed many centres to have good quality Internet access at an accessible price. In cases where this was not an option, the problem has been resolved by using satellite connections, usually installed in our laboratories.
For all the rural centres that are not connected to the Internet, it has been possible to transfer requests for tests via flash disk from the centre to the laboratory. The same applies to the transfer of backup of the centres. Once the backup reaches the laboratory, the software makes it possible to send all the backup of the satellite centres to a centralised server. Another important point: the size of files sent is reduced, to make them as robust as possible, so as not to be vulnerable to possible loss of data. An incremental backup system with especially strong redundancy was designed in order to achieve this.
Testifying to the quality of the networks (electrical as well as computer) of DREAM centres, VoIP communication systems have been introduced (at times supplied by the operators), which have allowed for the reduction in intercontinental teleconsultation costs. DREAM has chosen to invest in intensive short-term personnel training, followed by more prolonged in-service training with the support of expert personnel at the workplace.
Community intervention models have also been developed, such as outpatient care, community and home-based care. These do not require extensive resources and can be set up quickly. As a backup, a small number of high technology centres capable of supporting large areas (e.g. molecular biology laboratories) have been set up. In every DREAM treatment centre, a computer with the DREAM Software is available for all staff members; everyone follows the patient as per his/her specific competence and tasks and while doing so, has all the updated data of the said patient at his/her disposal.
Not only does this make procedures more efficient and the work of the centre more streamlined, it has also served to guarantee the quality of data, with each staff member able to verify the said data from his/her own station.
Centres are lcoated within a 150 km radius of cities and have been equipped so that they can offer the same qualitative level of treatment and monitoring as those closer to the cities. Apart from supplying equipment, the transport of blood samples and periodic supervision by DREAM staff are also organized.
The attention paid to the requests of the end users, covering every aspect of care and treatment, the possibility of having homogenous data from different countries, are only some of the significant features which have made this computer system an indispensable tool for the management of treatment and for epidemiological research.