HIV/AIDS

Information management system

Francois Bezuidenhout GIS Manager Geospace International South Africa

To implement such a system would require the buy-in of all the relevant stakeholders. Modern technology makes its design and implementation entirely possible, without extensive capital or human resource expense.

Although the fight against HIV/Aids has recently enjoyed high priority, the biggest obstacle towards a successful effort in fighting the pandemic remains an integrated and coordinated information structure to which all stakeholders has access.

Various government departments, NGOs, research institutions and private companies collect data regarding the pandemic in diverse fields such as HIV/Aids and Sexually Transmitted Diseases (STD) prevalence, behavioural risk factors, mass media impact, Anti Retro Viral (ARV) drug availability and distribution as well as new drug development and testing. This information remains fragmented across the various domains, meaning that at any one time, planning, decision and policy making by any institution or stakeholder is done with only a fraction of the information available.

This situation is detrimental to the effectiveness and relevancy of the planning and decision making process. Coordinated information gathering and updating can be one of the most effective tools in fighting the pandemic. One therefore needs to develop a system that can make this possible on a national level, across all the various domains dealing with HIV/Aids.

Methodology
To implement such a system would require the buy-in of all the relevant stakeholders. Modern technology makes the design and implementation of such a system entirely possible, without extensive capital or human resource expenditure. Data collection sites, such as VCT and antenatal clinics, hospitals, medical research institutions, HIV/Aids survey institutions, ARV testing laboratories, pharmaceutical companies and all NGOs and government institutions gathering local or national information about HIV/Aids must be identified. Through consultation, a master database can be designed on an Oracle or SQL server platform or the like. This master database will consist out of sections of attributes relevant to each site, since a VCT clinic would not capture the same data as a medical research facility, for example. The Master Database will be maintained and controlled from a single point. All the participating sites will be linked to the database via the web with a specific web site developed for the system. On a weekly or monthly basis, the responsible person at each site will update the database specific to that site using a simple front-end application and send it via the web to the Master Database, where it will automatically update that specific section.

Implementation
There are four basic stages of development that can be identified:

Stage 1: Determining the structure basis
In order to determine the structure basis, four audits needs to be completed:

• Stakeholder Audit: determine the key and peripheral stakeholders, obtain their buy-in and determine their capacities and needs.
• Information Audit: To audit existing information available, its structure and content, its quantity, quality and the information flow per stakeholder.
• Technology Audit: To audit existing hardware and software used by stakeholders as well as determining the equipment requirements per stakeholder.
• Human Resource and Skills Audit: Determine existing human resource capacity as well as skill levels per stakeholder in order to assess training requirements.

Stage 2: System development
The system and database will be developed to be as user-friendly and automated as possible. Five phases needs to be implemented for successful system development:

• Database design: The development, testing and implementation of the database design
• Web application development: The web user interface needs to be user-friendly and intuitive. The user interface will be a front-end application requiring little PC and no database skills.
• Graphic user interface: This interface will allow users to do spatial analysis on the data, create thematic maps, run spatial queries and do general view, query and print operations.
• Existing data integration: The data acquired from all stakeholders will be integrated into the database. This applies to statistical, attribute and spatial data.
• Testing of the system: Finally, the system will be tested in an operational environment with various pilot sites.

Stage 3: System implementation and capacity building
This stage refers to the actual implementation of the system and can be divided into 3 phases.

• The development and implementation of the system rollout plan: Visit all identified stakeholder sites, install equipment and networks (where necessary)
• Training and skills transfer: Train staff in the use of the Web User Interface, train selected stakeholder staff in the use of the interface with regard to view, query and print operations
• Technical operations: Assign usernames, passwords and ensure linkages between the relevant entities. As a system is implemented at each site, each stakeholder agency will come online. Thus the network will grow with each installation.

Stage 4: System maintenance
In order to make the system sustainable over the long run, system and database maintenance and updating is of utmost importance. The following issues are important during maintenance:

• The Master Database is to be hosted and maintained at one central point
• Technical maintenance at sites will be the responsibility of specialized team provided by the relevant agency or trained locally
• Problems, whether technical or administrative, can be logged on-line and responded to.
• The system is self-maintainable since updates are done on specified periods
• Data redundancy and cyclical errors will be dealt with automatically.
• Since the system will be in daily use, quality assurance will be a matter of course, with system errors being responded to immediately.

Result
The result would, therefore, be data about different aspects of HIV/Aids flowing from various sites across the country to one central database. All participating sites will have access to the Master Database and be able to extract information for decision making or planning. Information can be viewed, queried and printed within a statistical and spatial context. For example, a pharmaceutical company might want to know which clinics in a province are in need of a certain drug. They will then be able to access the Master Database and by doing simple queries on a front-end application, would ascertain which clinics need which drugs and how much of it. Similarly, HIV/Aids statistics will be updated constantly. Clinics and hospitals can update new cases, as well as deaths caused by Aids, TB and STD infections etc. Survey companies would be able to incorporate their data into the Master Database as surveys are done, whether it is data on prevalence, mass media impact or behavioural risk indicators. The same for surveys done by the state.

Conclusion
Information on HIV/Aids is fragmented on various fronts. The implementation of a National HIV/Aids Information Management system will enable us to fight the pandemic from a united front, which is essential for success. It will enable various institutions covering various domains to act in unison and with purpose and will enable target specific, accurate and affective location based service delivery to the people on the ground suffering from HIV/Aids, as well as people affected indirectly, such as orphans.

The main criteria for success should be the difference that it makes in the quality of life of people directly or indirectly affected by this pandemic. This system has the potential to deliver that.