{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T09:11:15Z","timestamp":1777540275067,"version":"3.51.4"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Aggregate electronic data repositories and population-level cross-sectional surveys play a critical role in HIV programme monitoring and surveillance for data-driven decision-making. However, these data sources have inherent limitations including inability to respond to public health priorities in real-time and to longitudinally follow up clients for ascertainment of long-term outcomes. Electronic medical records (EMRs) have tremendous potential to bridge these gaps when harnessed into a centralised data repository. We describe the evolution of EMRs and the development of a centralised national data warehouse (NDW) repository. Further, we describe the distribution and representativeness of data from the NDW and explore its potential for population-level surveillance of HIV testing, care and treatment in Kenya.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Main body<\/jats:title>\n                <jats:p>Health information systems in Kenya have evolved from simple paper records to web-based EMRs with features that support data transmission to the NDW. The NDW design includes four layers: data warehouse application programming interface (DWAPI), central staging, integration service, and data visualization application. The number of health facilities uploading individual-level data to the NDW increased from 666 in 2016 to 1,516 in 2020, covering 41 of 47 counties in Kenya. By the end of 2020, the NDW hosted longitudinal data from 1,928,458 individuals ever started on antiretroviral therapy (ART). In 2020, there were 936,869 individuals who were active on ART in the NDW, compared to 1,219,276 individuals on ART reported in the aggregate-level Kenya Health Information System (KHIS), suggesting 77% coverage. The proportional distribution of individuals on ART by counties in the NDW was consistent with that from KHIS, suggesting representativeness and generalizability at the population level.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The NDW presents opportunities for individual-level HIV programme monitoring and surveillance because of its longitudinal design and its ability to respond to public health priorities in real-time. A comparison with estimates from KHIS demonstrates that the NDW has high coverage and that the data maybe representative and generalizable at the population-level. The NDW is therefore a unique and complementary resource for HIV programme monitoring and surveillance with potential to strengthen timely data driven decision-making towards HIV epidemic control in Kenya.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Database link<\/jats:title>\n                <jats:p>(<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/dwh.nascop.org\/\">https:\/\/dwh.nascop.org\/<\/jats:ext-link>).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-023-02265-6","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T09:02:30Z","timestamp":1694768550000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Leveraging electronic medical records for HIV testing, care, and treatment programming in Kenya\u2014the national data warehouse project"],"prefix":"10.1186","volume":"23","author":[{"given":"Margaret","family":"Ndisha","sequence":"first","affiliation":[]},{"given":"Amin S.","family":"Hassan","sequence":"additional","affiliation":[]},{"given":"Faith","family":"Ngari","sequence":"additional","affiliation":[]},{"given":"Evans","family":"Munene","sequence":"additional","affiliation":[]},{"given":"Mary","family":"Gikura","sequence":"additional","affiliation":[]},{"given":"Koske","family":"Kimutai","sequence":"additional","affiliation":[]},{"given":"Kennedy","family":"Muthoka","sequence":"additional","affiliation":[]},{"given":"Lisa Amai","family":"Murie","sequence":"additional","affiliation":[]},{"given":"Herman","family":"Tolentino","sequence":"additional","affiliation":[]},{"given":"Jacob","family":"Odhiambo","sequence":"additional","affiliation":[]},{"given":"Pascal","family":"Mwele","sequence":"additional","affiliation":[]},{"given":"Lydia","family":"Odero","sequence":"additional","affiliation":[]},{"given":"Kate","family":"Mbaire","sequence":"additional","affiliation":[]},{"given":"Gonza","family":"Omoro","sequence":"additional","affiliation":[]},{"given":"Davies O.","family":"Kimanga","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"key":"2265_CR1","volume-title":"Global HIV & AIDS statistics - fact sheet","author":"UNAIDS","year":"2021","unstructured":"UNAIDS. Global HIV & AIDS statistics - fact sheet. 2021.\u00a0Available from:\u00a0https:\/\/www.usaid.gov\/sites\/default\/files\/documents\/UNAIDS_FactSheet_en.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR2","volume-title":"Understanding fast-track: accelerating action to end the AIDS epidemic by 2030","author":"UNAIDS","year":"2015","unstructured":"UNAIDS. Understanding fast-track: accelerating action to end the AIDS epidemic by 2030. 2015.\u00a0Available from:\u00a0https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/201506_JC2743_Understanding_FastTrack_en.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR3","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.ijid.2020.09.011","volume":"100","author":"Y Assefa","year":"2020","unstructured":"Assefa Y, Gilks CF. Ending the epidemic of HIV\/AIDS by 2030: Will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries? Int J Infect Dis. 2020;100:273\u20137.","journal-title":"Int J Infect Dis"},{"key":"2265_CR4","doi-asserted-by":"publisher","first-page":"2328","DOI":"10.12688\/f1000research.9247.1","volume":"5","author":"AD Harries","year":"2016","unstructured":"Harries AD, Suthar AB, Takarinda KC, Tweya H, Kyaw NT, Tayler-Smith K, et al. Ending the HIV\/AIDS epidemic in low- and middle-income countries by 2030: is it possible? F1000Res. 2016;5:2328.","journal-title":"F1000Res"},{"issue":"1\u20132","key":"2265_CR5","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/0169-2607(95)01672-G","volume":"48","author":"HJ Tange","year":"1995","unstructured":"Tange HJ. The paper-based patient record: is it really so bad? Comput Methods Programs Biomed. 1995;48(1\u20132):127\u201331.","journal-title":"Comput Methods Programs Biomed"},{"issue":"2","key":"2265_CR6","first-page":"62","volume":"48","author":"R Dehnavieh","year":"2019","unstructured":"Dehnavieh R, Haghdoost A, Khosravi A, Hoseinabadi F, Rahimi H, Poursheikhali A, et al. The District Health Information System (DHIS2): a literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries. Health Inf Manag. 2019;48(2):62\u201375.","journal-title":"Health Inf Manag"},{"key":"2265_CR7","volume-title":"Kenya demographic and health survey 2008\u201309","author":"Kenya National Bureau of Statistics and ICF Macro","year":"2010","unstructured":"Kenya National Bureau of Statistics and ICF Macro. Kenya demographic and health survey 2008\u201309. 2010.\u00a0Available from:\u00a0https:\/\/dhsprogram.com\/pubs\/pdf\/fr229\/fr229.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR8","volume-title":"Kenya demographic and health survey 2003","author":"Central Bureau of Statistics (CBS) [Kenya]","year":"2004","unstructured":"Central Bureau of Statistics (CBS) [Kenya], M.o.H.M.K., ORC Macro. Kenya demographic and health survey 2003. 2004.\u00a0Available from:\u00a0https:\/\/dhsprogram.com\/pubs\/pdf\/fr151\/fr151.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR9","volume-title":"Kenya demographic and health survey 2014","author":"Kenya National Bureau of Statistics and ICF Macro","year":"2015","unstructured":"Kenya National Bureau of Statistics and ICF Macro. Kenya demographic and health survey 2014. 2015.\u00a0Available from:\u00a0https:\/\/dhsprogram.com\/pubs\/pdf\/fr308\/fr308.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR10","volume-title":"Kenya AIDS indicator survey 2012: final report","author":"NAtional AIDS and STI Control Programme (NASCOP)","year":"2014","unstructured":"NAtional AIDS and STI Control Programme (NASCOP). Kenya AIDS indicator survey 2012: final report. 2014.\u00a0Available from:\u00a0http:\/\/nacc.or.ke\/wp-content\/uploads\/2015\/10\/KAIS-2012.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR11","volume-title":"Kenya AIDS inidcator survey 2007: final report","author":"National AIDS\/STI Control Programme (NASCOP)","year":"2009","unstructured":"National AIDS\/STI Control Programme (NASCOP). Kenya AIDS inidcator survey 2007: final report. 2009.\u00a0Available from:\u00a0http:\/\/guidelines.health.go.ke:8000\/media\/KAIS_2007_Final.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR12","volume-title":"Kenya population health impact assesment 2018: preliminary report","author":"National AIDS and STI Control Programme (NASCOP)","year":"2020","unstructured":"National AIDS and STI Control Programme (NASCOP). Kenya population health impact assesment 2018: preliminary report. 2020.\u00a0Available from:\u00a0https:\/\/www.health.go.ke\/wp-content\/uploads\/2020\/02\/KENPHIA-2018-PREL-REP-2020-HR3-final.pdf.\u00a0Cited 2021, August 30th."},{"issue":"9903","key":"2265_CR13","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1016\/S0140-6736(13)61809-7","volume":"382","author":"SG Deeks","year":"2013","unstructured":"Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382(9903):1525\u201333.","journal-title":"Lancet"},{"issue":"7","key":"2265_CR14","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1177\/0956462417724015","volume":"29","author":"D Achwoka","year":"2018","unstructured":"Achwoka D, Mandala J, Muriithi M, Zeng Y, Chen M, Dirks R, et al. Progress toward elimination of perinatal HIV transmission in Kenya: analysis of early infant diagnosis data. Int J STD AIDS. 2018;29(7):632\u201340.","journal-title":"Int J STD AIDS"},{"issue":"1","key":"2265_CR15","doi-asserted-by":"publisher","first-page":"e0190659","DOI":"10.1371\/journal.pone.0190659","volume":"13","author":"M Mwau","year":"2018","unstructured":"Mwau M, Syeunda CA, Adhiambo M, Bwana P, Kithinji L, Mwende J, et al. Scale-up of Kenya\u2019s national HIV viral load program: findings and lessons learned. 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EMR system assessments: harmonization report. 2009.\u00a0Available from:\u00a0http:\/\/guidelines.health.go.ke:8000\/media\/HARMONIZED_REPORT_FOR_EMR_SYSTEM_ASSESSMENTS-Final.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR18","volume-title":"Standards and guidelines for electronic medical record systems in Kenya","author":"Ministry of Medical Services and Ministry of Public Health and Sanitation","year":"2010","unstructured":"Ministry of Medical Services and Ministry of Public Health and Sanitation. 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Report on the review of EMR systems towards standardization, 2011. 2011.\u00a0Available from:\u00a0http:\/\/guidelines.health.go.ke:8000\/media\/EMR_Review_Towards_Standardization_Report_IEJ8JUc.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR20","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.ijmedinf.2016.09.013","volume":"97","author":"S Kang'a","year":"2017","unstructured":"Kang\u2019a S, Puttkammer N, Wanyee S, Kimanga D, Madrano J, Muthee V, et al. A national standards-based assessment on functionality of electronic medical records systems used in Kenyan public-Sector health facilities. Int J Med Inform. 2017;97:68\u201375.","journal-title":"Int J Med Inform"},{"key":"2265_CR21","volume-title":"HTS Lan & Refferal and linkage register","author":"National AIDS and STI Control Programme (NASCOP)","year":"2016","unstructured":"National AIDS and STI Control Programme (NASCOP). 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Where no universal health care identifier exists: comparison and determination of the utility of score-based persons matching algorithms using demographic data. JMIR Public Health Surveill. 2018;4(4):e10436.","journal-title":"JMIR Public Health Surveill"},{"key":"2265_CR24","unstructured":"National AIDS Control Council. Kenya HIV estimates report 2018. Available from: https:\/\/nacc.or.ke\/wp-content\/uploads\/2018\/12\/HIV-estimates-report-Kenya-20182.pdf. Cited 2021, August 30th."},{"key":"2265_CR25","volume-title":"Guidelines for antiretrovrial therapy in Kenya","author":"National AIDS and STI Control Programme (NASCOP)","year":"2005","unstructured":"National AIDS and STI Control Programme (NASCOP). Guidelines for antiretrovrial therapy in Kenya. 2005.\u00a0Available from:\u00a0https:\/\/www.who.int\/hiv\/pub\/guidelines\/kenya_art.pdf.\u00a0Cited 2021, August 30th."},{"key":"2265_CR26","volume-title":"Guidelines for antiretroviral therapy in Kenya","author":"National AIDS and STI Control Programme (NASCOP)","year":"2011","unstructured":"National AIDS and STI Control Programme (NASCOP). Guidelines for antiretroviral therapy in Kenya. 4th ed. 2011.\u00a0Available from:\u00a0http:\/\/guidelines.health.go.ke:8000\/media\/Final_guidelines_re_print_11-09-2012.pdf.\u00a0Cited 2021, August 30th.","edition":"4"},{"key":"2265_CR27","volume-title":"Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya","author":"National AIDS and STI Control Programme (NASCOP)","year":"2018","unstructured":"National AIDS and STI Control Programme (NASCOP). Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya. 8th ed. 2018.\u00a0Available from:\u00a0https:\/\/faces.ucsf.edu\/sites\/g\/files\/tkssra4711\/f\/Kenya-ARV-Guidelines-2018-Final_20thAug2018.pdf.\u00a0Cited 2021, August 30th.","edition":"8"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-023-02265-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-023-02265-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-023-02265-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:15:58Z","timestamp":1700439358000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-023-02265-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,15]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["2265"],"URL":"https:\/\/doi.org\/10.1186\/s12911-023-02265-6","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,15]]},"assertion":[{"value":"31 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Since data are collected from routine service delivery and are intended to be used for national HIV programme evaluation, clients have not been asked for their informed consent. Instead, ethics approval to collect, archive and use data from the repository without retrospectively seeking informed consent from clients, has been obtained under a non-routine non-research determination (NRD) protocol (P716\/2019) from AMREF\u2019s Health Africa Ethics and Scientific Review Committee (ESRC).This project was reviewed in accordance with CDC human research protection procedures and was determined to be research, but CDC investigators did not interact with human subjects or have access to identifiable data or specimens for research purposes\u00a0(CDC, reference number 2018\u2013528).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"183"}}