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BACKGROUND: Implementation of the National HIV/AIDS Strategy (NHAS) remains focused on the HIV Care Continuum Initiative. Monitoring health outcomes of people living with HIV (PLWH) is essential to evaluating the continuum. To help Iowa Department of Public Health (IDPH) Ryan White Part B (RWB) case managers better monitor care and viral suppression, the IDPH HIV surveillance team initiated scheduled importation of eHARS CD4 and viral load lab values into the CAREWare case management database. Under Iowa law, all viral load and CD4 results must be reported to surveillance. It follows that eHARS is a more accurate, complete, and timely source of these values than are results collected and entered into CAREWare by case managers
METHODS: RWB generated a spreadsheet of 7,241 persons in CAREWare for linkage with eHARS data. The CAREWare dataset included both HIV-infected and -affected persons. Initial linkage of the two databases produced far fewer matches than expected. This was largely the result of variations in name spellings, name changes, and numerous data entry errors in the CAREWare data. To resolve the issue, the surveillance team linked the datasets by name, birth date, social security number, URN and ADAP number.
RESULTS: A total of 2,469 true matches were found. Of the 2,469 persons, 1,286 were found to be alive and living in Iowa. The surveillance team added all CD4 and viral load values collected in eHARS since 2010 to the spreadsheet of 1,286 persons and imported it into CAREWare. Lab values were initially imported into CAREWare using URN as the import variable. However, URN was found to be unstable and not always identical in eHARS and CAREWare for the same person. Aware of the need to control for such errors and to make the import process less time consuming, IDPH retrospectively assigned a unique local ID number common to the same person in both databases. Persons newly added to CAREWare are assigned a local ID number that is simultaneously entered in eHARS. Subsequent data linkage is based only on this variable. eHARS to CAREWare imports are scheduled regularly.
CONCLUSIONS: Importing CD4 and viral load values regularly into CAREWare enables case managers to monitor continuous engagement of their clients in HIV care, generate graphs, and track viral suppression. Since they no longer collect and enter lab results, case managers are able to devote more time to working with clients to optimize health outcomes.