TRACnet is a software used by the GoR to collect and store clinic-level health
information at the central level since 2005.1 The software was developed by Voxiva inc (a Washington D.C. based software and telecommunications company), but is managed and used by the Treatment and Research AIDS Center (TRACplus) division of the Ministry of Health.
TracPlus
TRACplus is the new broader incarnation of the Treatment and Research AIDS Center (TRAC) division of the Ministry of Health. Originally, the group focused entirely on AIDS, but has expanded to encapsulate malaria and tuberculosis as part of its broader mandate, and plans to later include other conditions. It has changed its title to TRACplus to reflect these changes. Additionally TracPlus is the primary national agency
responsible for Preventing Mother-to-Child Transmission (PMTCT) and Voluntary Counseling and HIV testing (VCT), Epidemiology Surveillance, and Health ICT/ Information Management. As part of this mandate, TracPlus uses the TracNet software developed by Voxiva to store facility-level data.
TracNet is a collaboration between both the private and public sectors. MTN and
Rwanda-Tel, the local cell phone carriers, donated network time for facilities to use when reporting their data. Voxiva Inc., provided ICT support to the project. The United States Centers for Disease Control and Prevention (CDC) provided the financial and
administrative support through the President's Emergency Plan for AIDS Relief (PEPFAR).
The breadth of implementation to date is impressive. TRACnet has been deployed in all 94 health facilities offering ART in Rwanda, thus capturing virtually all ART treatment nationwide.2 In addition, approximately 6,000 individual case records are monitored using the system.3
According to the UN:
“TracNet is a dynamic information technology system designed to collect, store, retrieve, display and disseminate critical program information, as well as to manage drug distribution and patient information related to the care and treatment of HIV/AIDS. This system enables practitioners involved in anti-retroviral (ARV) treatment programs to submit reports electronically and have timely access to vital information. By dialing 3456, a Rwanda toll free number, or logging onto a
1
http://www.voxiva.net/rwanda.asp 2
From Voxiva website, with updated information from report, “Development Assistance to Health Information Systems Strengthening,” World Bank September 2007.
3
bilingual website (English and French), health centre staffers can submit or receive program results on HIV/AIDS patients as soon as they are processed. TRACnet uses solar energy chargeable mobile phones, which can be used in the most remote parts of the country.”4
In essence, TracNet provides a direct electronic means of transmitting consolidated data for programmatic decision making, including national level drug procurement. A process that once only provided one-way information and took months, has been reduced to minutes, and can now provide two-way information.
The aggregated data guides healthcare delivery activities at the national level. For
example, TracNet data informs drug procurement at a national level. The TracNet data is transferred to Camerwa, a Rwanda-based pharmaceutical company, that then keeps stock of the availability of ARV drugs. TRAC monitors and supervises health facilities that provide ARV treatment in the country. TRAC also has a team of IT personnel, who have trained over 200 health care providers in health facilities on how to submit data to
TRACnet, and who also monitor reporting into TRACnet and publish monthly reports. Data is entered either on a biweekly or monthly basis (depending on the statistic) and then collected in a national repository.
Data Quality
Some challenges remain in the implementation of TRACnet. Although TracNet’s coverage is wide, the depth and accuracy of data remain unclear. One evaluation
suggested that there is wide variance in the completeness of data depending on the size of the facility. All ART sites had data for over 90% of patients at the time of abstraction. However, 6 month follow-up rates for patients who were alive on ART were 56%, 60% and 14% for small-, medium, and large-sized ART clinics. Moreover, 12-month CD4 counts were only recorded for 35%, 30% and 25% of small-, medium-, and large- ART cites respectively. 5
Additionally, because patient-level data is not maintained electronically at most facilities, cross-checking clinic-level data is difficult and does not appear to occur under normal circumstances. There has been limited evaluation of data completeness to date but no comparison of individual records at facilities with data in TracNET. The difficulty of verification may provide perverse incentives to clinics; since drug supply is based on the number of patients they report, over-reporting might be rewarded with excess
medications and supplies. Further evaluations of the system are planned.
While this type of surveillance is valuable for capturing a broad understanding of groups of patients on ART, it does not identify the segment of the population whose HIV status
4
TracNet, Rwanda: Fighting Pandemics through Information Technology 5
Government of Rwanda (2008) TRAC Report on the Evaluation of Clinical and
Immunologic Outcomes from the National Antiretroviral Treatment Program in Rwanda, 2004 – 2005, p47
is unknown. These data collection efforts offer only a partial picture of the epidemic unless coupled with population-based survey efforts.
Exhibits
Architecture of the integration of information systems at TRACplus
Graphic from Shabani Cishahayo’s presentation at the Rwanda Health Education and Information Network (RHEIN) Workshop. Kigali, May 29-30, 2008.