Knowledge of the public health impact of HIV/AIDS in Guatemala is limited due to inadequate surveillance, monitoring, and evaluation. Medical facilities offering effective prevention and treatment are scarce. Hospicio San Jose is one of the few places in Guatemala focused on HIV/AIDS care. The hospice serves 41 inpatient children, 4 inpatient adults, and approximately 300 HIV-positive outpatients from Central America. We report on a long-term collaborative surveillance project at Hospicio San Jose. We aimed to develop a pilot system for HIV surveillance in Guatemala and to determine how an informatics system could improve patient care. Using EpiInfo, we constructed a system for data entry and analysis of patient information. We focused our efforts on inpatient children and were able to enter data for all 41 hospice children. We conducted preliminary quantitative analysis with this subset. Moreover, we performed qualitative analysis of both the hospice patient charts and the new computerized system. The current charts contained most variables needed to assess HIV care, including consistent data on CD4, viral load, and nutritional indicators. Problems included inconsistent chart organization, lack of units, illegibility, and contradictory information. The following variables were not regularly recorded: vital signs, allergies, place of birth, education level, date of admission, date of HIV diagnosis, type of HIV diagnostic test, antiretroviral (ARV) dose, date of ARV change, and justification for ARV discontinuation. The new informatics system permitted more efficient use of patient data. We conducted preliminary univariate and bivariate analysis demonstrating the various applications of the system, analyzing relationships such as those between age and nutrition and CD4 and viral load as a function of age. We demonstrated such relations for each patient individually, as well as for the entire cohort. In graphing CD4 and viral load as a function of age, we were able to demonstrate how each variable changes over time and also how the two relate to each other. Correlating trends in CD4 and viral load measurements with ARV or opportunistic infections can be used to demonstrate how hospice care affects disease status and treatment. We concluded this phase of the project by designing two forms to improve patient record keeping and making recommendations for further surveillance. This project was an important initial step in improving HIV monitoring and evaluation in Guatemala. Further analysis of Hospicio San Jose patient information will describe trends in disease transmission and treatment success and will help identify gaps in care.
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