Background: An electronic medical record (EMR) has the potential to improve completeness and reporting of notifiable diseases. We developed and assessed the validity of an HIV case detection algorithm and deployed the final algorithm in a national automated HIV case reporting system in Thailand. Method(s): The HIV case detection algorithms leveraged a combination of standard laboratory codes, prescriptions and International Classification of Diseases, 10th Revision diagnostic codes to identify potential cases. The initial algorithm was applied to the national EMR from 2014 to June 2020 to identify HIV-infected subjects to build the national HIV case reporting system (Epidemiological Intelligence Information System (EIIS)). A subset of potential positives identified by the initial algorithm were then validated and reviewed by infectious disease specialists. This review identified that a proportion of the false positives were due to pre-exposure prophylaxis/postexposure prophylaxis (PrEP/PEP) antiretrovirals, and so the algorithm was refined into a 'Final Algorithm' to address this. Result(s): Positive predictive value of identifying HIV cases was 90% overall for the initial algorithm. Individuals misclassified as HIV-positive were HIV-negative patients with incorrect diagnostic codes, prescription records for PrEP, PEP and hepatitis B treatment. Additional revision to the algorithm included triple drug regimen to avoid further misclassification. The final HIV case detection algorithm was applied to national EMR between 2014 and 2020 with 449 088 HIV-infected subjects identified from 1496 hospitals. EIIS was designed by applying the final algorithm to automated extract HIV cases from the national EMR, analysing them and then transmitting the results to the Ministry of Public Health. Conclusion(s): EMR data can complement traditional provider-based and laboratory-based disease reports. An automated algorithm incorporating laboratory, diagnosis codes and prescriptions have the potential to improve completeness and timeliness of HIV reporting, leading to the implementation of a national HIV case reporting system. Copyright 2022 Author(s) (or their employer(s)).

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supports country programs in identifying persons living with HIV infection (PLHIV), providing life-saving treatment, and reducing the spread of HIV in countries around the world (1,2). CDC used Monitoring, Evaluation, and Reporting (MER) data* to assess the extent to which COVID-19 mitigation strategies affected HIV service delivery across the HIV care continuum(†) globally during the first year of the COVID-19 pandemic. Indicators included the number of reported HIV-positive test results, the number of PLHIV who were receiving antiretroviral therapy (ART), and the rates of HIV viral load suppression. Percent change in performance was assessed between countries during the first 3 months of 2020, before COVID-19 mitigation efforts began (January-March 2020), and the last 3 months of the calendar year (October-December 2020). Data were reviewed for all 41 countries to assess total and country-level percent change for each indicator. Then, qualitative data were reviewed among countries in the upper quartile to assess specific strategies that contributed to programmatic gains. Overall, positive percent change was observed in PEPFAR-supported countries in HIV treatment (5%) and viral load suppression (2%) during 2020. Countries reporting the highest gains across the HIV care continuum during 2020 attributed successes to reducing or streamlining facility attendance through strategies such as enhancing index testing (offering of testing to the biologic children and partners of PLHIV)(§) and community- and home-based testing; treatment delivery approaches; and improvements in data use through monitoring activities, systems, and data quality checks. Countries that reported program improvements during the first year of the COVID-19 pandemic offer important information about how lifesaving HIV treatment might be provided during a global public health crisis.

In Thailand, antiretroviral therapy (ART) was initiated to treat human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) cases using the empirical regimen with no prior genotypic test to determine drug resistance. In order to assess prevalence rate of HIV drug resistance (HIVDR) among pre-treatment cases, four rounds of survey were carried out in ART clinics, including six, eight, 33 and four ART clinics in each round during 2006-2013. For which, HIVDR testing results were available in 310, 350, 797, and 413 cases in four rounds. It was revealed that HIVDR rates among naive cases were 2.0%, 2.8%, 4.0% and 4.8%, while in experienced cases, the rates were 0, 3.3%, 11.4% and 13.9%. The rates among all cases were 1.9%, 2.9%, 4.4% and 5.6%. Resistant drugs with the highest rates among all cases in the survey round 4 were nevirapine (3.6%) and efavirenz (3.1%). The results indicated the need to continue surveillance for pre-treatment HIVDR, and posed challenges to implement activities for protecting efficacy and prolong the use of empirical first-line regimen. A strategy to apply genotyping test, in a cost-effective approach, should be considered to prepare for situation when HIVDR increases beyond a critical level.