Applying biometric data to the HIV response removes obstacles in care continuum

The following is a guest post by Nena do Nascimento, of Data.FI at Palladium

Biometric data allows for the creation of an identifier that is based on a unique human feature that does not change over time, such as a fingerprint or a person’s iris. Technology companies are already using this form of identification in many of their products. I use a biometric identifier – my facial features – countless times a day to unlock my smart phone. Governments in many countries, including India and Kenya, are already working to harness biometric identification to better identify, keep track of, and provide better coordinated services to all citizens.

Healthcare providers in the HIV field struggle to track clients across the continuum of HIV services – including testing, treatment, lab, dispensing, prevention, and community-based services. Such tracking is critical to reaching global 95-95-95 targets by 2030.

To reach those targets, we must ensure that clients tested for HIV are linked to life-saving prevention, care, and treatment services, and that clients on treatment remain adherent to medications and stay virally suppressed. Without proper tracking, healthcare providers risk losing clients, squandering an opportunity to keep them healthy and to mitigate the risk of new community infections.

This care continuum is difficult to track within healthcare record-keeping systems for several reasons:

• Medical records are poorly completed, with inaccurate biographical (name, age, sex) and contact information.
• Clients access services at multiple health facilities, as well as multiple clinics within facilities (e.g., antenatal care and routine care and treatment) and may provide different identifying information.
• Siloed information systems contain different client records for prevention, treatment, lab, and dispensing data.

On the Data for Implementation (Data.FI) project, funded by the U.S. President’s Emergency Fund for AIDS Relief through USAID, we are providing technical expertise on how to operationalize sustainable biometric identification systems for HIV client health records in Nigeria and Burundi. The aim of this work is to enable countries to optimize client care and track achievements toward the 95-95-95 goals. This involves thinking about a range of policy and practical issues, such as:

• Addressing data security and data privacy and other data governance and legal protocols
• Ensuring data fields and definitions across information systems are standardized to allow for automated sharing of data across systems
• Developing digital solutions to interoperate siloed information systems
• Working with local stakeholders on how to ensure network connectivity of client service provision sites
• Advising government and local partners on ongoing strategic investments in systems, including maintenance and upgrading of hardware and software, data hosting, and maintenance costs.

Having worked on the intersection of HIV and health informatics for several years, I am excited about the potential of biometric identification as a new tool to improve HIV outcomes. However, as we work to address these big issues described above, I also recognize that moving to biometrics requires a significant investment of financial resources and technical expertise, particularly in contexts with more nascent health information systems.

Taking on biometric identification also requires directly addressing data security and data privacy requirements to ensure safeguarding of unique client data, particularly in countries with HIV epidemics that most affect key populations, where clients seeking services may intentionally avoid any form of identification.

What does this add up to? Biometrics is one tool to strengthen health systems, although it may not be appropriate in many contexts. There are other ways to optimize how clients are tracked to facilitate continuity of care. We are developing and rolling out automated processes to remove duplication of client records in current information systems; facilitating the development non-biometric unique patient IDs across healthcare records; supporting unidirectional and bidirectional data exchange across information systems; and promoting improved data quality through digital data checks or data review forums to discuss data and flag outliers. I think that in many contexts, these approaches may be just what is needed to improve patient outcomes through better tracking and retaining of clients.

Digital tools have an increasingly important role in supporting the HIV community to end the AIDS epidemic. Working on the Data.FI project on approaches that will enable better care inspires me every day. I especially value the collaboration with colleagues at the country level as we identify ways forward that make sense in their context and will contribute to stronger health systems.