Over the last decade, as donors and implementing partners provided support to Vietnam to monitor and combat its HIV epidemic, multiple software systems were introduced to collect data on HIV test results and treatment; this led to patient data being recorded and stored across multiple data systems.

These systems were neither developed for nationwide rollout nor did they follow the national and international data standards. With the limited connection between those data systems, there was nowhere for government and health officials to go to get a complete, nationwide understanding of the HIV epidemic.

This problem was further compounded by there often being duplicative and inaccurate data in the individual systems, making it especially difficult to get an accurate understanding of the number of HIV cases and how HIV was spreading in the country. Further, there was no information system with data analysis and visualization features to support easy interpretation and use of data.

With funding and technical support from the United States Centers for Disease Control and Prevention (CDC) Technical Assistance Platform, PATH supported the Ministry of Health’s Vietnam Administration for HIV/AIDS Control (VAAC) to improve the national HIV case surveillance system.

The current version—HIV INFO 4.0—has been upgraded from HIV INFO 3.1 to include modifications and enhancements that meet evolving business requirements and needed technological advancements.

This upgrade supports the integration of data from various sources across the country into a centralized database. Users now have access to swift and accurate verification of individuals infected with HIV because disease data reports are automatically aggregated and delivered on time. Data visualizations provided by HIV INFO 4.0 offer a rapid understanding of the HIV epidemic situation, including prevention and treatment program results.

HIV INFO 4.0 was introduced in April 2022, and system users range from the national to the community level, including the VAAC, regional institutes, district health centers, commune health stations, and community-based organizations. Using a decentralized approach, all users received training and technical assistance within their provinces to support their usage of HIV INFO 4.0.

For the first time in Vietnam, complete HIV patient data—including the time of diagnosis, treatment visits, and other health events—are available and being used across the health system, facilitating better program planning, and effectiveness toward ending the HIV/AIDS epidemic.

PATH has a broad data analytics and data management background, a rich legacy of advancing health technologies, and decades of experience in preventing, diagnosing, and treating HIV. PATH’s work in HIV spans more than three decades across 32 countries since 1987.

PATH has been working in Vietnam since 1980, partnering with government leaders, communities, and local changemakers to develop sustainable systems for tackling the country’s priority health challenges. PATH has been recognized as a leading and trusted technical assistant organization in HIV/AIDS control and digital health innovation in Vietnam.

For years, PATH also has worked closely with government agencies, health care providers, laboratories, and communities in Vietnam to strengthen the national health system through a coordinated, data-driven approach.

PATH’s approach to developing data systems is rooted in establishing respectful partnerships with government and health officials. We ensure from the beginning that the development process is country-led and uses human-centered design methods to ensure the creation of a system that is appropriate for the context and the intended users.

In addition, PATH’s digital technology experts help identify the necessary technical requirements and processes that will ensure the continuous functioning, optimization, and data security of health information systems. Below we describe two advanced technology approaches that were highlighted by the process of developing HIV INFO 4.0: the establishment of a standards-based, interoperable system architecture and the use of automated retrieval to clean and prepare merged data for analysis.

Using OpenHIE to develop the system architecture

In order to establish HIV INFO 4.0 as the national system for aggregating and analyzing HIV case information, a plan was needed for the underlying technology infrastructure. This system architecture was developed based on the open-source Health Information Exchange (OpenHIE) framework and tailored to the Vietnamese context.

OpenHIE provides a model that can be used as a foundation to support complex, interoperable systems for information exchange. It ensures that health information from various external systems can be gathered into a single, unified system. The PATH team also applied HL7® International’s Fast Healthcare Interoperability Resources (FHIR®) standards, which are international standards for establishing a secure pathway for various data systems to communicate with each other and exchange data seamlessly.

HIV INFO 4.0 was then built using the open-source tool OpenSearch, a software suite for searching, visualizing, and analyzing data. OpenSearch consists of data storage, a search engine, and a user interface that allows users to visualize data and run/scale OpenSearch clusters (OpenSearch Dashboards).

The final system architecture includes six components:

1. External data sources—HIV testing and treatment data from outpatient clinics and hospitals feed into the system.
2. Integration—The open-source Health Information Mediator (OpenHIM) is used for integrating nationwide data sources.
3. Case reporting and management—Case data can be reported directly into the system nationwide.
4. HIV treatment data storage—The system provides secure storage for HIV treatment data from various data sources.
5. Analytics—OpenSearch is used to merge data for case surveillance analytics.
6. Dashboard and data mining—The merged dataset is used to create dashboards and reports using OpenSearch Dashboards.

Applying patient matching techniques to improve the quality of HIV data

A key challenge in ensuring the quality of data in the integrated system is data duplication. HIV patients may be registered in different health facilities, leading to duplicate health records.

The second issue is inconsistent data formats in these health records, as different health facilities may record personal information in different formats including birthdates and addresses. This complicates the process of comparing and consolidating data.

In addition, during the process of recording medical information, data entry errors and mistakes can occur, leaving health records incomplete or with inaccurate information.

To accurately count cases and track disease progression, surveillance programs require a method to detect duplicate health records and group an individual patient’s various records. Without patient matching and deduplication, particularly in the absence of unique national identifiers, integrated data systems can over estimate the number of disease cases, skewing critical epidemic data.

In practice, HIV INFO 4.0 successfully implemented deterministic algorithms to support the process of identifying duplicate records. This method helped system users to quickly identify records that are likely from the same individual and to accurately analyze system data. Therefore, deterministic algorithms are proving to be a promising method for data cleaning and integration in the Vietnamese context.

After completing system upgrades, PATH supported the VAAC in planning for the phased rollout and rapid scale-up of HIV INFO 4.0. Between March and June 2022, PATH conducted training for HIV INFO 4.0 across all provinces. The PATH team collected feedback from training participants and saw overall positive feedback, highlighting it as a clear, easy-to-use, and informative system.

By December 2022, HIV INFO 4.0 had been deployed in 546 out of 705 districts (77%), 4,716 of the 10,599 communes (45%), 658 of the 1,125 HIV testing and counseling sites (58%), and 134 of the 208 confirmatory labs (65%). With the rapid progress made, the VAAC listed HIV INFO 4.0 as one of its top 10 achievements of the year for 2022.

By December 2023, the system was operational in 100% of Vietnam’s provinces and districts, 85% of communes, 95% of testing and counseling sites, and 87% of confirmatory labs. There are more than 370,000 HIV case records in the system.

Going forward, the PATH team will continue to work with the VAAC, the CDC, and other project stakeholders to further expand HIV INFO 4.0—this includes connecting it to other existing systems and databases, assuring data quality, verifying potential health records that need to be linked, evaluating the system’s security, and enhancing its technologies, user interface, and user experience based on user requirements.