Table 1 Characteristics of the management of test results before NETLAB and with NETLAB

Efficiency

(e #1)

The records showed an average of 6,516 CD4 counts and 6,744 viral loads processed per year between 2004 and 2006.

The NETLAB system recorded, processed and registered 16,053 CD4 counts and 16,047 viral loads in 2007.

After the test was completed, paper-based laboratory results took an average of 60 days [range 15-120 days] to reach a group of selected users.

After the test is completed, Internet-based results are available immediately to the appropriate users. The average time to publication of results is 1 day [range 1-22 days].

Enhanced quality

(e #2)

No system existed to track samples throughout the country.

NETLAB uses the same barcode system throughout the country, minimizing human error and enabling sample tracking.

No system existed to check the quality of samples and verify information or request new samples.

NETLAB checks all samples for quality and readability, and requests additional information and/or new samples from health providers and establishments through email messages.

The laboratory results were manually entered and had no function to detect duplication or omission of patient data.

NETLAB automatically detects the duplication or omission of patient data and verifies the information through automatic email messages.

There was no mechanism to verify the test results entered in the database.

The laboratory coordinator verifies all test results before allowing their publication in the NETLAB system.

Evidence-based

(e #3)

No periodic evaluation of the system was carried out.

The "traffic light" system provides real-time monitoring of the system.

Additionally, repeated evaluations of NETLAB have been carried out since its inception.

Enable information exchange (e #4) and Extend healthcare beyond its traditional boundaries (e #9)

Laboratory results were not accessible for PLHIV and only for a small number of users.

Laboratory results can be accessed by PLHIV or by health providers, depending on the individual's user profile.

Results were available in paper format and sent through regular mail, which could take months to become available.

Results are available on the Internet almost in real time as soon they are ready. They're presented in a user-friendly format and include current and historical test results in text and graphic format.

There was a limited number of users (66 total).

NETLAB has a high number of users (2,037 total), which continues increasing.

Empowerment of clients (e #5), Encouragement of new relationship between providers and clients (e #6), and Equity (e #8)

Education of clients and providers

(e #7)

There was no access for people living with HIV and limited access for health providers.

There are currently 944 people living with HIV and 1,093 health providers who have access to NETLAB.

There was no mechanism for client feedback.

There is a user feedback function on the NETLAB page. All comments are responded to within 24 hours.

No HIV-centered education was provided.

User-friendly, user-group specific information is provided to NETLAB users and others who access the webpage.

Ethics

(e #10)

Results in the database were only available to laboratory personnel. In order to have legal value, all results needed to be printed and signed and then sent to the health establishments, which could take months.

Results are available at any time on the Internet and confidentiality is maintained through a system of usernames and passwords.

The digital certificate means that all NETLAB results have legal value whether they are viewed, downloaded or printed.