Ethiopia Base Implementation Guide, published by MOH Ethiopia. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/MoH-Ethiopia/ETBase/ and changes regularly. See the Directory of published versions

User Scenarios

For HIV Diagnosis, ART Initiation, and Follow-up Care in an Ethiopian Health Center

Context

This scenario describes the care of an adult patient receiving HIV services at a public health center in Ethiopia, following national HIV guidelines. The scenario reflects typical workflows supported by digital health systems deployed by the Ministry of Health.

Actors

• Patient: Adult Ethiopian citizen
• Health Care Provider: Nurse or Health Officer trained in HIV services
• Laboratory: Facility or referral lab
• Pharmacy Unit
• He alth Facility: Public Health Center
• Digital Systems: -EMR -Laboratory Information System (LIS) -Pharmacy System -National Health Information Exchange (FHIR-based)

Scenario Narrative

** 1.Patient Registration ** A 32-year-old woman named Aster Tesfaye visits Bishoftu Health Center for general outpatient services. At registration:

• The registrar creates a Patient record in the EMR.
• Demographic details such as name, date of birth, sex, marital status, education level, and address (Region, Zone, Woreda, Kebele) are captured.
• Her husband is recorded as a RelatedPerson for contact and support purposes.

📌 FHIR Resources - Patient (EthPatient profile) - RelatedPerson - Organization (Health Facility)

** 2.Clinical Encounter ** Aster is seen by a nurse during an outpatient visit.

• An Encounter is created representing the visit.
• The nurse records presenting complaints and performs routine assessments.

📌 FHIR Resources - Encounter - Practitioner - CareTeam (Nurse + Clinician)

** 3.HIV Testing **

Based on national guidelines, the nurse recommends HIV testing.

• A ServiceRequest is created for an HIV rapid test.
• The laboratory performs the test.
• The result is recorded as an Observation.

📌 FHIR Resources - ServiceRequest (HIV test) - Observation (HIV test result)

** 4 HIV Diagnosis ** The test result is HIV positive.

• The clinician records HIV as a confirmed diagnosis.
• An active Condition resource is created for HIV infection.

📌 FHIR Resources - Condition (HIV)

** 5 Baseline Investigations ** Baseline investigations are ordered:

• CD4 count
• Viral load
• Pregnancy status Each test:
• Is requested using ServiceRequest
• Results are returned as Observations
• Grouped in a DiagnosticReport

📌 FHIR Resources - ServiceRequest - Observation - DiagnosticReport

** 6 ART Initiation ** The clinician counsels Aster and initiates ART according to Ethiopian national guidelines.

• A MedicationRequest is created for a first-line ART regimen.
• The pharmacy dispenses the medication.
• The first dose is recorded as MedicationAdministration.

📌 FHIR Resources - Medication - MedicationRequest - MedicationAdministration

** 7 Care Planning and Goals ** A personalized care plan is established.

• A CarePlan is created outlining:
  • ART adherence
  • Scheduled viral load monitoring
  • Counseling services
• A Goal is defined:
  • “Achieve viral suppression within 6 months”

📌 FHIR Resources - CarePlan - Goal

** 8 Follow-up Appointment ** A follow-up visit is scheduled after one month.

• An Appointment is created.
• The patient is informed of her next visit date.

📌 FHIR Resources - Appointment

** 9 Ongoing Follow-up and Monitoring ** At subsequent visits:

• Viral load and adherence are monitored using Observations
• ART refills are managed through MedicationRequest and MedicationAdministration
• CarePlan is reviewed and updated

Summary of FHIR Resource Flow md Patient ├── RelatedPerson
├── Encounter
│ ├── Observation (HIV Test)
│ ├── Condition (HIV)
│ ├── ServiceRequest (Labs)
│ ├── DiagnosticReport
│ ├── MedicationRequest
│ ├── MedicationAdministration
│ ├── CarePlan
│ │ └── Goal
│ └── Appointment
└── CareTeam