Yi-Hsuan Lin, HIV Case Manager, Center for Infection Control

With the advancement of highly active antiretroviral therapy (HARRT), HIV has increasingly become a manageable chronic disease. Case management for people living with HIV (PLWH) focuses on delivering comprehensive and continuous care, supporting patients in maintaining regular medical visits, adhering to treatment, staying healthy, and preventing further transmission.

At National Cheng Kung University Hospital (NCKUH), the Interdisciplinary Case Management System integrates medical records from multiple sources. It consolidates case management data across specialties, enabling the care team to access a holistic and up-to-date picture of each patient’s health. To further support HIV care, the system includes a dedicated HIV module designed with role-based access control to ensure the highest level of privacy protection for PLWH. HIV case managers can efficiently perform clinical management and follow-ups through several key digital features:

• HIV Case List: The system automatically generates a list of patients based on follow-up schedules, key tracking information, and lab data. (Figure 1)
• Smart Dashboard: The “Integrated Care Dashboard” offers a high-level view of each patient’s medical status, including records for other chronic diseases and high-risk alerts. The “HIV Case Management Dashboard” focuses on HIV-specific information, such as lab results and prescription refill records. (Figure 2)

By digitalizing HIV case management, the system significantly reduces the time spent on manual data retrieval and record-keeping, allowing case managers to concentrate on delivering physical and emotional support. This improves the quality of care for PLWH and enhances the integration and efficiency of healthcare resource use.

Figure 1. HIV Case List