A partnership between the Kiribati MHMS and Hepatitis B Free is revolutionising the management of vulnerable patients in one of the world’s most unique countries. Hepatitis B is a serious but manageable condition that requires long-term, complex care. If untreated, the disease can lead to liver failure and death – but with expert, long-term treatment, patients can be managed, transmission can be reduced and many can live symptom-free. In many patients, complete recovery is also possible. Long-term management of patients in Kiribati is extremely difficult however – the islands are widely dispersed across thousands of kilometres of ocean and longitudinal patient care remains challenging. Information is often captured only on paper, patients move between health facilities, and communications are often limited. A new partnership is addressing this problem, enabled by the use of Tamanu EMR.

The Hepatitis B Clinic at Tungaru Central Hospital (TCH) in Kiribati have become the first in the world to implement Tamanu’s new Program Registry module. Configured for the management of Hep B, the module went live at the HOPE Clinic on the 13^th March, following training of 25 users from all across Kiribati. The clinic is registering patients in the new system, allowing them to track this patient cohort and capture fit-for-purpose data across the continuum of care.

The training of users from all over Kiribati was conducted in early March, 2024.

The program has initially launched at TCH’s Hepatitis B clinic but the future aim is for screening and management of Hep B patients to be conducted outside of TCH at the 14 clinics in South Tarawa. The early signs are good – 75 patients were registered in the first 3 days of use and staff are positive about the innovation.

“Tamanu will be a revelation for digital healthcare in Kiribati. The intention for its introduction to the Hepatitis Overview Programme to trEat (HOPE) was to help clean and centralise patient records. However, it has the potential to ultimately simplify care, streamline data and become an essential disease surveillance tool.”

Dr Thomas Russell (Internal Medicine Specialist – Kiribati MHMS/ Hepatitis B Free)

Ultimately, the aim is to improve Hepatitis B screening and management across the entire country – Kiribati has one of the highest prevalence rates of the disease in the world. The national prevalence rate of Hep B is approximately 15%, with pockets having greater than 20%. Kiribati also has one of the highest prevalence rates of co-infection of Hepatitis B and D (almost 50% co-infection).

There has been strong uptake of the tool by staff, who are all positive about the new project.

Tamanu is used in six PICTs for the management of patient records from birth to death – this innovative project is the first to use Tamanu’s new Program Registry module, a flexible tool which can be used to securely and confidentially manage patient cohorts across any vertical program, research project or area, such as HIV, high risk NCD patients, or victims of gender-based violence.

Tamanu is a free and open-source EMR supported by DFAT’s Global Health Division

The Kiribati MHMS, Hepatitis B Free and BES are grateful to DFAT’s Global Health Division for supporting the development of this new module, which is expected to be rolled out soon for other programs in Samoa and Nauru. The module is free and open-source, coming as an embedded module in Tamanu’s EMR. BES’ work in Kiribati is led by Project Manager Shakti Gounder and IT Support Officer Rewi Tamango.