HIV/AIDS DIAGNOSTIC SYSTEM

BY

CHIICHII, ORSEER HOSEA

UE/18714/10

08033515694

A PROJECT WORK SUBMITTED TO THE

DEPARTMENT OF MATHEMATICS/STATISTICS/COMPUTER

SCIENCE,

UNIVERSITY OF AGRICULTURE, MAKURDI

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

THE AWARD OF A BACHELOR OF SCIENCE (B.Sc.)

DEGREE IN STATISTICS/COMPUTER SCIENCE

i

MAY 2014

ii

Declaration

I, CHIICHII ORSEER with registration number UE/18714/10

of the department of Mathematics/Statistics/Computer

Science, Federal university of Agriculture, Makurdi in Benue

State of Nigeria hereby declare that the dissertation

entitled HIV/AIDS Diagnostic System (HADS) is my research

work and has not formed the basis for award of degree in any

other university or higher institution of learning.

NAME OF STUDENT: CHIICHII ORSEER HOSEA

REGISTRATION NUMBER: UE/18714/10

SIGNATURE OF STUDENT: ………………………………….

DATE: ………………………………….

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iv

Certification

This is to certify that the dissertation work entitled

HIV/AIDS Diagnostic System (HADS) is a bonafide research

work carried out by CHIICHII, ORSEER HOSEA with registration

number UE/18714/10 in the department of

mathematics/statistics/computer science, federal university

of agriculture, Makurdi, Benue state as part of the

requirements for the award of Bachelor of Science degree in

statistics/computer science

Title of Project: HIV/AIDS Diagnostic System

Mr. M.A AGANA ………………………

…….…………….. Project Supervisor

Signature Date

Dr. T ABOIYAR ….………………………

…….…………….. Head of Department

Signature Date

v

Prof M.A Tiamiyu …………………………

…………..……….. External Examiner

Signature Date

Dedication

I sincerely dedicate this work to God almighty who has

not only created and kept me alive till this day, but has

also given me the wisdom throughout my educational pursuit.

I also dedicate this research work to my guardian angels

Late M.W.O J.N Chiichii and Late Mrs N. Chiichii for

overseeing me right from my birth and not forsaking me even

in their absence as their inspiration keeps me going.

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Acknowledgement

With a joyful heart and gratitude to God I lack words

and space to appreciate all the contributors to the success

of not just this research work but my academic carrier,

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however I wish to mention but a few. My humble appreciation

goes to my family who even in the stormy weather of our

life’s have relentlessly provided for me in every way they

could until this day, I wish to say a big thank you to them

and hope God in his infinite mercy guide them all through. I

appreciate the efforts of all my close friends who have

pushed me and stayed beside me in my trial times, I also wish

to identify in person the likes of Mr Ekoja Peter and Miss

Akpa Nancy Suleyol.

To my Supervisors, Mr Agana M.A and Mr Onoja G.U, I lack

the right words to use for your competency, your joint effort

in monitoring my research work have been of great help to me

as I now derive joy performing research work despite my

previous hatred for research. To all the staff of the

department of mathematics/statistics/computer science federal

university of agriculture Makurdi, Benue state, I say keep

the flag flying, and to all those who I could not mention but

have however contributed to my academic pursuit, may God

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bless you all. I also cannot hide my sincere appreciation to

all the staff and volunteers of Positive Health Media

Initiative (PHMI), staffers of Aids Health Foundation (AHF)

and staffers of Centre for Integrated Health Program (CIHP),

my research work would have not been possible if not from the

knowledge generated from your respective organizations. At

this point, I acknowledge my team of programmers Mr Orapine

hycienth and Chiekieze Kelvin for their joint effort as a

team which made this project a success.

AbstractExpert system is a computer system that emulates the decision making ability of ahuman expert. That is, it acts in all respects like a human expert. It uses humanknowledge to solve problems that would require human intelligence. The expertsystem represents expertise knowledge as data or rules within the computer. Theserules and data can be called upon when needed to solve problems. HIV/AIDS is aknotty viral disease that is very common in the modern world. HIV/AIDS is a seriousdisease that affects the white blood cells directly. If left unchecked at the earlystage, it results to serious complications including death. Though the diseasecannot possibly be cured completely for the time being, it can be well managed orcontrolled and the patient can live a very healthy life. Early HIV/AIDS diagnosisplays a crucial role in HIV/AIDS control, and can prevent further medicalcomplications. This study presents the design and development of a medicalexpert system for HIV/AIDS disease and its support diagnosis, gives informationabout complications and acts as HIV/AIDS diagnosis trainer. It uses rule basedapproach to collect data and forward chaining inference technique. This systemprovides a user interactive, menu driven environment. Symptoms and risk factors

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associated with HIV/AIDS are taken as the basis of this study. In case of diagnosis,the system asks a bunch of questions about the symptoms and risk factorsthrough the expert system user to the person diagnosed, where the person gives ayes or no answer to perform risk analysis and a check on possible opportunisticinfections associated with the disease. According to the answers, the system givespercentage possibility and advice for laboratory test where final test result is thengiven out through a colour matching of the test result with some results availablein the deigned expert system. Persons diagnosed to be negative are then advisedthrough the expert system user on how to stay negative, while the personsdiagnosed positive of the virus are enrolled for collection of drugs so as to stayalive and healthy. The system is drawn up with PHP/MYSQL expert system buildingtool in Windows environment where all the knowledge are embedded for effectivedecision.

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TABLE OF CONTENTS

Declaration……………………………………………………………………….ii

Certification……………………………………………………………….……..iii

Dedication………………………………………………………………………..iv

Acknowledgement……………………………..…………………………………v

Abstract……………………………………………………………………..……vi

Table of Contents……………………………………………………………......vii

CHAPTER ONE: INTRODUCTION…………….…………………………........1

1.1 BACKGROUND OF THE STUDY…………………..……………………11.2 STATEMENT OF THE PROBLEM……………………………………….41.3 JUSTIFICATION OF THE STUDY………………….……………………61.4 AIMS AND OBJECTIVES OF THE STUDY……..……………………….71.5 SCOPE OF THE STUDY……………..……………………………………81.6 DEFINITIONS OF TERMS……………………………………………….10

CHAPTER TWO: LITERATURE REVIEW…………………………………….15

2.1 INTELLIGENT SYSTEM EVOLUTION……………………………........15

2.2 EXPERT SYSTEM………………………………………………...............17

2.3 EXPERT SYTEM COMPONENT……………………………………...…23

2.4 EXPERT SYSTEM IN MEDICAL DIAGNOSIS……………………...….30

2.5 MEDICAL DIAGNOSIS SYSTEM……………………...………………..31

2.6 HIV/AIDS…………………………………………………………………33

2.7 DIAGNOSING HIV/AIDS……………………………………………..…35

2.8 VOLUNTARY COUNSELLING AND TESTING……………………….41

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2.9 DRUG PRESCRIPTION AND DISPENSAL…………………………….50

CHAPTER THREE: RESEARCH METHODOLOGY…………………………52

3.1 SYSTEM STUDY AND INVESTIGATION………………………….….52

3.2 DORMAIN AND KNOWLEDGE ACQUISITION…………………..…..56

3.3 KNOWLEDGE REPRESENTATION…………………………………….56

3.4 SYSTEM DEVELOPMENT AND SPECIFICATION……………………64

3.5 USER REQUIREMENTS……………………………………………....…65

3.6 SYSTEM DESIGN AND DEVELOPMENT PROCESS………………….65

3.7 DATABASE……………………………………………………………….73

3.8 DATA SECURITY………………………………………………………...74

CHAPTER FOUR: RESULTS, DISCUSSION AND CONCLUSION…………..75

4.1 DOCUMENTATION……………………………………………………...75

4.2 HARDWARE REQUIREMENTS…………………………………………75

4.3 INSTALLATION GUIDE…………………………………………………76

4.4 SYSTEM TESTING……………………………………………………….77

4.5 TRAINING…………………………………………………………………77

4.6 SYSTEM MAINTENANCE………………………………………………77

4.7 SYSTEM IMPLEMENTATION…………………………………………..78

4.8 SYSTEM SPECIFICATIONS……………………………………………..85

4.9 RESULTS AND DISCUSSION…………………………………………...90

4.10CONCLUSION……………………………………………………………90

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4.11RECOMMENDATIONS AND SUGGESTIONS…………………………91

REFERNCES…………………………………………………………………….93

APPENDIX:

APPEMDIX A: LIST OF TABLES AND FIGURES

LIST OF TABLES

APPENDIX:

APPENDIX A:

LIST OF TABLES AND FIGURES:

LIST OF TABLES

Table 4.0: HADS Database………….…………………………..………………....

Table 4.1: ADMIN Table.................................86

Table 4.2: STAFFS Table………………….……...…………………………….....87

Table 4.3: PATIENTS Table………………….…...………………………………87

Table 4.4: APPOINTMENT Table………………………………………………...87

Table 4.5: Detailed Module specification

Table…………………………………...89

LIST OF FIGURES

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Figure 2.1: Basic components of an expert system

……………………………….21

Figure 2.2: Expert system components and human

interface……………………..23

Figure 2.3: HIV positive, Negative and Invalid test result

with determine test kit..31

Figure 2.4:HIV positive, Negative and Invalid test result

with uni-gold test kit….32

Figure 2.5:HIV positive, Negative and Invalid test result

with stat-pak test kit…..33

Figure 2.6: Serial algorithm for HIV testing……………….

……………………...39

Figure 2.7: parallel algorithm for HIV testing……………………………….

……40

Figure 3.1:Hierachy of expert system

development……………………………….44

Figure 3.2:Modules of the proposed expert system for

HIV/AIDS diagnosis……..45

Figure 3.3:Domain and knowledge acquisition……………………………………48

Figure 3.4: System development procedure……………………………………….55

Figure 3.5: System flow chart……………………………………………………..58

Figure 3.6: Procedural flow of the system.. ……………..

………………………..59

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Figure 3.7: Procedural flow of the system.. ………………………..

……………..60

Figure 3.8:SQL Database management system as used in the

proposed system.…61

Figure 3.9:SQL Database management system as used in the

proposed system….61

Figure 4.1: Administrators page….…………………………….…..……………...66

Figure 4.2: Index (Home) page..…………………....…………………..…………68

Figure 4.3: Analysis page…………….………….....…….………………………..69

Figure 4.4: Risk analysis page………………..…….……………………………..69

Figure 4.5:Determine test page…….……….....………..…………………………70

Figure 4.6: Uni-Gold test page………..…..………….……………………………70

Figure 4.7: Stat-pak page…………….…………..….....…..………………………71

Figure 4.8:Positive test result page…………..….………...

……………………….71

Figure 4.9:Negative test result page…….………………..

………………………...72

Figure 4.10: Client Enrolment page…………………..……………………………72

APPENDIX B:

CODES……………………………………………………………………………..95

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CHAPTER ONE: INTRODUCTION

1.1 BACKGROUND OF THE STUDY

The quality of service delivery all around the world is

continuously improved by the usage of computer-based

applications. These applications are mostly built based on

artificial intelligence which is the area of computer

science that focuses on the creation of machines that can

perform functions considered as intelligent by humans.

These functions performed by the machines are highly

sensitive and require knowledge in the domain where these

machines are designed to act as if originally, they are in

control of situations. The ability to create such machine

has intrigued humans since the advent of technology, and

today, with the introduction of computers and great

research of ages into the field of Artificial Intelligence

programming techniques, the production and design of smart

machines is becoming a reality as researchers can now build

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a system which can mimic human thought and understand human

behaviour via expert system technology (Nilsson, 1990).

An expert system is a computer application that

performs a task that would otherwise be performed by a

human expert, such tasks include but are not limited to

making financial forecast, scheduling routes for delivery

vehicles, diagnosing human illnesses, and several others.

Most expert systems are designed to take human place while

others are designed to aid humans. To design an expert

system, the domain of the knowledge field is required, so

an individual needs to be able to study how the human

expert makes decisions and translate the rules used into

terms that the computer would understand. Expert system is

an example of a symbolic paradigm being one of the two

major paradigms for developing intelligent systems in the

field of artificial intelligence

(http://www.webopedia.com/). To however get a detailed

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understanding about expert systems, a brief history of

Artificial Intelligence is unavoidably necessary.

The quest for Artificial Intelligence is as modern as

the frontiers of computer science and as old as antiquity.

The concept of thinking machine began as early as 2500BC,

when the Egyptians looked to talking statues for mystical

advice (Haack, 2004). Artificial Intelligence as both a

term and a science was coined 120 years later, after the

operational digital computer had made debut. In 1956, Allen

Newell, J.C Shaw and Herbert Simon introduced the first

Artificial Intelligent program, the Logic Theorist to find

the basic equations of logic as defined in principia

mathematica by Bertrand Russell and Alfred North Whitehead.

For one of the equations, the Logic Theorist surpassed its

inventor’s expectations by finding a new and better proof.

Suddenly a true thinking machine that knew more than its

programmers evolved and lead to the development of another

system called the General Problem Solver (G.P.S). They were

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developed to imitate human problem solving protocols

regardless of the information contained in the domain,

however, as time progressed they were said to be weak a

method as they covered weak information about their domain

of study which led to weak performance in problem solving

involving complex domains (Nilsson, 2009).

The foundation of Artificial Intelligence covers

several disciplines including but not restricted to

philosophy, mathematics, psychology, computer engineering

and linguistics. The connectionist paradigm evolved from a

model proposed on artificial neurons that mimics the

structure of human brain, the model was proposed in 1943 by

McColloch and pitts. The rise of Artificial Intelligence

continued as Feigenbaum and others at Stanford began the

heuristic programming project (HPP) to investigate other

problem domains that could benefit from the expert system

technology. By this the next major effort was in the area

of medical diagnosis, MYCIN was developed by Bruce Buchanan

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and Dr Edward Shortliffe to diagnose bacterial infection in

the blood using about 450 rules. MYCIN is the most widely

known expert system in the era of the growth of Artificial

Intelligence because of the two reasons below as coined

from (Feigenbaum and Buchanan, 1993)

I Its design was based on interviews with several

doctors that specialized in particular domains,

hence, it contains a number of heuristic rules used

in identifying certain infections by physicians.

II It lead to the later development of EMYCIN (Empty

MYCIN) which was the first expert/knowledge-based

system shell, the development time of EMYCIN was

considerably reduced as compared to MYCIN, the

researchers developed EMYCIN by taking all the

rules out of the system and leaving just an empty

shell in which other developers in other domains

can just plug in their knowledge base.

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From the dark ages also known as the birth of

Artificial Intelligence to the era of great expectations

also known as the rise of Artificial Intelligence, expert

systems have been providing pre-selected rules for decision

making within specialized domains of knowledge but are

limited by the fixed choice and by the date of the expert

opinion embodied in the decision rules. Expert systems have

been found to have profound impacts which include reducing

time of task from days to hours, minutes to seconds. The

benefits of expert system since this time include but are

however not limited to improved customer satisfaction,

improved quality of products and services, accurate and

consistent decision making. They operate in hazardous

environments where humans could be exposed to various risks;

expert systems have featured and make things easier in

various fields such as agriculture, education, manufacturing

industries, banking, medicine, and so on. In medicine,

diagnosis of patients’ complicated conditions, clinical

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laboratory identification of bacterial infectious diseases

and recommendation of treatments, surgery, emergencies,

drugs and toxicology and dentistry are some of the domains

for expert system development. Expert systems emulate the

decision making ability of human experts, they are designed

to solve complex problems by reasoning about knowledge like

an expert, and not by following the procedure of a developer

as in the case in conventional programming (Meech, 2006).

1.2 STATEMENT OF THE PROBLEM

The continuous increase in population without a

corresponding increase in medical infrastructure has

brought about drastic limitations in health care sector,

this has made it necessary to think of designing an expert

system that can assist the health sector in the diagnosis

of HIV/AIDS. The idea of this system is backed by the

following facts which show how limited human expertise is

as compared to an expert system as coined from Juhola, et al.

( 1995);

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Human experts are inconsistent: As each day goes by,

human day to day decisions are rarely consistent, this

leads to invalid decision making in the field of HIV/AIDS

diagnosis, hence the idea of building an expert system that

can work consistently and continuously is deemed necessary.

Human experts die or retire: Human experts do not live

and work forever, they tend to retire with time and others

even die leading to a reduction in workforce.

Human experts are at times deliberately biased: A

diagnostic expert might tend to be deliberately partial in

releasing the result of a test so as to hide certain

information for selfish reasons.

Human experts do not process large amount of data

quickly:The procedure of diagnosis involves a number of

steps before results are made available, handling of this

data are often not easy for the human brain, but as the

computer is capable of handling large data in micro

seconds, the thought of a diagnostic system is necessary.

xxiii

Human expertise is very scarce: It takes considerable

amount of time to understand the procedure for manual

diagnosis of HIV/AIDS since persons who specialize in such

are scarcely available, the design of this system will

counter such limitations as an easy to use manual will be

documented.

Human experts lack confidentiality: One of the

major reasons why most persons are scared of HIV/AIDS

diagnosis is the issue of non-confidentiality of test

results, with the use of a diagnostic system which shall

involve the use of the expert machine, test results will be

secured in a database.

1.3 JUSTIFICATION OF THE STUDY

The relevance of this study cannot be overemphasized as

the numerous challenges faced in the medical area of

HIV/AIDS are so obvious that most health practitioners tend

to shy away from providing services of such nature as

described by this study, this has put much work load on the

xxiv

few agencies offering such services, which are mostly non-

governmental organizations. An expert system for diagnosing

HIV/AIDS is therefore a system with enormous level of

significance that cannot be undermined, this system will be

of great benefit to not just man but also government and

health sectors. The obvious challenges faced by the

government, health sector and individual are enough to

suggest that the relevance of the system are not limited to

but include the following; Professionalism: This system

shall contain valid and well researched algorithm that

shall aid in decision making, this decision support system

shall be written on the basis of the manually collected

data and enhanced through well designed syntax to take

decisions that are seen to be from facts already

programmed, by this the system tends to be very

professional and reliable. The system is also not prone to

mistakes and can be easily updated.

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Reduced time consumption: One of the major advantages of

an expert system is speed, the system to be designed will

reduce the time consumption of record handling and enhance

efficiency as the workload will be reduced to the minimum

level.

Confidence in the system: The fact that computers do not

easily make mistakes, the diagnostic system will ensure a

quick, accurate and real time diagnosis.

Proper data collection: The expert system will use a

secured database management system to safely store

information that can be collected and made reference to when

required.

Confidentiality: The system will handle the issue of

the fear of result and status exposure, people believe that

with the already existing manual system, their results pass

through hands that they should not, with the computerized

system, anonymity and patient’s confidentiality will be

maintained.

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Ease in learning:The time used in learning the

procedure of proper diagnosis will be reduced as knowledge

of experts using the system will be documented for further

reference by those who will be coming in newly from time to

time, this will improve learning in the domain

1.4 AIMS AND OBJECTIVES OF THE STUDY

The general aim of this study is to design a knowledge

based expert system with a medical encapsulation for the

diagnosis of HIV/AIDS, the system will handle facts about

the domain of study and tend to use this known facts with

the information provided by the users to check how

corresponding it is for an effective decision making.

Furthermore, the aim of this study is also targeted at

implementing a HIV/AIDS diagnostic system having some

things in mind acting as hypothetical objectives for

comparison of the already existing system and the system

designed, these hypotheses are;

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a To design an expert system that can effectively

diagnose HIV/AIDS and handle treatment plan with

great accuracy

b To test for the effectiveness of knowledge domain

and production rule in the diagnostic system.

c To check if the confidentiality in HIV/AIDS

diagnostic system is more than using the manual

system.

d To perform a comparative analysis on HIV/AIDS

prevalence by means of risk analysis and actual

laboratory testing

1.5 SCOPE OF THE STUDY

The study covers the design of a knowledge based system

in the medical domain of HIV/AIDS diagnosis, the knowledge

based system handles symptomatic fields of relatedness to

the one understudy where patients are checked through

stepwise procedure using the following;

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- Voluntary pre-test counseling: This link

will handle risk assessment where the person under

diagnosis will be briefly introduced to factors

that transmit HIV virus and other related ailments,

they will also be taught on risk reduction methods

where general advice will be given on how to live a

medically healthy life.

- Voluntary HIV/AIDS testing: This is done using

approved HIV testing protocol which uses three

different HIV/AIDS test kits for HIV/AIDS

confirmatory test before result is given out.

- Voluntary post counseling: This link handles

emotional support and referral, in this aspect,

individuals whose test results are made available

are advised, this advice is of two distinct levels;

1: If diagnosis reads negative, the individual is

advised on how to remain negative and healthy, this

xxix

is done based on what to do and not to do so as to

avoid contacting the virus.

2: If diagnosis reads positive, emotional talks

are delivered to show the patients that positive

test result does not mean the end as people living

with the HIV/AIDS virus can still live a normal and

healthy life like everyone else, further tests are

then carried on for drug placement and dispensing.

All the above are embedded into the knowledge base

of the expert system so that it can work in aspects that are

best fitting, based on information provided, the computer is

however viewed as a dummy that can do nothing on its own but

strictly based on information available to it, by this,

users are advised to be honest since it has to do with

life., this will enable their various queries of the system

to provide valid result.

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1.6 DEFINITIONS OF TERMS

Artificial Intelligence (AI): The phrase “AI” can be defined as

the simulation of human intelligence on a machine, so as to

make the machine efficient to identify and use the right

piece of “Knowledge” at a given step of solving a problem.

(Konar, 2000)

Expert Systems (ES): This is a type of computer

application that makes decision or solves problems in a

particular field such as finance and medicine by using

knowledge and analytical rules defined by domain experts

(Noran, 2000).

Decision Support System (DSS): This refers to an

interactive computerized system that gathers and presents

data from a wide range of sources, they are systems and sub-

systems that assist people in decision making based on data

collected from a wide range of sources (Marek J. Druzdzel

and Roger R. Flynn, 2002).

xxxi

Intelligence: This is a term for referring to general

mental capability to reason, solve problems, think

abstractly, learn and understand to make decisions

(Microsoft Encarta, 2009).

Fact: This is a concept in philosophy that treats both

the meaning of the word true and the criteria by which we

judge the truth or falsity in spoken and written statements

(Microsoft Encarta, 2009)

Domain: The term, domain, refers to a particular

area of study, it is also used to describe the scope of a

subject and an area of activity over which somebody has

influence (Noran, 2000).

Knowledge: This is a theoretical or practical

understanding of a subject or domain, those who posses

knowledge are called experts, a domain expert is one who has

deep knowledge of both facts and rules and strong practical

experience in a particular domain (Noran, 2000).

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Domain Knowledge: This is that knowledge which is

specific to a study area and not general or common sense

knowledge (Noran, 2000).

Heuristic Knowledge: These are judgmental knowledge that

underline expertise, they are usually implicit and are not

necessarily being explicit even to the expert.

Knowledge Base: This is the part of a program in which

rules and other methods of representations are used to

store domain knowledge (Noran, 2000).

Inference Mechanism: This provides the reasoning

ability that enables the expert system to form conclusions

(Noran, 2000).

HIV: This is an Acronym for Human Immunodeficiency

Virus, infectious agent that causes acquired

immunodeficiency syndrome (AIDS), a disease that leaves a

person vulnerable to life-threatening infections (Microsoft

Encarta, 2009).

xxxiii

Counseling: Advice or guidance, especially as provided

by a professional in a given field (Microsoft Encarta,

2009).

Pre test counseling: This provides an opportunity for

clients to explore their risk of HIV, to learn about the

strategies for avoiding HIV, and help clients decide whether

to take the HIV test (www.patient.co.uk/health/hiv-and-

aids).

Counselors: They are persons who have received special

training in client centered HIV counseling. They do not only

provide information, they also help the client make an

informed choice about HIV testing, adoption of safe

behavioral practices in order to reduce and minimize HIV

transmission and facilitate coping with the psychosocial

impact of a positive HIV test result

(www.patient.co.uk/health/hiv-and-aids).

Voluntary: It is a self decision that is not based on

force from any one, the decision to pursue HIV testing must

xxxiv

be made by the client after counseling (Microsoft Encarta,

2009).

Window period: The window period is described as the time

it takes for a person who has been infected to test positive

for HIV antibodies (www.patient.co.uk/health/hiv-and-aids).

Adherence: Taking medications exactly as prescribed.

Poor adherence to HIV treatment increases risk for

developing drug resistant (www.patient.co.uk/health/hiv-and-

aids).

CD4 T-cells: CD4 T-cells also known as helper T-cells

acts as a co-coordinator of the immune response, they are

unfortunately the main targets of the HIV. HIV destroys

infected CD4 T-cells leading to an overall weakening of the

immune system (www.who.int/).

Cluster of Differentiation (CD4) Count: This is also known as

CD4 cell count or CD4 Lymphocyte count. It is a laboratory

test that measures the number of CD4 cells in a sample of

blood (www.who.int/)

xxxv

Testing: This is a laboratory procedure for detecting

ailments, in HIV/AIDS diagnosis, it is a way of detecting

antibodies in the serum or plasma, and they include tests

like the Elisa test and the rapid HIV tests. (Microsoft

Encarta, 2009)

Baseline test: Base line testing includes CD4 count,

viral load and resistant testing, the results are used to

guide HIV treatment choices and monitor effectiveness of

Anti-Retroviral Therapy (ART). Baseline is an initial

measurement used as the basis for future comparison

(www.who.int/).

Confirmatory test: A specific test designed to

confirm the result of an earlier test, it is an important

test for eliminating false positive result where a negative

sample will tend to read positive (www.who.int/).

Risk reduction: The goal of HIV counseling is to eliminate

risk, it is discovered that this can be best achieved

xxxvi

through small steps for incremental behavioral changes that

bring a reduction in risk of infection (www.who.int/).

Referral: The act or process of directing somebody or

something to somebody else, especially of sending a patient

to consult a medical specialist (Microsoft Encarta, 2009).

Condom: a close-fitting rubber covering worn by a man

over the penis during sexual intercourse to prevent

pregnancy or the spread of sexually transmitted diseases

(Microsoft Encarta, 2009).

Opportunistic infections: they are infections that take

advantage of a weakened immune system; they include

bacterial infections, fungal infections, pneumonia e.t.c

(Cichocki, 2009).

World Health Organization (WHO): Agency of the United

Nations that organizes and funds health-care programs in

nearly every country in the world. WHO was established in

1948 (Microsoft Encarta, 2009).

xxxvii

UNAIDS: UNAIDS, is the Joint United Nations Program on

HIV/AIDS, it is an initiative partnership that leads and

inspires the world in achieving universal access to HIV

prevention, treatment, care and support (www.unaids.org/).

Antiretroviral Therapy (ART): This is treatment of people

infected with Human Immunodeficiency Virus (HIV) using anti-

HIV drugs. The standard treatment consists of a combination

of at least three drugs (often called Highly Active

Antiretroviral Therapy (HAART) that suppresses HIV

replication. ART has the potential both to reduce mortality

and morbidity rates among HIV-infected people, and to

improve their quality of life( www.who.int/).

xxxviii

CHAPTER TWO: LITERATURE REVIEW

2.1 INTELLIGENT SYSTEM EVOLUTION

As the attributes of personal computing hardware

(speed, memory, storage capacity, and resolution) have

doubled since the 1980s, our society has reached a point

where no serious performance limitations exist for

"intelligent methods" and the computational complexities are

now embedded within or subsumed beneath the Human-Machine

Interface. As a result, these approaches can be applied to

study and solve extremely complex and intricate problems

beyond the ability of the human mind to handle in a time

frame appropriate for process control. Process control has

traditionally tried to maintain a system at a set-point for

as much time as possible in response to upsets or

disturbances in load variables. Nowadays, the set-points

themselves have become disturbances with updates occurring

at increasing frequencies as communication and measurement

xxxix

cycles have sped up to bandwidths previously unimaginable

(Meech, 2006).

The definition of intelligent systems is a difficult

problem and is subject to a great deal of debate. From the

perspective of computation, the intelligence of a system can

be characterized by its flexibility, adaptability, memory,

learning, temporal dynamics, reasoning, and the ability to

manage uncertain and imprecise information

Expert systems technology was originally invented in

the AI laboratories in an attempt to apply the state-space

search, knowledge representation, and inference techniques

developed in early research to some "real-world problems."

The hope of the inventors was to demonstrate, especially to

those always-fickle funding agencies, that AI was possible

and practical and that thinking about thinking machines was

scientifically sound. They succeeded beyond their wildest

dreams. Expert systems have evolved as a highly marketable

offshoot of research in the subfield of computer science

xl

called artificial intelligence (AI). Since its unofficial

inception at the Dartmouth Summer Research Project on

Artificial Intelligence in 1956 (attended by well known

personalities such as Marvin Minsky, Allen Newell, Herbert

Simon, Claude Shannon and John McCarthy), AI has had as one

of its primary goals the creation of ‘thinking machines.’

While this ambitious goal has not yet been attained to

anyone’s acknowledgment, there have been substantial

advances in what we now know about human thinking and

learning. Along the way, research in AI from the late 1950s

to the 1970s at Stanford, MIT and Carnegie-Mellon

Universities provided some very powerful techniques for

codifying human experience and knowledge so that computers

can store it and apply it to solve practical problems. The

mid-1970s saw the emergence of the first expert systems for

applications (Avron and Feigenbaum, 1981).

According to Barr and Feigenbaum (1981), the mid-1970s

saw the emergence of the first expert systems for

xli

applications such as medical diagnosis (Mycin, by

Shortliffe), chemical data analysis (Dendral, by Lindsay and

others), and mineral exploration (Prospector, by Duda and

others). Furthermore, Turing is seen to have made a

significant and characteristic provocative debate in

artificial intelligence. Turing (1950) in his Turing test

defined intelligent behaviour as the ability of human level

performance in all cognitive tasks. The issue of acting

humans springs up when intelligent systems interact with

people. For example, an expert system explaining how it came

to a diagnosis or a natural language processing system has a

dialogue with a user. He later concluded that, for any

complex decision to be made, or problem to be solved,

experts in specific areas have particular knowledge,

specific alternatives, the chances of success, and also the

benefits or costs that may be inquired. Based on these

earlier concepts, intelligent systems were developed and

xlii

have since been very useful to supervisors and managers with

situational assessment and long time planning.

2.2 EXPERT SYSTEM

Expert systems are computer programs that can perform

some tasks which typically require the capabilities of a

skilled human. These tasks are usually of a decision-making

nature rather than physical actions. Examples of such tasks

are managing water levels in a wetland, forecasting weather

conditions, assessing environmental impacts, and selecting

mitigation measures for environmental hazards. As computer

programs that contain human expertise, they are referred to

variously by the labels expert systems, knowledge-based

systems, inference systems or rule-based systems (Abraham,

2005 ).

In the late 1960's to early 1970's, expert systems

began to emerge as a branch of Artificial Intelligence. The

intellectual roots of expert systems can be found in the

ambitions of Artificial Intelligence to develop “thinking

xliii

computers”. Domain specific knowledge was used as a basis

for the development of the first intelligent systems in

various domains. Feigenbaum (1981) published the best single

reference for all the early systems. In the 1980's, expert

systems emerged from the laboratories and developed

commercial applications due to the powerful new software for

expert systems development as well as the new possibilities

of hardware. Feigenbaum (1982) defined an expert system as

"an intelligent computer program that uses knowledge and

inference procedures to solve problems that are difficult

enough to require significant human expertise for their

solution". Differences from conventional programs include

facts such as: An expert system simulates human reasoning

about a problem domain as the main focus is the expert's

problem solving abilities and how to perform relevant tasks,

as the expert does. An expert system performs reasoning over

representations of human knowledge in addition to doing

numerical calculations or data retrieval using the knowledge

xliv

base and the inference engine separately. An expert system

solves problems using heuristic knowledge rather than

precisely formulated relationships in forms that reflect

more accurately the nature of most human knowledge dealing

with symbolic values and procedures.

Shu-Hsien (2004) said that Expert system (ES) is a

branch of applied artificial intelligence community in the

mid 1960’s. The basic idea behind expert system is simply

that expertise, which is the vast body of task-specific

knowledge, is transferred from a human to a computer. This

knowledge is then stored in the computer and users call upon

the computer for specific advice as needed. The computer can

make inferences and arrive at a specific conclusion. Then

like a human consultant, it gives advice and explains, if

necessary, the logic behind the advice. Turban and Aronson

(2001) provided powerful and flexible means for obtaining

solutions to a variety of problems that often cannot be

dealt with by other more traditional and orthodox methods.

xlv

Thus, their use is proliferating too many sectors of our

social and technological life, however, their applications

categories are; rule-based systems, knowledge-based systems,

neural networks, fuzzy expert system, object oriented

methodology, case-based reasoning (CBR), system architecture

development, intelligent agent (AI) systems, modeling,

ontology, and database methodology together with their

applications for different research and problem domains. The

goal of expert systems research is to program into a

computer the knowledge and experience of an expert. Expert

systems are used in medicine, business management, mining

natural resources and much more. An alternative way to

present them is functionally, i.e., according to the types

of problems that they address. The non-exclusive categories

that seem to capture most applications are classification,

prediction, interpretation, planning, monitoring and

control, and analysis. The categorical approach is

advantageous because the user then acquires an appreciation

xlvi

of the broad applicability of expert system methodology

without becoming distracted by details that are specific to

particular applications (Davis and Clark, 1989; The surveys

in Hushon, 1987, Moninger and Dyer, 1988).

The areas explained below are some of the fields where

expert systems are used, according to Alexander and

Fairbridge( 1999). These fields of applying expert system

technologies are however not limited to just the underlisted

fields as the growth in technology advances day-by-day.

Classification problems are the most common type of

application. This is due to the impact of our inherent human

need to classify objects and events as being members of

particular groupings. A salient characteristic of

classification problems is that there is a finite (usually

small) and enumerable list of possible groups; this make

these problems relatively easy to solve. Hence, all problems

that fall into a particular solution group are treated

similarly with respect to action. Diagnosis is a very common

xlvii

application problem, where systems are diagnosed in terms of

the causes of malfunction. These include biological systems

(e.g., trees, crops or fish populations), hydrological and

chemical systems (e.g., lakes and streams), mechanical

systems (e.g., waste treatment) or physical systems (e.g.,

hailstorm severity). The cause may be a pathogen, a

malfunctioning pump, a parasite, a climate change, and so

on. Other non-diagnostic classification systems only seek to

place an object or event into a particular category without

labeling that category as malfunctional; for example,

identification of type of atmospheric inversion,

classification of soils, selection of options in

insecticides, or identification of species.

Another large class of expert systems applications

includes those that deal with prediction, these estimate some

important future characteristic of an environmental system

based on current details about it. Some examples of

prediction problems are forecasting for weather and other

xlviii

environmental phenomena, qualitative modeling of biological

or physical systems (e.g., vegetation change, crop

production and wildlife populations), and damage estimation

(e.g., following toxic contamination, for insect epidemics

or for flooding). When these expert systems select their

predictions from a small set of possible future conditions,

they can also be categorized as classification expert

systems. It should be apparent that there is some overlap

between classification and prediction problems. In fact, all

these categories are non-exclusive, and hence overlaps exist

between most of them. In fact, many systems can be

categorized in multiple ways.

Interpretation problems are similar to prediction problems

except that the characteristic to be estimated is a current

one, rather than a future one. Because this characteristic

condenses and summarizes the information about an

environmental system, it usually carries with it some

important management implications. Ways in which expert

xlix

systems have been applied include hazard and risk ratings

(e.g., fire danger rating, and contamination or toxicity

potential estimation), environmental assessment (e.g.,

impacts of human intervention, cost estimation, and report

evaluation or generation), data interpretation (e.g., model

interpretation, site selection or ranking, species selection

and equipment selection), and management actions (e.g., fire

suppression, and crop production and treatment

prescriptions).

Solutions to the above three categories of problems

most often consist of a single action or parameter estimate.

Planning type problems, on the other hand, are resolved by

specifying an ordered set of actions to be performed.

Because a large number of possible action sequences is

possible, planning problems tend to be much more difficult

to solve and are more computationally costly. Examples of

reported applications in this area are catastrophe

mitigation (e.g., hazardous site cleanup, and fire

l

suppression), forest and agriculture production (planting,

treatment and harvest), construction (e.g., roads or airport

runways), and scheduling and resource planning (e.g., for

regional water quality, landscape and land use). Expert

systems provide a viable approach to solving planning

problems because these problems usually have a fairly well

defined goal that is constrained by certain of their

attributes. Moreover, they are non-quantitative in nature

and require a systematic search through a large number of

possible solutions.

In contrast to the off-line decision making that is

inherent in the problems described above; there are

situations in which decisions are made as part of real-time

operations, Monitoring and control problems are of this type. In

many of these instances monitoring and control activities

are intertwined in the sense that a process is monitored by

an expert system that also takes action when some condition

signals its attention. At other times, an expert system only

li

performs monitoring, and a human being performs the control

action. Examples of monitoring and control applications are

very few in the environmental sciences, and this category is

only mentioned here for the sake of completeness.

A final application for expert systems is in the area

of analysis. Here, an expert system assists with evaluation of

a system, or data about a system, or it enhances the

operation of existing analysis methods. In the first case,

expert systems can help collect or filter data, or suggest

analyses for data; in the latter case they serve as

‘intelligent’ front ends or internal enhancements to

existing software. Expert systems appear as laboratory

recording aides, report generators, data collection and

selection aides, cartographic aides, data error detectors

and correctors, curve shape analyzers, and data quality

assessors. As intelligent front ends and embedded

‘intelligence,’ expert systems have been used with

ecological models, geographic information systems, remote

lii

sensing and cartographic systems. Most of these systems are

designed for in-house laboratory use to enable scientists

and technicians to work better and more efficiently.

Expert systems applications are either of computational

or deterministic applications and heuristics for problem

solving applications, of the two, the best application

candidate for expert system is however those that deal with

heuristics, here, conventional computer programs are based

on factual knowledge, an indisputable strength of computers.

Humans by contrast, solve problems on the basis of mixture

of factual and heuristic knowledge. Heuristic knowledge,

composed of intuition, judgment, and logical inferences, is

an indisputable strength of humans. Successful expert

systems will be those that combine facts and heuristics and

thus merge human knowledge with computer power in solving

problems. To be effective, expert systems must focus on

particular problem domains.

liii

2.3 EXPERT SYSTEM COMPONENTS

Most expert systems consist of several distinct

components. These are knowledge base, working memory,

reasoning engine, explanation subsystem and a user

interface. The knowledge base contains the scientific

knowledge and experience for the particular area of

expertise. Imagine that we are designing an expert system to

diagnose automobile engine malfunctions. We might want to

include knowledge about spark plugs, fuel pump, battery,

starter, fuel injectors, etc., and also how these engine

components affect engine operation. A competent mechanic can

usually pinpoint engine problems fairly quickly with only a

small amount of information about the functioning of the

various parts. Often a specialist, such as a mechanic,

possesses intuition that he or she has acquired through

years of experience. This intuition is often ratified in

rules-of-thumb (or good guesses) that allow the specialist

to solve problems quickly and effectively. For this type of

liv

expert knowledge to be used by a computer it must be

represented in some way that the computer can easily

manipulate. There are numerous techniques for knowledge

representation, but traditionally the most common one is the use

of condition-action rules, the expert system operates either

in consultation mode or knowledge acquisition mode. The

various system components enable it to solve problems for

which it has knowledge in the knowledge base, to interact

with users, and to explain the rationale for the solutions

it reaches. This is further explained in figure 2.1 by Luger

and Stubblefield (1989), as a comprehensive review of the

techniques of the functions of expert system components

(Alexander and Fairbridge, 1999).

Condition–action rules are IF-THEN statements where the

consequent action(s) are performed if the premise conditions

are true. For example, IF battery charged AND battery-cables

= clean AND engine-starting = not cranking THEN check

starter. This method of knowledge representation is popular

lv

because each rule is modular and contains a ‘chunk of domain

knowledge, expert system programmers find rules easy to

program, and experts are often able to express their

heuristic knowledge in the IF-THEN format. Working memory is

like the short-term memory of the expert system. It contains

assertions about the problem currently under investigation.

These assertions may be obtained from the user (via

queries), from external programs, from a real time process,

or from external data files. Assertions may be facts

gathered from the above sources, or they may be hypotheses

which have been inferred from other facts that are already

known. Because the ultimate goal of knowledge system

consultation is to infer problem solutions, some of these

intermediate hypotheses will eventually be solutions. All

facts and hypotheses in the working memory together describe

the current context, or the current state, of a consultation

session. Usually a closed world assumption is assumed, i.e.,

only those assertions that are present in the working memory

lvi

are true and all other possible assertions about the state

of the world are assumed false. While the knowledge base and

working memory are passive entities, the reasoning engine

navigates through the knowledge base and registers

established assertions in the working memory. A reasoning

engine operating on a knowledge base and working memory is

how an expert system solves problems. Navigation is

performed by the particular control strategy that the

reasoning engine employs. A control strategy determines the

order in which knowledge base elements (such as rules) are

examined in order to arrive at the solution to a problem.

Assertions are established as true by the particular

inference mechanism used. In a rule-based knowledge

representation, the inference method is usually used and

rules are selected for evaluation either by the content of

their premise conditions (data-driven control) or by their

consequent actions (goal-driven control). Details of how the

reasoning engine operates are determined by the knowledge

lvii

representation method used, what types of assertions must be

made, and the overall problem-solving methods that are

applied. The purpose of an explanation subsystem is to enable

the expert system to display to users an understandable

account of the motivation for all of its actions and

conclusions. Explanation is part of the larger issue of

human factors engineering, which also includes the user

interface – i.e., the how’s and why’s of a computer system’s

interaction with users. Explanation systems are not involved

with the correct execution of an expert system. Instead,

their purpose is to convince the user that the system’s

conclusions are reasonable, to explain how it reached those

conclusions, and to aid system developers in debugging the

knowledge base and the reasoning methods (Alexander and

Fairbridge, 1999).

The term user interface refers to the physical and sensory

interaction between computer and user. Functionally, this

means how the user inputs information to the system and how

lviii

information is returned to the user. The more natural (i.e.,

intuitive and understandable) this interface is, the more

effective the human computer interaction will be.

Traditionally, this interaction has been serial and text

based using the conventional, interactive terminal format.

Recent advances in computer interfaces enable expert systems

to utilize display graphics, hot graphics (graphical objects

that perform some action when activated), point-and-click

operations, video, sound and animation. For most software

users, the interface is the application, and hence expert

systems may fall into disuse if they lack good user–

interface capabilities, figure 2.1 shows the basic

components of an expert system.

lix

Fig 2.1: Basic components of an expert system

According to (Schmoldt, 1999), other major

components of expert systems that have to be understood are;

Knowledge engineer: This refers to the engineer who

encodes the expertise in a declarative format of the

knowledge base.

Domain expert: This refers to the individual or set of

individuals who are currently experts, solving the

problems in a more manual way which the system is

designed to solve.

System user: These are individuals who will be consulting

with the system to get advice which have already been

encoded by the experts.

System engineer: The individual who builds the user

interface, designs the declarative formats of the

knowledge base and implements the inference engine

lx

Depending on the size of the system to be designed, the

knowledge engineer and the system engineer might be the

same person. For a custom built system, the design of the

format of the knowledge base and the coding of the domain

knowledge are closely related. The format has a significant

effect on the coding of the knowledge. The development of

expert systems may enable a major acceleration in several

areas of human endeavours, for instance computer programs

have important advantages over books as medium for the

recording of knowledge, in that they can be updated rapidly

and are necessarily more precise and unambiguous. The

availability of the expertise of a leading practitioner in

a field in a fully precise and directly testable form may

well enable others to find improved ways of teaching the

underlying skills. A refined form of the knowledge might

again be stored in the form of an expert system, a valuable

benefit of designing an expert system, which has been

little exploited so far, is the possibility that it may be

lxi

directly used as an aid for training or educating or other

services. Although the pace of development in the expert

system field in recent years is extremely impressive, it is

hard to escape the feeling that we are still only

scratching the surface of a major new technology with

potentials which are yet barely appreciated.

Figure 2.2 shows by Unified Modeling Language (UML),

how an expert system interacts with its component

User

Domain

Expert

User Interface

lxii

Expertise

System

Engineer

Knowledge

Engineer

Encoded

Expertise

Fig 2.2: expert system components and human interface

(Source:

www.myreaders.info/html/artificial_intelligence.html)

For a perfect expert system design, all users are

put into consideration and their major functions and

activities are linked to them, also, those having

relatedness are also linked perfectly to each other as

demonstrated in the diagram above.

Inference

Engine

Knowledge

Base

Working

Storage

lxiii

2.4 EXPERT SYSTEM IN MEDICAL DIAGNOSIS

Expert systems for medical diagnoses are interactive

computer programs, designed to assist health professionals

with decision making tasks. The clinicians interact with the

system using both the clinician knowledge and the system to

make a better analysis of the patient’s data than either

humans or software could make on their own.

Intelligent systems, particularly expert systems for

diagnosis and treatment, have been developed for use in a

range of medical contexts:

MYCIN: It was the first well known medical expert system

developed by Shortliffe at Stanford University (Buchanan and

Shortliffe, 1984) used for diagnosis and remedy of bacterial

infections. It uses backward chaining inference procedure. It

helps doctors, not expert in antimicrobial drugs to prescribe

such drugs for blood infections. The limitation of MYCIN is

that its knowledge base is incomplete since, it does not

cover anything like the full spectrum of infectious diseases.

lxiv

Running it would have required more computing power than most

hospitals could afford at that time (1976). Doctors do not

relish typing at the terminal and require a much better user

interface than that provided.

PERFEX: It is a medical expert system that supports solving

problems clinicians currently have in evaluating perfusion

studies (Ezquerra et al., 1992). The heart of the PERFEX

system is the knowledge base, containing over 250 rules. They

were formulated using the expertise of clinicians and

researchers at Emory University Hospital. PERFEX limitation

resides in its output. It is mostly numerical.

INTERNIST-I: It is a rule-based expert system designed at the

University of Pittsburgh in 1974 (Kumar et al., 2009) for the

diagnosis of complex problems in general internal medicine.

ONCOCIN: It is a rule-based medical expert system for

oncology protocol management (Wiederhold et al., 2001)

developed at Stanford University. ONCOCIN was designed to

assist physicians with the treatment of cancer patients

lxv

receiving chemotherapy.

Dxplain: It is a decision support system which uses a set of

clinical findings (signs, symptoms, laboratory data) to

produce a ranked list of diagnoses which might explain (or be

associated with) the clinical manifestations (Elhanan et al.,

1996). The Dxplain provides justification for why each of

these diseases might be considered, suggests what further

clinical information would be useful to collect for each

disease and lists what clinical manifestations, if any, would

be unusual or typical for each of the specific diseases.

PUFF: It is an expert system for the interpretation of

pulmonary function tests for patients with lung disease

(Shortliffe et al., 1984). PUFF was probably the first AI

system to have been used in clinical practice.

2.5 MEDICAL DIAAGNOSIS SYSTEM

Medical diagnosis, simply termed often as diagnosis

refers both to the process of attempting to determine or

identify a possible disorder or disease. The history of

lxvi

medical diagnosis began in earnest from ancient Egypt and

the day of Hippocrates (The father of medicine) in ancient

Greece. In Traditional Chinese Medicine, there are four

diagnostic methods namely inspection, auscultation-olfaction

(to study sounds arising within organs such as the heart,

lung, and stomach prior to treatment), interrogation and

palpation (a method of clinical examination using gentle

pressure of the fingers to detect growths, changes in the

size of underlying organs, and unusual tissue reaction to

pressure) (Berger, 1999)

Esagil-kin-apli (1069-1046 BC) introduced the use of

empiricism, logic and rationality in the diagnosis of an

illness or disease, the book made use of logical rules in

combining observed symptoms on the body of a patient with

its diagnosis and prognosis. There are a number of methods

and techniques that can be used in diagnostic procedure

including differential diagnosis or following medical

algorithms (Berger, 1999).

lxvii

Differential Diagnosis: The method of differential diagnosis is

based on finding as many candidate diseases or conditions as

possible that can possibly cause the signs and symptoms,

followed by a process of elimination or at least rendering

the entries more or less probable by further medical test.

Pattern recognition: In a pattern recognition method the

provider uses experience to recognize a pattern of clinical

characteristics. It is mainly based on certain symptoms or

signs associated with certain diseases or conditions, not

necessarily involving the more cognitive processing involved

in a differential diagnosis

DIAGNOSTIC CRITERIA

The term diagnostic criteria designate the specific

combinations of signs, symptoms and test results that the

clinician uses to attempt to determine the correct diagnosis

(www.patient.co.uk/health/diagnostic_criteria).

lxviii

2.6 HIV/AIDS

HIV stands for Human Immunodeficiency Virus. This is

the virus in the group of viruses called retrovirus. HIV

destroys cells in the body called CD4 T cells. CD4 T cells

are a type of lymphocyte (A white blood cell). These are

important cells involved in protecting the body against

various bacteria, viruses and other germs. HIV actually

multiplies within CD4 cells, it cannot be destroyed by white

blood cells as it keeps changing its outer coat so as to

protect itself (www.patient.co.uk/health/hiv-and-aids).

AIDS stands for Acquired Immunodeficiency Syndrome.

This is the term which covers the range of infections and

illness which can result from a weakened immune system

caused by HIV. Because ART has altered the way we think

about the condition, the term late stage HIV is being used

instead of AIDS (www.patient.co.uk/health/hiv-and-aids).

From the above, it can be noted that, HIV and AIDS are

not the same thing and persons with HIV infections do not

lxix

automatically develop AIDS. AIDS is even unlikely to develop

in people who have been treated in the early stage of HIV

infection. Even in people who do not receive treatment, the

time lag is usually several years between first being

infected with the virus and then developing infection and

other AIDS problems, this is because it usually takes

several years for the number of CD4 T cells to reduce to a

level where our immune system is weakened

(www.patient.co.uk/health/hiv-and-aids).

CONTACTING HIV According to www.patient.co.uk/health/hiv-

and-aids, the commonest ways of being infected with HIV

include but are however not limited to the following

- Sexual transmission: This is the most common way to

pass the virus on. In 2010, it accounted for about 19

in 20 new confirmed cases in the United Kingdom.

Semen, vaginal secretion and blood from an infected

person contain HIV, the virus can enter the body

through the lining of the vagina, vulva, penis,

lxx

rectum or mouth during sex. Having vaginal or anal

sex with an infected person is the most common route.

Oral sex carries a much lower risk, but this

increases if you have a condition which affects the

defense barriers of the mouth like ulcer,

bleeding/damaged gums or sore throat. One cannot be

infected with HIV by coming into contact with the

saliva of an infected persons, HIV is also not passed

on by coughing and sneezing.

- Needle sharing: HIV (and other viruses such as

hepatitis B and hepatitis C) can be passed on by

people who are dependent on inject-able drugs and

share needles, syringes and other injecting equipment

which are contaminated with infected blood. However,

needle-exchange services run by hospitals, clinics

and drug dependency units and the more ready

availability of medicines taken by mouth has

lxxi

drastically reduced needle sharing as a source of

infection.

- Infected blood: In the past, quite a number of

cases occurred from infected blood transfusions. This

is now rare as since 1985, all blood products are

checked for HIV before being used. However, in

developing countries, it is still a significant

problem.

- From Mother to Child: HIV can be passed to an unborn

child from a HIV infected mother. However, with

appropriate treatment, the vast majority of babies

born to HIV-positive mothers will not have HIV.

Achieving this depends on detecting HIV before

pregnancy, or, in early pregnancy, when anti

retroviral medicines can be taken by the mother.

Having a caesarean section to deliver the baby

reduces the risk even further. HIV can occasionally

be passed to babies through breast milk during breast

lxxii

feeding. If formula milk is available, mothers with

HIV are encouraged not to breast feed.

2.7 DIAGNOSING HIV/AIDS

HIV tests are used to detect the presence of the human

immunodeficiency virus (HIV), the virus that causes acquired

immunodeficiency syndrome (AIDS), in serum, saliva, or

urine. Such tests may detect antibodies, antigens, or RNA.

HIV has been found in saliva, tears, nervous system

tissue and spinal fluid, blood, semen (including pre-seminal

fluid, which is the liquid that comes out before

ejaculation), vaginal fluid and breast milk. However, only

blood, semen, vaginal secretions and breast milk generally

transmits infection to others (www.about.com/Diagnosis of

AIDS_HIV.htm). Mandel, Bennet and Dolin (2007) however,

stated that AIDS begins with HIV infection. People infected

with HIV may have no symptoms for 10 years or longer, but

they can still transmit the infection to others during this

symptom-free period. If the infection is not detected and

lxxiii

treated, the immune system gradually weakens and AIDS

develop. The symptoms of AIDS are primarily the result of

infection that does not normally develop in individuals with

healthy immune system. These are called opportunistic

infections. People with AIDS have had their immune system

damaged by HIV and are very susceptible to these

opportunistic infections. Common symptoms are chills, fever,

sweating (particularly at night), swollen lymph glands,

weakness, weight loss and others.

The first stage of contracting HIV is known as the

primary infection. About 8 in 10 persons develop symptoms at

this time. The three most common symptoms (sometimes known

as the classic triad) are sore throat, fever and a blotchy

red rash. Other symptoms can include feeling sick, diarrhea,

swollen glands, headache, tiredness and general aches and

pains. The symptoms can last up to three weeks and are often

thought of as flu or mild viral illness. After any primary

infection settles, the individual can remain without any

lxxiv

symptoms for several years hence even without treatment,

there are often no symptoms for a long time (often up to 10

years) so as many do not even realize they are infected,

however, the virus continues to multiply, the number of CD4

T cells tends to gradually fall and the virus can be passed

on to others. During this time, some persons develop

persistent swollen lymph glands or night sweats and with

time, experience problems such as recurring mouth ulcers,

recurring herpes or shingles infections, old Tuberculosis

(TB) infections may reactivate in some cases even before

AIDS develops, especially in people in the developing world,

other symptoms of HIV that may be experienced before AIDS

include diarrhea, skin rashes, tiredness and loss of weight

(www.patient.co.uk/health/hiv-and-aids.)

The term AIDS is used to describe the advanced stage of

HIV infection, people who have an early HIV diagnosis and

treatment do not develop this stage. AIDS is a general term

lxxv

which includes various diseases which can result to a

weakened immune system. Typically, a person with AIDS has:

- A very low CD4 T cells (around 200 cells per cubic

millimeter of blood or below), and/or

- One or more opportunistic infection such as

pneumonia, severe thrush in the vagina or mouth,

fungal infections, Tuberculosis, etc. these

infections can cause a range of symptoms such as

sweats, fever, cough, diarrhea, weight loss and

generally feeling unwell.

In addition, people with AIDS often have increased risk

of developing other conditions as;

- Certain cancers: Kaposi’s sarcoma is a cancer which

is actually only seen in people with AIDS. There is

also an increased risk of developing cancer of the

cervix and lymphoma.

- An AIDS-related brain illness such as encephalopathy

(AIDS dementia).

lxxvi

- A severe body wasting syndrome.

The laboratory diagnosis of HIV infection is usually

made on the basis of the detection of antibodies to HIV.

Serological tests for detecting antibodies to HIV are

generally classified as screening assays (sometimes referred

to as first-line assays) or supplemental assays (sometimes

referred to as confirmatory assays). First-line assays can

provide the presumptive identification of antibody-positive

specimens, and supplemental assays are used to confirm

whether specimens found reactive with a particular screening

assay contain antibodies specific to HIV and/or HIV antigen.

The most widely used screening assays are enzyme

immunoassays (often referred to as EIAs or ELISAs) as they

are the most appropriate for screening large numbers of

specimens on a daily basis, e.g. blood donations. The

earliest assays used purified HIV lysates (1st generation),

and often lacked sensitivity and specificity. Improved

assays based on recombinant proteins and/or synthetic

lxxvii

peptides, which also enabled the production of combined HIV-

1/HIV-2 assays, became rapidly available (2nd generation).

The so-called 3rd generation or sandwich EIAs, which use

labeled antigen as conjugate, are extremely sensitive and

have reduced the window period considerably. Enhanced EIAs

have been developed that detect both HIV antibody and

antigen (4th generation assays) leading to earlier detection

of HIV infection and further reducing the window period

(Duong et al, 2007).

A variety of simple, instrument-free assays are now

available, including agglutination, immunofiltration (flow-

through tests), immunochromatographic (lateral-flow tests)

and dipstick tests. Specimens and reagents are often added

to the test device by means of a dropper. A positive result

is indicated by the appearance of a colored dot or line, or

by an agglutination pattern. Most of these assays can be

performed in less than 20 minutes and are therefore called

rapid assays. Other simple assays are less rapid and their

lxxviii

procedures require 30 minutes to 2 hours. The results are

read visually. In general, these assays are most suitable

for use in testing and counseling centers and laboratories

that have limited facilities and process low numbers of

specimens daily. When a single screening assay is used for

testing in a population with a very low prevalence of HIV

infection, the probability that a person is infected when a

positive test result is obtained (i.e., the positive

predictive value) is very low, since the majority of people

with positive results are not infected. This problem occurs

even when an assay with high specificity is used. Accuracy

can be improved if a second supplemental assay is used to

retest all those specimens found reactive by the first

assay. The negative predictive value will generally always

approach near to 100%, irrespective of prevalence. A third

assay may also be required to elucidate the correct status

(www.who.int/diagnostics_laboratory/en/).

ASSAYS FOR LABORATORY DIAGNOSIS OF HIV

lxxix

An assay is a quantitative or qualitative test of a

substance to determine its components; frequently used to

test for the presence or concentration of infectious agents

or antibodies e.t.c (Advanced English Dictionary)

According to Jeffery et al (2006), the commonly used

assays for HIV rapid tests in laboratories today are;

Determine HIV Rapid Test

The test kit which can appear in any of the form shown

in figure 2.3 is used to detect HIV antibodies in serum or

plasma. It is termed as first line test, it is the first kit

used on the patient, if patient is found reactive, the

second line is introduced for conclusion, else the test

result is given as negative.

lxxx

Fig 2.3:HIV positive, negative and invalid test result with

Determine Rapid test kit

Uni-Gold Recombigen HIV-1 Test

The Uni-Gold assay which can appear in any of the form

shown in figure 2.4 is a lateral flow immunochromatographic

procedure for the qualitative determination of HIV-1

antibodies in finger-stick or venipuncture whole blood,

serum, and plasma. It is termed the second line test kit as

it is used when the first line (Determine) test result is

reactive, it is a confirmatory test kit and when its result

comes out positive, the client is positive, and else the

third line is introduced.

lxxxi

Fig 2.4:HIV positive, negative and invalid test result with

HIV uni-gold test kit

HIV 1/2 Stat-Pak

A qualitative immunochromatographic assay which can

appear in any of the form shown in figure 2.5 is used for

the detection of antibodies to human immunodeficiency virus

types 1 and 2 (HIV-1 and HIV-2) in human serum, plasma and

whole blood. It is termed as the third line test also known

as chain breaker, when used, the result is always final. If

the patient test positive to the first two lines and

negative to the third, the patient is advised to come back

in three months time for testing again

lxxxii

Fig 2.5:HIV positive and HIV negative test result with HIV

1/2 Stat-Pak

2.8 VOLUNTARY COUNSELLING AND TESTINGAccording to Saeed (2001), ever since the beginning of

AIDS epidemic in 1981, the number of people infected and

affected by HIV/AIDS is on the rise. During the course of

infection, a broad range of physical, social and

psychological needs and problems is experienced. Changing

nature of the illness imposes a variety of psychological and

emotional strains on individuals and those closest to them.

Taking into account the dilemmas associated with it, the

effects of HIV epidemic are enormous. AIDS, in fact, is seen

more as a psychosocial phenomenon than a disease. HIV/AIDS

counseling assists people to make informed decisions, cope

better with their condition, live more positive lives, and

prevent HIV transmission. HIV/AIDS counseling is important

because infection with HIV is forever. Role of counseling in

lxxxiii

HIV/AIDS is perhaps more important than in any other

disease.

HIV COUNSELLING

HIV counseling is a confidential dialogue between a

client and counselor aimed at enabling the client to cope

with stress and take personal decisions related to HIV/AIDS.

The counseling process includes evaluating the personal risk

of HIV transmission and discussing how to prevent infection.

It concentrates specifically on emotional and social

issues related to possible and actual infection with HIV and

AIDS. HIV counseling has as its objectives both prevention

and care. It is important for counselors to have a basic

understanding of the HIV antibody tests that may be

performed, as well as the necessity of confirmatory HIV

antibody testing (Nigerian Federal Ministry of Health,

2011).

Pre-test Counseling

lxxxiv

Pre test counseling should focus on two main topics:

(a) the person's personal history of risk behaviors or

having been exposed to HIV, and (b) assessment of the

person's understanding of HIV/AIDS (including modes of

transmission), and the person's previous experiences in

crisis situations. The aim of pre-test counseling is to

provide information about the technical aspects of testing

and the possible personal, medical, social, psychological

and legal implications of being diagnosed as either HIV

positive or negative. Information should be up to date and

given in a manner that is easy to understand. Testing of

blood donors is different from testing of those suspected of

having HIV/AIDS, however, both require enquiring about risk

behaviors. Testing should be discussed as a positive act

that is linked to changes in risk behavior, coping and

increasing the quality of life (Nigerian Federal Ministry of

Health, 2011).

Post-test Counseling

lxxxv

The counseling session should begin by trying to put

the person at ease. If possible, the room should be quiet,

without the fear of being disturbed. Arrange the chairs so

that bright light will not shine in anyone's eyes. The

counselor should then tell the person the test result in a

clear and direct manner. The result (either positive or

negative) should then be discussed, including how the person

feels about the result. Providing further information might

be necessary although the person may be shocked (no matter

what the result), and may not fully take in all the

information. However, in some circumstances, this might be

the only chance to counsel this person and so asking them to

repeat the information, or have some basic facts written

down will be helpful. It is important for the person to have

time to reflect on the result and understand the next course

of action. Ideally, couple and/or family counseling should

be started and further counseling follow-up arranged

(Nigerian Federal Ministry of Health, 2011).

lxxxvi

HIV - negative Test Result Counseling

If the HIV test is negative, then counseling about

risk behaviors and methods of prevention are vitally

important. Also, the counselor must explain about the

"window period" (between 3-6 months) when a negative result

may be a false negative, if there is concern about the HIV

status of the person, counsel him to return for a repeat

test in 3-6 months. Ensure protection in the meanwhile,

explaining that the client could become infected at any

time. This is an ideal time to discuss sexual practices and

preferences and potential drug abuse (particularly

intravenous drug use) and other risk behaviours. The person

will probably be more open to learning about safe sex

practices and modifying risk behaviors and be willing to

consider necessary behaviour changes. Free condoms can be

given out during this session together with advice on how to

use them and where to get more when needed (Nigerian Federal

Ministry of Health, 2011).

lxxxvii

HIV-positive Test Result Counseling

(The positive test result will only be given after the

second HIV test confirms a positive result.) The counselor

should tell the person as gently as possible, providing

emotional support and discussing how best to cope with the

result. This is not the time for speculation, but time to

give clear, factual explanations of what the news means.

Assess the emotional impact of the news and validate the

person's reactions as normal. Fear of dying, job loss,

family acceptance, concern about the quality of life, the

effects of treatment and response by society might be

explored. If there is a concern that the person might not

return for follow up counseling, then information about

relevant related services might be included, such medical

treatment for opportunistic infections, social services for

financial and ongoing psychosocial support etc. However, if

follow up counseling is an option, then it would be

advisable to leave this information to a later date when the

lxxxviii

person is more able to absorb the details and explore some

options. Assess the person's understanding and ability to

use preventive methods. Free condoms can be given out during

this session together with advice on how to use them and

where to get more (Nigerian Federal Ministry of Health,

2011).

HIV TESTING

According to the National guidelines for HIV Counseling

and testing by the Nigerian Federal Ministry of Health in

November 2011, HIV testing is mainly carried out using anti-

body detecting techniques, which include enzyme-linked

Immunosorbent Assay (ELISA), simple and rapid tests. Testing

is carried out in public and private health facilities

including Non-Governmental Organizations (NGOs) and Faith

Based Organizations (FBOs) at the following tiers of care:

1 Tertiary health facilities like Teaching

hospitals, Federal medical centers and Research

institutes.

lxxxix

2 Secondary health facilities like General

hospitals and state specialist hospitals.

3 Primary health clinics, community health

centers, NGO’s and alone HCT centers, health

posts and mobile clinics.

The indications for HIV testing include:

1.Need to know one’s health Status

2.Screening of donated Blood for organ transplant and

transfusion.

3.HIV prevalence surveillance in a given population

4.Diagnosis of HIV infection in individuals

5.Treatment Monitoring

6.Research.

LABORATORY HIV TESTING

Persons who become infected with HIV produce antibodies

over a period of three(3) months according to the Nigerian

Federal Ministry of Health Guidelines for HIV counseling and

Testing presentation in November 2011. Different types of

xc

tests are available for the detection of these antibodies in

adults and children over 18 months of age.

TYPES OF HIV TESTS

- Rapid Test: Rapid tests are recommended for HCT

services because they are fast, simple and accurate. It

takes about 15 – 30 Minutes to perform; it can be

performed even in clinics without laboratories or

specialized laboratory equipment and are accurate when

the instructions are strictly followed.

The test is performed using a small sample of blood

(taken from the clients finger tip), serum or plasma and

the result is ready within 15 Minutes (Nigerian Federal

Ministry of Health, 2011).

- Enzymes Linked ImmunoSorbent Serologic Assays (ELISA):

ELISA test results usually take longer to obtain, and

was originally developed for donor blood screening and

therefore is more suitable for batch testing in settings

where large number of clients are seen daily. Only

xci

trained medical laboratory scientist are to perform this

test (Nigerian Federal Ministry of Health, 2011).

- Virology Test: Virology testing detects the presence of

the viral particles and gives the most accurate results,

examples include Deoxyribonucleic acid (DNA) and

Ribonucleic acid (RNA) by Polymerase Chain Reactions

(PCR) tests, P24 antigen tests and viral culture. These

tests are not used in HIV counseling and testing services

because they are expensive and require high level of

skills (Guidelines for HIV Counselling and Testing,

November 2011). The test is however recommended for Early

Infant Diagnosis (EID) in children less than 18 months of

age (Nigerian Federal Ministry of Health, 2011).

RECOMMENDED HIV TEST KITS

An essential requirement of all HIV testing is accuracy of

the test result. The rapid test kits used are those approved

by health agencies as part of the algorithm by HIV/AIDS

xcii

Division of federal ministry of health (Nigerian Federal

Ministry of Health, 2011).

TESTING ALGORITHMS

Testing algorithms show the strategies to be used for

HIV testing, there are three strategies defined by World

Health Organization (WHO), based on different principles or

methods known as testing algorithm (Nigerian Federal

Ministry of Health, 2011).

Serial Testing: With serial testing, an innitial blood

sample is taken and tested using the more sensitive kit. If

the result is negative, the result is given to the client as

HIV negative. If the result is positive, the blood sample is

tested using a second HIV rapid test kit, if the second test

is also positive, the result is given to the client as HIV

positive. However, if the second test is negative, a tie

Breaker is used as the third test kit and the result of the

tie breaker becomes final (Nigerian Federal Ministry of

xciii

Test Specimen with Screening Test

Test Result Negative

Test Result Positive

Report as Negative Test Specimen using a second rapid test with a different antigenic specifity

Test Result Negative

Test Result Positive

Report as PositiveTest Specimen using Tie breaker

Test Result Negative

Report as Negative

Test Result Positive

Re-test client in 3 months

Health, 2011). The serial testing algorithm flow is shown in

the figure 2.6 below.

xciv

Test specimen with two rapid test kits of different antigenic specifity

at the same time

Both Test Kits give same result?No

Test Specimen on a different Third Test Kit (Tie-Breaker)

Fig 2.6: Serial Algorithm for HIV testing.(Source: Nigerian Federal Ministry of Health, 2011)

Parallel Testing:Parallel testing strategy involves use of

blood samples (plasma, Serum or whole blood) with two HIV

test kits based on different test principles simultaneously

(in parallel) and the result issued if both test gives the

same result (concordant result), however, if one result is

positive and the other is negative (discordant result), the

tests are repeated using the same test kits. If the result

is still discordant, a recommended tie breaker is used and

the result from the tie breaker is given to the client. In

cases where the tie breaker is not available, the client is

referred to a reference laboratory (Nigerian Federal

Ministry of Health, 2011). Parallel algorithm is further

explained by the figure 2.7 below.

xcv

Yes

Report Test Result as seenReport Test Result as seen

Fig 2.7: Parallel Algorithm for HIV testing.

(Source: Nigerian Federal Ministry of Health, 2011)

2.9 DRUG PRESCRIPTION AND DISPENSAL

In the early 1980s, when the HIV/AIDS epidemic began,

patients rarely lived longer than a few years. But today,

there are many effective medicines to fight the infection,

and people with HIV have longer, healthier lives. Although

there is still no cure for HIV, treatment is now effective

at allowing people with HIV to live their lives as normally

as possible. Since the introduction of medicines to treat

xcvi

HIV, the death rate of AIDS has reduced dramatically. With

effective treatment, very few people go on to develop AIDS.

HIV is now a treatable medical condition and most

people with the virus remain fit and well on treatment.

Since the 1990’s, a number of medicines have been developed

called antiretroviral medicines. Antiretroviral medicines

work against HIV infection by slowing down the replication

of the virus in the body, newer medicines are more effective

than medicines in the past. There are several classes of

these medicines which include Neucleuside Reverse

Transcriptase Inhibitors (NRTIs), Neucleutide Reverse

Transcriptase Inhibitors (NtRTIs), Protase Inhibitors (PIs)

and Non- Neucleuside Reverse Transcriptase Inhibitors

(NNRTIs). Newer classes of medicines have recently been

introduced which are Integrase Inhibitors, Fusion Inhibitors

and CCR5 antagonists. The medicine in each class works in

different ways but all work to stop the HIV from replicating

itself. This method of treatment is called Anti-Retroviral

xcvii

Therapy (ART), it is still occasionally referred to as

Highly Active Antiretroviral Therapy (www.MedlinePlus.htm).

As a general rule, drug dispenser is normally started

when

- CD4 T cells has fallen below a certain level (around

350 cells per cubic millimeter of blood or less) even

without symptoms, the exact level when drug is

dispensed depends on various factors which doctors do

discuss with the infected persons during post

counseling. These include any symptom present and the

rate of decline of the CD4 T cells.

- Opportunistic infections or other AIDS-related problems

develop. Opportunistic infections are usually treated

with anti-biotics, anti-fungals or anti-TB medicines

obviously depending on which infection develops, even

if infections have not developed, once the CD4 T-cells

fall to a low level, regular doses of one or more

antibiotics is being advised or other medicines to

xcviii

prevent certain infections from developing

(www.MedlinePlus.htm).

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 SYSTEM STUDY AND INVESTIGATION

The proposed expert system, ‘An Expert System for

HIV/AIDS Diagnosis’ (HADS), is a rule based medical expert

system for the diagnosis of HIV/AIDS. Though the system is

built as a standalone application that works offline with the

xcix

computer system running as the system host with the use of a

local host server, a web browser is needed to display user

interfaces for interactions between the system and its users,

therefore, the system uses Personal Home page Hypertext

Preprocessor (PHP) scripting language with Structured Query

Language (SQL) database as the programming languages. Forward

chaining inference mechanism is employed in HADS. This is a

menu based interactive system where systems communicate with

users in common understandable language. The system consists

of multiple options for diagnosis, how to use the system and

also answers some frequently asked questions related to

HIV/AIDS, it also keeps track of patients that miss their

scheduled appointments and documents treatments of those

found positive during the diagnosis which involves step-by-

step questioning by the system users and recording of answers

in the counseling procedure which aid the patients to live a

normal life Those found negative are also advised on how to

continue living a HIV/AIDS free life. The system uses plain

c

English language to interact with users, no special knowledge

is required for individuals to use it. In the diagnosis

option, based on the individual’s answer, the system analyses

the risk level of patients and calculates the percentage

possibility of positivity/negativity of the patient. The

proposed expert system is however not a substitute for

physicians, the expert system will provide a generic

conclusion based on user inputs. The application will

identify the patient’s risk level but cannot be used as a

conclusive result of the patient’s status, the application

will further advice the patients to go for a laboratory

testing where their laboratory results will be entered and

final conclusions can then be made basically by the actual

laboratory result generated and keyed into the system. The

research methodology and system design actually follow the

hierarchy represented in the figure below

ci

Fig 3.1: Hierarchy of Expert System development process

From figure 3.1, the background, concepts and problem

selection are discussed under the same heading as the system

study and investigation, where a procedure is undertaken in

learning about HIV/AIDS and its various symptoms and

available treatment before looking for a way of designing a

system that will be able to use these selected problems to

diagnose the ailment. By this, it was learnt that, to be

diagnosed, the patient has to go through a process known as

cii

Voluntary Testing and Counseling (VCT). The process therefore

consists of the basic steps used in the design of the

proposed system as it basically involves pre–test counseling,

actual testing and post test counseling, by this, the

HIV/AIDS Diagnostic System (HADS) is divided into modules to

handle the above tasks.

HIV/AIDS DIAGNOSTIC SYSTEM MODULES

Fig. 3.2: Modules of the Proposed Expert system for HIV/AIDS

Diagnosis

From the above module in Figure 3.2, the pre-test

counseling module is an interactive module that serves as a

dialogue room between the counselor and the patient

VOLUNTARY COUNSELING AND TESTING

PRE-TEST COUNSELING

TESTING

POST-TEST COUNSELING

ciii

(client), during this session, the counselor helps the

client to decide whether or not to be tested for HIV, this

module encapsulates the following areas;

(a) Reasons for wanting the test

(b) Giving information and rectifying misconceptions

about HIV and its transmission

(c) Assessment of personal risk

(d) Explanation of the test, procedure, meaning of a

positive result and positive implications

(e) Assessment of social support system, if the test

result turns out to be positive (partner, family,

friends, etc): coping with a positive result

(f) Development of personal risk reduction plan

(g) Informed consent/dissent for the HIV antibody test

giving freely

After the entire session, the patient (client) is given

adequate time to ask questions and digest new information.

Some clients will tend to defer the following procedure

civ

(testing) while others will go ahead and perform the test

at that instance, all the above processes are included in

the design of this module.

The testing module handles the laboratory procedure of

taking small amount of blood from the client’s arm using

needle and syringe, or by pricking the client’s finger tip

to get blood on a test kit for laboratory examination. The

result (positive), shows the presence of antibodies in the

blood which indicates that the body is trying to defend

itself against the virus. An infected client will develop

these antibodies within three months of getting infected.

REACTIVE (POSITIVE) TEST RESULT

When a line appears adjacent to control and adjacent to

test on the device (test kit) where a blood sample is

collected, a positive test is read, this is however

performed again using another test kit for confirmation,

when the same lines appears, it implies a reactive result is

confirmed from the sample collected.

cv

NON-REACTIVE (NEGATIVE) TEST RESULT

A negative result is read when a line only appears

adjacent to the control line but no line appears adjacent to

the test line, if this occurs at the baseline level, another

sample is collected on another test kit and if same occurs,

a negative result is confirmed.

INVALID RESULT

Invalid results are of two kinds, results are said to

be invalid when after a sample is collected, there is no

line on either the control line or the test line and/or if

there happen to be just a single line adjacent to the test

line but the control line is blank, when this happens, the

test is performed again as the kit used might be faulty or

an error occurred during the procedure.

The next module is the post test counseling module,

this covers the after test talks where the patient(client)

is taught how to live with his/her result, a positive

result, is counseled and advised to perform further test

cvi

that suggests the treatment procedure of the positive

client, the client performs further test known as CD4 test

to ascertain the level of the viral load so as to commence

his treatment, a negative result counseling however differs,

the client in this case is taught on how to stay negative

and live a HIV free life.

3.2 DOMAIN AND KNOWLEDGE ACQUISITION

Knowledge acquisition includes the elicitation,

collection, analysis, modeling and validation of knowledge.

It is one of the most difficult phases in the building of an

expert system according to Chakraborty (www.myreaders.info).

However, it is not really surprising that it should be

difficult to extract rules from an expert whose skills will

generally lie in performing a given task and not in

explaining to others how it should be done. Diagnosticc

knowledge concerns the way a HIV/AIDS diagnosis is

performed. It is distiguished in two types. The first type

procedural diagnostic knowedge, refelcts the diagnostic

cvii

procedure. Diagnosis of HIV/AIDS is a two fold procedure. An

initial diagnosis, called early diagnosis, it is performed

based on the body fluid samples such as blood, semen, urine,

vaginal fluid and clinical data of the patient. This is then

used as a reference base for another test known as a

confirmatory test which the patient is adviced to undergo

six month after the early test. This later diagnosis may or

may not coincide with the initial. If it does, there is a

full assurance of the initial result. The second type of

diagnostic kowledge, heuristic diagnostic knowledge,

represents experience accumulated through years and concerns

the way an expert uses the patient data to make diagnoses.

Heuristic knowledge is acquired by actually interviewing

experts in the field and constructing a diagnosis tree based

on criteria such as their sex and the age of the

patients(clients), the existence and the acuteness of

symptoms like pains, fever, etc, these are all based on

qualitative features, such as whether the concentration of

cviii

smptoms is uniform or not, and quantitative features such as

whether the sickness is normal, slightly increased, or

persistent e.t.c. These real parameters will then act as the

used attributes. The knowledge of physicians consist of

general knowledge they may have obtained from medical books

plus their experiences connected with cases they have

treated themselves or colleagues have told them about.

Particularly, in diagnostic tasks, the thought of physicians

circle around typical cases. They consider the difference

between current patients and typical or known exceptional

cases. The main purpose of such generalised knowlegde is to

guide the retrival process and most times, to decrease the

amount of memory requirements by erasing redudant cases.

Much of the efforts in building a case based system goes

into case collection. Cases in the case library should be

able to provide much coverage as possible about achieving

reasoning goals (Eriksson, 1992). With all the above, the

system knowledge is acquired for the proposed HIV/AIDS

cix

Diagnostic system (HADS) and its basis is further

illustrated in figure 3.3 below.

Fig. 3.3: Domain and knowledge acquisition

From the perspective of the designed system, the system

was designed following the procedure listed below;

1. Planning of knowledge base (the content of the

knowledge base, relevant inputs and outputs, strategy for

testing, knowledge dictionary, concepts etc) were

identified.

2. Domain experts and knowledge sources were then

carefully selected

3. Knowledge Acquisition was carried out by visiting

organizations and establishments practicing HIV/AIDS

diagnosis.

KNOWLEDGE BASE

DOMAIN KNOWLEDGE

KNOWLEDGE ENGINEER

cx

4. Formulation and representation of knowledge (knowledge

is formulated in the form suitable for inference).

5. Implementation of knowledge base (knowledge is encoded

in machine-readable form.)

6. Testing of knowledge base depending on the results.

3.3 KNOWLEDGE REPRESENTATION

Knowledge representation is important and crucially

affects the case and speed with which the inference engine

can use it. Knowledge representation implies a systematic

means of encoding what an expert knows about a knowledge

domain in an appropriate medium (Goodall, 1985). A number of

knowledge acquisition techniques have been developed.

(Turban, 1993) discussed a variety of techniques, the

selection of a technique depends on the type of knowledge

that should be retained in the knowledge base. Knowledge can

be classified according to him (Turban, 1993) as Surface

knowledge, to put declarative and procedural knowledge into

heuristic to solve a problem quickly or deep knowledge,

cxi

which involves fundamental knowledge of domain including the

definitions, axioms, general laws, principles and causal

relationships upheld by the knowledge. Surface knowledge is

the basis for most common expert systems using production

rules. Production rules are widely used and quite efficient

in diagnostic problems. They are used to encode rules of

thumb also called heuristics used by humans (Turban, 1995).

According to Beynon-Davies (1991) knowledge

representation is the systematic means of encoding knowledge

of the human expert in an appropriate medium. Knowledge can

be represented as;

Predicate calculus

Business applications in the form of production rules

Semantic networks, which organize knowledge through

nodes in graphs rather than data structure and

represent relationships between the facts by links

between the nodes, and

cxii

Frames or structured objects that use data structure

to store all structural knowledge of specific objects

in one place.

Logic itself is not a way for computers to store

knowledge, but proves to be a vital tool to think about

how computers store knowledge. According to Goodall

(1985), logic is part of mathematics and can be used in

various forms to reason about the correctness of

computation and inferences. The forms of knowledge

include:

- Programming languages such as PROLOG (PROgramming in

LOGic).

- Pre-positional logic or calculus that consist of

building blocks such as elementary sentences joined

by “and”, “or” and “not”. The internal structure of

the elementary sentence is irrelevant, and

- Predicate logic with its basic building block objects

and relations such as “is-a”, and “has-a” between

cxiii

them to build statements. The relations are called

predicates and deal with the logic operators “and”,

“or” and not.

The above provide a theory to formalize the study of

reasoning, determining valid knowledge representations.

It is used to prove the correctness or determine that

certain types of inferences are correct or incorrect.

However, the basic forms of knowledge representation

according to De-Kock (2003) often used in expert

systems are;

Rules, rules are often called production rules and the

programs that reason with rules, a production system,

especially when the inference is data directed and forward-

chaining(matching the current state with the rules,

antecedents or conditions in the knowledge base), this implies

that, every knowledge base consists of facts and rules and a

rule interpreter to match the rule condition against the facts

with a means of extracting this knowledge so that to derive a

cxiv

new knowledge. Most expert systems represent knowledge as

rules and therefore the knowledge base is often refered to as

the rule base. The reason for its popularity is that almost

every piece of knowledge can be written as a rule. Many expert

systems exist that require rules as inputs and tempt knowledge

workers to express knowledge as such. Rules are natural and

the only way to codify some knowledge. Rules are a simulation

of the cogntive behaviour of human experts. They represent

knowledge, but also represent a model of actual human

behaviour. Rules are easy for a human expert to read,

understand and maintain. If the message is expressed as data

and not encoded in the program control mechanism, it can be

returned to the user in form of explanations. Production rules

involve simple syntax that is flexible and easy to understand.

They are quite efficient in diagnosing problems of the form:

If (condition)

Then(conclusion)

cxv

Each production rule in a knowledge base implements a chunk

of expertise and when fed to the inference engine, as part

of a set, should synergestically yield a better result than

any of the rules individually. In reality, rules are highly

independent and adding a new rule may contradict other rules

or cause other rules to be revised. Rule system can broadly

be classified into simple, all rules on the same level and

available to every search cycle, and structured rule base

systems where searches are limited to segments of the rule

base, thus improving the efficiency of the search. A rule

set is a named collection of individual rules pertaining to

a distinct aspect of a problem and helps in comprehending

and maintaining the rule base. This structure is a kind of

meta-knowledge that is imposed on the knowledge base. Each

sub problem could have its own rule set (Klein and Methlie,

1995).

Semantic Nets is a popular and easy to understand way of

representing non-rule knowledge. Semantic network organises

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knowledge through nodes in a graph rather than a data

stucture. Links or arcs presents relationship between the

named nodes. The links or arcs represents relationships such

as is-a, has, is, own, needs and reflects the association

between concepts. An expert system that stores information

as a semantic network incprporate an inference engine

devoted to operations like inheritance. Such an iference

engine will consist of two parts, one part will deal with

rules by forward chaining, backward chaining or some other

method. The other part will handle net operations matching

relevant links in the net to deduce facts. Objects can be

described by a number of features or attributes, many of

which stay constant from one instant to the next.

A Frame is a piece of structured data about typical

characterisics of an object, act or event. The knowledge is

more descriptive than procedural. Similar to rules, frames

must be able to deal with uncertainty and missing values.

Frames may have default values and slot filling procedures

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associated with the slot to cope with missing values. Frames

enable reasoning about objects features such as inheritance

and the occurance of exceptions. The reasoning process

starts by identifying a frame as applicable to the current

situation. Matching the set of frames against the facts

available selects an appropriate frame. The use of frame is

relevant to non-monotonic logic. Non-monotonic reasoning

expresses reasoning with default attributes (Kock, 2003).

Case-based reasoning is a process that uses similar problems

to solve the current problem, it consists of two steps:

1 Find those cases in memory that solved problems

similar to the current problem.

2 Adapt previous solutions to fit the current

problem.

The case library forms an extra important component in

case based reasoning. The inference engine, using case based

reasoning consist of retrieving solutions, adapting

solutions and testing solutions.

cxviii

The critical step is to find and retrieve a relevant

case from the case library. Cases are stored using indexes.

The stored case contains a solution, which is then adapted

by modifying the parameters of the old problem to suit the

new situation resulting in a proposed solution. The solution

is tested and if found successful, added to the case library

(Klein and Methlie, 1995). Knowledge acquisition is easier

in case based reasoning because of the granularity of the

knowledge. The knowledge representation of the proposed

system (HIV/AIDS Diagnostic System) is also cased-based as

most of the results from the system are read from the

knowledge of known and stored details(cases). By that, users

only key in answers to asked questions and actions are

performed using the answers, for instance, in the aspect

where result is being displayed, users only select from a

list of available results, the best that suits their case

and the client result is told based on the selected case.

Similarly, questions asked in assessing clients’ risks are

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based on cases stored in the knowledge base, from those

cases, the user is given a percentage possibility of his/her

client’s status.

3.4 SYSTEM DEVELOPMENT AND SPECIFICATION

The proposed system, ‘HIV/AIDS Diagnostic System’

(HADS), is a case based medical expert system for the

diagnosis of HIV/AIDS using PHP to enable proper interface

design and coding of instructions (syntax) with MYSQL

technology as the programming languages. Forward chaining

inference mechanism is employed in the system design. This

is a menu based interactive system where systems communicate

with user in common understandable language. The system

consists of multiple options for diagnosis and training help

manual. As the system uses plain English language to

interact with users, no special knowledge is required for

individuals to use it. In the Diagnosis option, based on the

individual’s answer, the system checks the possibility of

the individual having HIV antibodies, if the result is found

cxx

positive it also checks the CD4 T cells and advices the

pattern for treatment. The system is also provided with

HIV/AIDS step-by-step counseling options which can be used

to develop awareness among the people. The proposed system

is however, not a substitute for physicians, the system will

provide a generic conclusion based on user input. The

application will identify the individual’s risk possibility

and advice for some laboratory test from time to time.

Furthermore, from the design specification as required

by users of the manual system due to its limitations, the

new system can preserve knowledge for future use and other

references in both diagnostic and research work.

3.5 USER REQUIREMENTS

The requirements for the proposed system for HIV/AIDS

diagnosis will comprise of any computer set that is

compatible with the WAMP(Windows APACHE My-sql PHP)-SERVER ,

this implies that the proposed system will be able to run on

any computer system with a web server, My-sql(structured

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PHASE 3: Development of a prototype systemChoose a tool for building an intelligent systemTransform data and represent knowledgeDesign and implement a prototype systemTest the prototype with test cases

PHASE 1: Problem AssessmentDetermine the Problem’s characteristicIdentify the main participants in the projectSpecify the projects objectivesDetermine the resources needed for building the system

PHASE 2: Data and Knowledge AcquisitionCollect and Analyze data and knowledgeMake key concepts of the system design more explicit

PHASE 4: Develop a complete systemPrepare a detailed design for a full scale systemCollect additional data and knowledgeDevelop the user interfaceImplement the complete system

Query Language), PHP(Personal Homepage Hypertext Pre-

Processor) and a web browser as its basic requirements.

3.6 SYSTEM DESIGN AND DEVELOPMENT PROCESS

The system design and development process followed a

phase by phase procedure, each of the phases followed are

first of all explained below with a diagrammatical flow

represented in figure 3.4 below for more understanding;

cxxii

PHASE 4: Develop a complete systemPrepare a detailed design for a full scale systemCollect additional data and knowledgeDevelop the user interfaceImplement the complete system

PHASE 5: Evaluation and Revision of the SystemEvaluate the system against the performance criteriaRevise the system as Necessary

PHASE 5: Integration and Maintenance of the SystemMake arrangement for technology transferEstablish an effective maintenance program

Fig. 3.4 System development procedure

Problem assessment phase: During this phase, the problem

characteristics are determined, project participants

identified, specify the project’s objectives and determine

what resources are needed for building the system.

To characterize the problem, we need to determine the

problem type, input and output variables and their

cxxiii

interactions, and the form and content of the solution as

well as identify the problem type which is a medical

diagnostic problem.

Data and knowledge acquisition phase: During this phase,

further understanding of the problem domain is obtained by

collecting and analyzing both data and knowledge, and making

key concepts of the system’s design more explicit. The data

collection was specific from recognized Non-Governmental

Organizations in Benue state, mostly from Positive Health

Media Initiative (PHMI) located opposite S.R.S Junction,

University of Agriculture Makurdi park in North Bank Makurdi

where the program manager, Mr. Innocent Ogidi acquainted the

researcher with manual testing procedures and practically

sent the researcher with some team of volunteers to the feed

where we did the manual testing and counseling. Dr Ochalebe

Peter of Centre for Integrated Health program located off

Atom Kpera road in Makurdi also provided some helpful

knowledge on test procedures and went ahead to connect with

cxxiv

Aids Health Foundation (AHF) also in Makurdi, Benue State,

while at Aids Health Foundation, a volunteer for the

organization was contacted to acquire adequate knowledge

required for the research work during which villages like

Abinsi in Guma Local Government, Agasha in Guma Local

Government, Wannune Local Government, Tse-Kucha in Gboko

Local Government and others all in Benue State of Nigeria

were visited to perform manual testing and counseling for

basic understanding of the manual procedure for effective

design of the computerized diagnostic system.

Development of a prototype system phase: This

actually involves creating a small version of the system and

testing it with a number of test cases. A prototype system

can be defined as a small version of the final system. It is

designed to test how well we understand the problem, or in

other words to make sure that the problem-solving strategy,

the tool selected for building a system, and techniques for

representing acquired data and knowledge are adequate to the

cxxv

task. It also provides us with an opportunity to persuade

the skeptics and, in many cases, to actively engage the

domain expert in the system’s development.

Development of a complete system phase: As soon as

the prototype begins functioning satisfactorily, what is

actually involved in developing a full-scale system can then

be assessed. A plan was structured, schedule and budget for

the complete system was made, and also a clear definition of

system’s performance criteria. The main work at this phase

is often associated with adding data and knowledge to the

system.

Evaluation and revision of the system phase: Intelligent

systems, unlike conventional computer programs, are designed

to solve problems that quite often do not have clearly

defined ‘right’ and ‘wrong’ solutions. To evaluate an

intelligent system is, in fact, to assure that the system

performs the intended task to the user’s satisfaction. A

formal evaluation of the system is normally accomplished

cxxvi

with the test cases selected by the user. The system’s

performance is compared against the performance criteria

that were agreed upon at the end of the prototyping phase.

The evaluation often reveals the system’s limitations and

weaknesses, so it is revised and relevant development phases

are repeated.

Integration and maintenance phase: This is the final

phase in developing the system. It involves integrating the

system into the environment where it will operate and

establishing an effective maintenance program. By

‘integrating’, it means interfacing a new intelligent system

with existing systems within an organization and arranging

for technology transfer. It must be checked that the users

knows how to use and maintain the system. Intelligent

systems are knowledge-based systems, and because knowledge

evolves over time, it is necessary to be able to modify the

system.

cxxvii

ENTER CD4-COUNT AND OPPORTUNISTIC

INFECTION RESULT

Take a Diagnostic test

Pre-Test Counseling

Correctly counseled?

VIEW & ATTEND

TO REQUESTS

DISPENSE DRUGS

Enter password

Start

Password correct?

Staff page

HCT STAFF DOCTOR LABORATORY

PHARMACIST

CONSULTANT

StopStop

From the above described phases, a model of the

proposed system was built using the flow represented below

in figure 3.6, figure 3.7 and figure 3.8

NO

YES

cxxviii

ENTER CD4-COUNT AND OPPORTUNISTIC

INFECTION RESULT

VIEW NEWLY

DIAGNOSED

VIEW APPOINTMENT LIST

VIEW INDIVIDUAL HISTORY

StopStop

Stop

Stop

Laboratory Testing

Stop

Correctly counseled?

Save record

Want a lab test?

1

Case 3Case 1Case 2

1

LABORATORY TESTING

NO YES

Fig. 3.6 System Flow Chart

KIT A cxxix

Invalid RESULT

Positive HIV antibodies result

Case 1

Case 2

KIT BNegative HIV antibodies

result

Negative Post-Test Counseling

STOP

Positive HIV

antibodies result

Case 1

Case 2

Negative HIV antibodies result

Positive HIV antibodies

result

KIT C

Test for Opportunistic infections2

STOP

YES

Fig. 3.7 Procedural flow of the system

Test for Opportunisticinfections

2

Negative HIV

cxxx

Fig. 3.8 Procedural flow of the system

Reoccurringinfections

CD4 >500 &viral load

CD4 >=200 ||<=500 viral

CD4 <200 &viral load

Immediatetreatment

Keep monthlycheck and

Keep monthlycheck and

Immediatetreatment

STOP

cxxxi

3.7 DATABASE

A database is a collection of information organized

in such a way that a computer program can quickly select

desired pieces of data. It can be thought of as an

electronic filing system. They are organized in fields,

records and files where a field is a single piece of

information; a record is one complete set of fields; and a

file is a collection of records. A database management

system (DBMS), which is a software system designed to allow

the definition, creation, querying, update and

administration of databases and includes software like

oracle, Microsoft access, dBASE, FoxPro, MySQL, SQLite,

helps in maintaining the database. For the proposed system,

MySQL Database Management System was used for data

cxxxii

collection and manipulations, the sample of a database

management system in MYSQL Query Browser format is shown in

figure 3.9 and 3.10 below.

Fig 3.9: Sample of SQL Database management system as used in the proposed

system

Fig 3.10: Sample of SQL Database management system as used in the proposed

system

3.8 DATA SECURITY

Data security has to do with safe keeping of collected

data in the system, the most important part of the designed

system is its database as the entire system operations

revolve round it. From the system specifications, the

manual system had problems of privacy and other issues like

cxxxiii

loss of data, since this system is an expert system, such

issues will not come-up and data security will be guaranteed

using the following steps:

1 The system usage is restricted to only registered

staff with passwords and unauthorized entry will not

be possible

2 There is staff organizational hierarchy which limits

staff functions, by this, most sensitive functions

are performed only by administrative staff

3 Patient’s diagnosis cannot be altered by staff for

any personal reason.

4 Saved records can remain in the system for as long as

required without being tempered with.

5 The system is properly built and packaged after

several error test at various

design levels.

cxxxiv

CHAPTER FOUR: RESULTS, DISCUSSION AND CONCLUSION

4.1 DOCUMENTATION

The HIV/AIDS diagnostic system (HADS) is a medical

expert system that aids in the diagnosis of HIV antibodies

and in detecting the extent of the infection so as to

recommend treatment options in infected persons, it contains

answers to some frequently asked questions about the

disease, it has a help module that assists the users, it has

its operational terms and condition module, the system also

contains many secured modules that are used for its actual

design purposes. These modules are made secured so as to

ensure that usage is only by authorized personnel and

restriction to diagnostic procedures is guaranteed. The

system is to be however used following recommendations of

its designer which revolve around the presence of a human

expert in any medical establishment using the system.

cxxxv

4.2 HARDWARE REQUIREMENTS

There are great varieties of hardware available for

various computer information system, the requirement for the

proper usage of any expert system depends on the task

performed by the system, due to high processing operation of

the designed system, powerful microcomputers with very high

processing speed are required, hence the system will

function well in a well ventilated environment where there

is constant power supply with the following components

connected together for as many as available users;

A computer Central Processing Unit (CPU) with at least 1GB

memory and 100GB hard disk capacity and a 200GB external

hard disk for backup

A computer Visual Display Unit (VDU) otherwise known as a

Monitor of at least 14 inches

A computer Keyboard, and

HP Laserjet Printers of model P1100 and above

cxxxvi

All the Central Processing Units (CPU) must have been

installed with a Web Server (APACHE) which acts as the

system local host, My-SQL My Admin which is used for the

system database, PHP which is the scripting language used

for the system design and there must be a web browser like

Google chrome browser, torch browser or any other web

browser to enable Graphical User Interface (GUI).

4.3 INSTALLATION GUIDE

The installation for the system is done by getting

WAMP(Windows APACHE Mysql and PHP) server software which

contains the APACHE as a host, My-SQL as a database and PHP

as the scripting language, this software is then installed

on the number of central processing units required by the

agencies using the designed system, after the installation,

the WAMP is then located in drive C of the CPUs, opened to

locate a folder known as BIN which houses another folder

called PHP that contains PHP configuration settings. When

located, settings are done by the installer as it suits the

cxxxvii

CPUs in use. The PHP My Admin is also located using the same

procedure by locating WAMP and further locating the MyAdmin

folder which houses Config.inc, this file is opened and the

password setting is done on the application installed to

ensure security of the database in use.

4.4 SYSTEM TESTING

System testing is a crucial aspect of implementation

activity. It requires careful planning on the part of the

designer. System testing involves running of the program

with data representation of all the anticipated processing

conditions that will be encountered so as to detect possible

errors and fix them in the course of the system design.

Before a system is put to use, this procedure is very

important as it is indeed a programming practice to

extensively test a program before compiling it. In the

course of this design, a prototype of the HIV/AIDS

diagnostic system was first designed and tested before the

complete system design was carried out, this procedure was

cxxxviii

of great help as it reduced the errors during system testing

of the complete design to the barest minimum and only few

corrections where made during this stage.

4.5 TRAINNING

The training of the system users of the designed system

should be properly ensured in all expert system designs,

this is for the fact that, an expert system does not however

eliminate the need for a human expert, it only fastens the

job of human experts, by this, each and every center where

this system is to be used must have competent computer

operators who are properly trained, the system itself

contains a help module that further gives some basics of

usage to persons that have already been oriented on the

usage.

4.6 SYSTEM MAINTENANCE

This stage has to do with the monitoring, evaluating

and modification of the system to suit desirable and

necessary improvements, this aspect is to be handled by an

cxxxix

expert who is mostly the program designer as it requires

some special skills for proper modifications to be effected

on the system. The programmer if not available at any point

in time is required to pass the administrative security to

someone who is trusted by the establishment so that the

person can have access to maintenance tools.

4.7 SYSTEM IMPLEMENTATION

The system implementation phase describes the completed

system based on its mode of operation, at this stage, the

system definition is checked practically as end users are

trained, an operational team is built as a productive

environment is set for required performance.

The designed system helps clients detect with great

reliability and assurance of security their HIV status in

testing centers by entering test results based on test and

control lines on test kits into the system. The system is

built with analytical operational analogies conforming to

that of the national interim algorithm for HIV serology as

cxl

defined by the Nigerian Federal Ministry of Health, by their

definition, Test kit 1 represents the first line kit which

in the case of the designed system, the first line test kit

is “determine”, Test Kit 2 is “uni-Gold” and Test Kit 3 is

“Stat pak”. The result is determined by the appearance of

certain lines on the above mentioned test kits, these lines

are recorded into the result form as designed in the system.

The designed system contains numerous pages for effective

implementation such as;

Admin page: The admin page shown in figure 4.1 is the most

secured and most important page of the designed system, the

access to the page is granted by the system designer to the

head of the establishment where the system is to be used. It

cxli

is an important page because the person who is made the

administrator controls and gives accesses to other staff of

the establishment, the page is as shown below;

Fig 4.1: administrator’s page

Index Page: The index page or home page of the system

shown in figure 4.2 contains some introductory messages that

explain the system, it also contains two login information

for both newly created staff and old staff, at the creation

of staff by the system administrator, the staff is created

with some default details, hence the login for new staff is

a link, that takes them to a page that validates their login

with their own preferred passwords, by the change of their

default details, they are then granted access to the staff

area of the system by proper login from the index page which

contains fields for Username and Passwords. The username is

automatically created during staff creation by the system

administrator, it contains both variables and characters

cxlii

which are concatenated together. Samples of some staff

usernames are shown below.

Hads5449

Hads3082

Hads2122

Hads1971

The usernames are randomly created and do not follow

each other serially, the method improves the system security

a lot, the index page is as shown below.

Fig 4.2: index (home) pagecxliii

Staff Page: On successful login, the staff is taken to

his/her respective page to perform their functions, the

available staff pages on the system are the counselors’

page where counseling and testing are carried out, the

laboratory page where laboratory test results are recorded,

the doctor page where drug prescription is done, the

pharmacy page where drug dispensing is done and finally the

consultant page where clients who fail to stay healthy

after taking drugs are sent for proper checking. The

activities performed by the counseling and testing staff

involve risk assessment of clients so as to know how to

cxliv

perform counseling properly, the assessment page is as

shown in figure 4.3 below;

Fig 4.3: analysis page

During the above analysis, client risk and opportunistic

infection analysis are performed by counting from his/her

response during analysis, the result aids the staff on

counseling. The possibilities are calculated as seen below

in figure 4.4;

cxlv

Fig 4.4: Risk analysis page

Testing page: The test page is of three sectors, the

determine page is the first test page, its contains three

test result using determine as line one (1) test procedure,

the results are the positive result, negative result and the

invalid result. The uni-gold test page is also similar to

the determine and so also is the stat-pak test page as they

all have test results of type positive, negative and

invalid. The images of the three test pages which are the

determine test page, uni-gold test page and stat-pak test

page are respectively represented below in figure 4.5,

figure 4.6 and figure 4.7 respectively.

cxlvi

Fig 4.5: Determine test page

Fig 4.6: Uni-gold test page

cxlvii

Fig 4.7: stat-pak test page

Result page: The test result page represented in

figure 4.8 and figure 4.9 declares the status of the client,

during testing, there are two possible test results to be

expected, a Positive test result as seen in figure 4.8

indicates that the antibody responsible for HIV infection is

found present in the client while a negative result as shown

in figure 4.9 shows that the client is free of such

antibody. The result pages for positive and negative results

are respectively shown below;

cxlviii

Fig 4.8: Positive test result page

Fig 4.9: Negative test result page

Enrolment page: The enrolment page shown in figure

4.10 handles client enrolment into treatment plan for those

found to be positive, the page collects clients’ details and

records into the system database for continuous treatment

cxlix

procedures since the cure for HIV is not yet available, the

page is shown below;

Fig 4.10: Client enrolment page

4.8 SYSTEM SPECIFICATIONS

DATABASE SPECIFICATION

The database used in the system design is MySQL

database, the choice is due to its flexibility and easy

ability to communicate with windows applications. The system

has several tables in the database, the tables aid easy

information movement in and out of the database. The system

database is named using the abbreviation of HIV and AIDS

cl

Diagnostic System (HADS), the HADS database tables are as

shown below in table 4.0;

Table 4.0: HADS Database

Each table in the database contains fields in rows and

columns, they are designed to house variables as defined for

the purpose of the diagnostic system. A look at few of the

system tables to see their data type and data sizes are

cli

shown below in figure 4.1, figure 4.2, figure 4.3 and figure

4.4;

Table 4.1: ADMIN Table

Table 4.2: STAFF Table

clii

Table 4.3: PATIENTS Table

Table 4.4: APPOINTMENT Table

PROGRAM MODULE SPECIFICATION

The HIV/AIDS Diagnostic System is divided into several

modules, these modules were merged together to produce the

whole system, the modules are;

1 The Login Module

2 The Staff module

3 Counseling and Testing module

4 Laboratory Module

5 Prescription module

6 Drug dispenser module

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7 The history module

The above modules all work together to form the whole

diagnostic system, the function of each of the modules is

further explained using table 4.5

S/NO MODULE NAME PROGRAM MODULE ACTIVITY MODULE

1 Login

Module

Myindex.php Grants access to registered

staff

2 Staff

Module

Staffpage.php Provides links to varying

locations due to staffcliv

profession and clearance code

3 Counseling

and Testing

Module

Analysis.php Accesses clients’ risks and

use risk analysis to counsel

client before testing client

4 Laboratory

Module

Viewrequest.ph

p

Views client’s test request,

performs and records the

required test on client for

proper prescriptions by

doctors

5 Prescriptio

n Module

Prescribe.php Client’s drugs are prescribed

and recorded for future

references

6 Drug

Dispenser

Module

Dispensed.php Pharmacist dispenses drugs to

positive clients and records

drugs dispensed for history

purpose

7 History

Module

Viewhistory.ph

p

The history module handles

client’s drug collection

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history, it is important as

in time of drug failure, the

client’s history is checked

and forwarded to a consultant

for proper consultations

Table 4.5: Detailed Modules specification Table

4.9 RESULTS AND DISCUSSION

The result from the merged system produced wonderful

output, the system was able to build confidence in clients

as most persons show interest in computer-based systems as

compared to manual systems, by that, the usage presented

great deal of reliability as clients tend to attend to users

of the diagnostic system during test procedure and hence

increasing convenience in the side of both the clients and

system users.

The effectiveness of Knowledge domain was also proven

as during the risk analysis stage, clients risk count was

clvi

performed and an analysis of possibilities was also given

based on the knowledge embedded inside the knowledge domain

of the system, the result phase was also built on the bases

of knowledge domain as selection based on colour change

produces a test result for clients.

The entire system also shows a result regarding its

financial implications, though the initial cost of

installing the system is high, it however reduces the number

of staff in each and every organization interested in the

use of the system, by these, the cost involvement of

HIV/AIDS diagnosis in establishments can reduce drastically

with time. However, the output from the few hands tends to

be more as compared to the manual system.

4.10 CONCLUSION

Medical expert systems have by all means proven

effective in medical establishments, by these, the use of

medical diagnostic system has become very popular in medical

establishments of recent. The proposed system can help

clvii

establishments that use it in effective and confidential

counseling and testing. The system gives with great amount

of accuracy due to clients responses the possibility of a

client being infected with the virus before displaying the

result, though the surest way is by testing, the

effectiveness of its risk analysis cannot be undermined as

during its testing phase, a count on those infected due to

high risk analysis and opportunistic infection analysis

shows that persons with high percentage above 50% end up

having the virus when an actual laboratory test is

performed.

4.11 RECOMMENDATIONS AND SUGGESTIONS

RECOMMENDATIONS

There should be a human expert who is knowledgeable in

the manual operation of the previous system, the human

expert will monitor the expert system and certify it after a

period of time.

clviii

Back-up files should be used and from time to time

archived in safe locations away from areas prone to accident

so that a recovery can be done in case of accidents.

The system should be installed and properly monitored

in establishments of needs so that accurate data capturing

can be guaranteed, by these, data analysis will become

easier when it comes to medical research involving HIV/AIDS.

SUGGESTIONS

The system design had a lot of challenges which created

some limitations to the system, if proper studies are done,

the system can be upgraded to cover more areas and by the

coverage further studies can be carried so that medical

diagnosis of HIV/AIDS through blood implantation can be made

possible.

Government and other external bodies should encourage

sponsorship on projects involving HIV/AIDS, by these,

seminars and campaigns should be organized to spread

clix

knowledge and open other possible work areas on HIV/AIDS

diagnosis

A system that does HIV/AIDS diagnosis together with

other opportunistic infection diagnosis jointly will be

important as patients tend to have many opportunistic

infections after contracting HIV, by detecting the both

jointly, patients’ conditions become more certain as it will

be possible to tell if the patient is on HIV infection or

AIDS stage.

clx

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Avron Bar and Edward Feigenbaum. (1981). The Handbook of Artificial Intelligence,volume 1. William Kaufman, inc.

Berger, D. (july 1999). A brief history of medical diagnosis and the birth of the clinical laboratory. www.mlo-online.com.

Beynon-Davies, P. (1991). Expert Database Sytems: A gentle introduction. McGraw-Hill.

Chakraborty, R. www.myreaders.info.David E. Alexander and Rhodes W. Fairbridge. (1999).

Encyclopaedia of Environmental Science. Boston: Kluwer Academic Publishers.

Edward Feigenbaum and Buchanan. (1993). Dendral and metadendral:Roots of Knowledge System and Expert System Applications. Artificial Intelligence, 59:233-240.

Galina S, Mariusz D, Wioletta S, Monika P, Tomasz K. (2009).Artificial Intelligence Approach to Diabetes Diagnostics . International Book Series "Information Science and Computing" pp209.

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Goodall, A. (1985). The guide to expert systems. Medford: Learned Information, inc.

Haack, S. (. (July 2004). Abrief history of Artificial Intelligence. www.atariarchives.org/deli/artificial_intelligence.php.

Health, F. M. (November 2011). National Guideline for HIV Counselling and Testing. Nigeria.

Jeffery L. Greenwald et al. (2006). A Rapid Review of Rapid HIV Antibody Tests: Current Infectious Disease Reports . Boston: Current Science Inc.

Jiang Ming-yan and Chen Zhi-jian. (1997). Diabetes Expert System-IEEE International Conference on Intelligent Processing System.

Juhola M, Auroma Y, Kentala E, pyykko I. (1995). An essay on power of Expert Syatem versus human expertise. London: Med infrom .

Kock, E. D. (2003). Decentralizing the Codification of Rules in a Decission Suport Expert Knowledge base. University of Pretoria: unpublished.

Konar, A. (2000). Artificial intelligence and soft computing: Behavioral andcognitive modelling of the human brain. United State of America: CRC press LLC.

Klein M.R and Methlie L.B. (1995). Knowledge-Based Decision Support Systems with Applications in Business. England: John Wiley &Sons.

Marek J. Druzdzel and Roger R. Flynn. (2002). Decision Support Systems. New York: Marcel Dekkar, Inc.

Mark Cichocki, R. (May 02, 2009). About.com.AIDS/HIV. Meech, J. A. (June 2006). The Evolution of Intelligent Systems in the

Minning Industries. Sudbury, Ontario.Meech, J. A. The Evolution of Intellingent system in the Mining Industries.

Columbia.

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Microsoft Encarta 2009. (1993-2008). Encarta Dictionaries. Microsoft Corporation.

Nilsson, N. J. (1990). Logic and Artificial Intelligence. Stanford: Elsevier Science Publishers B.V.

Nilsson, N. J. (2009). The Quest for Artificial Intelligence: A History of Ideas and Achievements. Cambridge University Press.

Noran, O. (2003 ). Case Study: A course advisor expert system, Advances in Artificial Intelligences. Griffith University School of Computing and information technology Australia: SpringerLink .

Noran, O. S. (2000). Evolution of Expert Systems. Griffith University School of Computing and information technology Australia: Springer Link .

Saeed, D. A. (August 2001). Counseling for HIV/AIDS. Schmoldt, D. L. (1999). Expert Systems and the Environment.

Encyclopaedia of Environmental Sciences.Turban, E. (1993). Decision support and expert systems: Management

support systems. New York: Macmillan.Turban, E. (1995). Decission Support and Expert Systems: Management

Support Systems. Englewoods Cliffs, N.J: Prentice Hall.UNAIDS and WHO. (September 2003). A History of The HIV/AIDS Epidemic

with Emphasis on Africa. New York.

APPENDIX BCODES

CONNECTIONS<?php

//database connection

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$connection=mysql_connect("localhost","root","smartest");if (!$connection){die ("database connection

failed".mysql_error()); }//database selecrion

$db_select=mysql_select_db("hads",$connection);if (!$db_select){die ("database selection

failed".mysql_error()); }?>SESSION

<?php session_start();function logged_in(){return isset($_SESSION['username']);

}function confirmed_logged_in(){ if(!logged_in())

{ header("Location:myindex.php");}}?>HEADER<html><head>

<title>HIV/AIDS DIAGNOSTIC SYSTEM</title><link href="stylesheets/default.css" rel="stylesheet"

media="all" type="text/css"></head>

<body bgcolor="#6699FF"><table width="1300" border="0" align="center"> <tr>

<td colspan="7"><div align="center"><imgsrc="images/header.JPG" width="1200" height="160"

/></div></td> </tr><tr bgcolor="#FFFFFF">FOOTER<tr>

<td colspan="5" bgcolor="#FF0000"><div align="right"class="H"><em><strong> <div align="left">

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<div align="right">DESIGNED BY CHIICHII ORSEER HOSEACopyright &copy;

<?php //This code displays the year when the site designed

to the current date<br /> /*NOTE that the start means when the site was designed

and the <br /> start year can be set by you (i.e $startYear = 2006;)

*/ ini_set('date.timezone', 'Europe/London');

$startYear = 2013; $thisYear = date('Y');if ($startYear == $thisYear) { echo $startYear; }else {echo "{$startYear}/{$thisYear}";} </td></tr></table><?php //close connectionif (isset($connection)){mysql_close($connection);

}?>INDEX CODE<?php require_once("includes/session.php");?> <?php require_once("includes/connection.php")?> <p> <?php include("includes/header.php") ?> <?php if(isset($_POST['submit'])){ $userid=$_POST['userid']; $password=$_POST['password'];$hash_password=sha1($password); $query="SELECT userid,password FROM staffs WHERE userid='{$userid}' AND password='{$hash_password}'"; $result=mysql_query($query,$connection); if(!$result){ die("Database Query Failed Due to: ".mysql_error());} if(mysql_num_rows($result)==1){ if($found_user=mysql_fetch_array($result)){$_SESSION['password']=$found_user['password'];

$_SESSION['username']=$found_user['userid'];if($_SESSION['pa

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ssword']= $password) {header("Location:staffpage.php?userid={$_SESSION['username']}&&status={$field}");}}else {header("Location:errorpage.php?userid={$_SESSION['username']}");} }else{header("Location:errorpage.php");}} ?> <form name="form1" method="post" action="myindex.php"> <table width="1200" border="0" align="center"> <tr> <td width="338"><font color="#CC0000"><em><strong>NEW STAFF SHOULD <a href="home.php">CLICK HERE</a></strong><a href="home.php"></a></em></font></td> <td width="575" rowspan="3" background="includes/images/bgimage.jpg"><p align="center"><strong><font color="#000066">STAFF LOGIN</font></strong></p> <p align="center"><font color="#000000">USERNAME:</font> <strong <input name="userid" type="text" id="userid" size="25"> </strong></p> <p align="center"><font color=""#6699FF"">PASSWORD</font><strong> <input name="password" type="password" id="password" size="25"> </strong></p> <div align="center"> <p> <input type="submit"name="submit" id="submit" value=" LOGIN"></p> <p>&nbsp;</p></div> </form> <p align="center">&nbsp;</p></td> <td width="338">&nbsp;</td> </tr> <tr> <td height="164" width="150"><p align="left"><a href="myindex.php">Home</a>|| ||<a href="basis/mission.php">Mission</a>|| ||<a href="vission.php">Vission</a>|| ||<a href="basis/help.php">Help</a></p> <p><img src="includes/images/side.JPG" width="310" height="133" /></p></td>

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<td><div align="justify"><font color="#000000">HIV/AIDS has been an epidemic not only in Nigeria but the world in general, many people have died due to this epidemic, the death rate is very high due to many reasons including lack of awareness, this system tend to provide this awareness to individuals and groups for proper handling of people living with the virus and also educates people on how to stay free from it.............</font></div></td> </tr> <tr> <td height="143"><p><font color="#000000">The HIV/AIDS diagnostic system is a medical diagnostic system used in medical establishments trained by the system designers to cover HIV/AIDS related conditions, it helps in diagnosing and treating clients, it is easy to use and reliable for medical establishments...</font></p></td> <td><div align="right"><img src="includes/images/index13.jpg" width="330" height="155" /></div></td> </tr> <tr> <td height="25" colspan="2"><div align="right"><a href="basis/contact.php"> <font color="#CCCCCC">Contact Us</a>|| ||<a href="basis/help.php">Help</a>|| ||<a href="basis/faq.php">F.A.Q</a>|| ||<a href="basis/terms.php">Terms &amp; Conditions</a></div></td></tr> <?php include("includes/footer.php") ?>STAFF PAGE<?php require_once("includes/session.php");?><?php require_once("includes/connection.php")?><?phpinclude("includes/header.php") ?><?php if(isset($_GET['userid'])){ }?><?phpif(isset($_POST['submit'])){ $query = "SELECT * ";

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$query .= "FROM staffs "; $query .= "WHERE id = '{$id}' ";$result = mysql_query($query, $connection); $found_staff =mysql_fetch_array($result); header("Location:confirm.php?userid={$_SESSION['username']}&&status={$found_staff['field']}"); }?> </p> <tr align="center" class="RED"> <tdbgcolor="#FFFFFF"><div align="center"> <p><ahref="myindex.php">LOGOUT</a> </p> </div></td></tr><table width="1200"border="1" align="center"> <trbgcolor="#FF0000"> <td bgcolor="#66FF00"><divalign="right" <?php //Date echo "Today is ".date("l F d,Y");?> </div> <div align="right"></div></td> </tr><tr bgcolor="#FF0000"> <td height="23"><palign="center"><strong><font color="#000000">WELCOME TO THEDIAGNOSTIC SYSTEM, PLEASE SELECT YOUR FIELD OFSPECIALIZATION</font></strong></p></td> </tr> <tr><td height="44" bgcolor="#66FF00"><div align="center"class="white"> <form id="form1" name="form1" method="post"action=""> </form> <strong> <a href="confirm.php?id=<?php echo $_SESSION['username'] ?>">HCT STAFF</a> || ** ||<a href="confirmd.php?id=<?php echo $_SESSION['username'] ?>">DOCTOR</a> ||** || <a href="confirmp.php?id=<?php echo$_SESSION['username'] ?>">PHARMACIST</a> ||** || <ahref="confirml.php?id=<?php echo $_SESSION['username'] ?>">LABORATORY TECHNICIAN</a> || ** ||<ahref="confirmcon.php?id=<?php echo $_SESSION['username'] ?>">CONSULTANT</a></strong></div></td> </tr> <tr> <tdbgcolor="#66FF00"><div align="center"><imgsrc="images/imageis.jpg" width="549" height="261"align="middle" /></div> <divalign="center"></div></td> </tr> <tr> <td colspan="4"bgcolor="#FF0000"><div align="right" class="H"><em><strong>

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<div align="left"> <div align="right">DESIGNED BYCHIICHII ORSEER HOSEA Copyright &copy; <?php//This code displays the year when the site designed to thecurrent date<br /> /*NOTE that the start means when thesite was designed and the <br /> start year can be setby you (i.e $startYear = 2006;) */ini_set('date.timezone', 'Europe/London'); $startYear =2012; $thisYear = date('Y'); if ($startYear ==$thisYear) { echo $startYear; } else { echo "{$startYear}/{$thisYear}"; }?></tr></table></body></html>CREATE CLIENT PAGE<?phprequire_once("../includes/session.php");?><?phprequire_once("../includes/connection.php")?><p><?phpinclude("../includes/header.php") ?><?php //Date $date=date("l F d, Y");?> <?php $rand = rand(000,900);?><?php$rand = "HOSP"."/".$rand."/"."HS"?><?php $query4 = "SELECT *"; $query4 .= "FROM count "; $query4 .= "WHERE sno = '0' ";$result4 = mysql_query($query4, $connection); $found_count =mysql_fetch_array($result4); $mtotal =$found_count['mtotal']; $mtotal = $mtotal + 1; $query5 ="UPDATE count SET mtotal ='{$mtotal}' WHERE sno='0'";$result5 = mysql_query($query5, $connection);?> <?php$query4 = "SELECT * "; $query4 .= "FROM count "; $query4 .="WHERE sno = '0' "; $result4 = mysql_query($query4,$connection); $found_count = mysql_fetch_array($result4);$mtotal = $found_count['mtotal']; $ftotal =$found_count['ftotal']; $total = $found_count['total'];$total = $mtotal + $ftotal; $query6 = "UPDATE count SETtotal ='{$total}' WHERE sno='0'"; $result6 =mysql_query($query6, $connection); ?><?php if

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(isset($_GET['id'])) {$id = $_GET['id']; $id =@$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROM client"; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1);$_SESSION['id']=$found_client['id']; }?> <?php $yes_status ='unchecked'; $no_status = 'unchecked'; $selected_radio =@$_POST['select']; if ($selected_radio==8) { $yes_status ='checked'; }else if ($selected_radio == 0){$no_status ='checked';}$selected_radio1 = @$_POST['select2']; if($selected_radio1==8) {$yes_status = 'checked'; }else if($selected_radio1 == 0) {$no_status = 'checked';}$selected_radio2 = @$_POST['select3'];if($selected_radio2==8) {$yes_status = 'checked'; }else if($selected_radio2 == 0){ $no_status = 'checked';}$selected_radio3 = @$_POST['select4'];if($selected_radio3==8){$yes_status = 'checked';}else if($selected_radio3 == 0){$no_status = 'checked';}$selected_radio4 = @$_POST['select5']; if($selected_radio4==10){$yes_status = 'checked'; }else if($selected_radio4 == 0){$no_status = 'checked';}$selected_radio5 = @$_POST['select6'];if($selected_radio5==8){$yes_status = 'checked'; }else if($selected_radio5 == 0){$no_status = 'checked';}$selected_radio6 = @$_POST['select7']; if($selected_radio6==8){$yes_status = 'checked';}else if($selected_radio6 == 0){$no_status = 'checked';}$selected_radio7 = @$_POST['select8'];if($selected_radio7==8){$yes_status = 'checked';}else if($selected_radio7 == 0){$no_status = 'checked';}$selected_radio8 = @$_POST['select9']; if

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($selected_radio8==8){$yes_status = 'checked'; }else if($selected_radio8 == 0){ $no_status = 'checked';}$selected_radio9 = @$_POST['select10'];if ($selected_radio9==8){$yes_status = 'checked'; }else if($selected_radio9 == 0){ $no_status = 'checked';}$selected_radio10 = @$_POST['select11'];if($selected_radio10==8){$yes_status = 'checked';}else if($selected_radio10 == 0){$no_status = 'checked';}$selected_radio11 = @$_POST['select12']; if($selected_radio11==10){$yes_status = 'checked';}else if ($selected_radio11 == 0){$no_status = 'checked';}$selected_radio12 = @$_POST['select13']; if($selected_radio12==10){$yes_status = 'checked';}else if ($selected_radio12 == 0){$no_status = 'checked';}$selected_radio13 = @$_POST['select14']; if($selected_radio13==10){ $yes_status = 'checked'; }else if($selected_radio13 == 0){ $no_status = 'checked';}$selected_radio14 = @$_POST['select15']; if($selected_radio14==10){ $yes_status = 'checked'; }else if($selected_radio14 == 0){ $no_status = 'checked';}$selected_radio15 = @$_POST['select16'];if ($selected_radio15==10){ $yes_status = 'checked'; }elseif ($selected_radio15 == 0){ $no_status = 'checked';}$selected_radio16 = @$_POST['select17']; if($selected_radio16==10){ $yes_status = 'checked'; }else if($selected_radio16 == 0){ $no_status = 'checked';}$selected_radio17 = @$_POST['select18']; if($selected_radio17==0){$yes_status = 'checked'; }else if ($selected_radio17 == 10){$no_status = 'checked';} $selected_radio18 =@$_POST['select19']; if ($selected_radio18==10)

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{ $yes_status = 'checked';}else if ($selected_radio18 == 0){$no_status = 'checked';} $selected_radio19 =

@$_POST['select20']; if ($selected_radio19==10){ $yes_status= 'checked'; }else if ($selected_radio19 == 0){ $no_status ='checked';} $selected_radio20 = @$_POST['select21']; if($selected_radio20==10){ $yes_status = 'checked'; }else if($selected_radio20 == 0){ $no_status = 'checked';}$selected_radio21 = @$_POST['select22']; if($selected_radio21==10){ $yes_status = 'checked'; }else if($selected_radio21 == 0){ $no_status = 'checked'; }$opt_analysis = @$selected_radio7 + @$selected_radio8 +@$selected_radio9 +@$selected_radio10 + @$selected_radio11 +@$selected_radio19 + @$selected_radio20 +@$selected_radio21; $opt_analysis =$opt_analysis."%";$risk_analysis = @$selected_radio + @$selected_radio1 +@$selected_radio2 + @$selected_radio3 + @$selected_radio12 +@$selected_radio13 + @$selected_radio14 + @$selected_radio15+ @$selected_radio16 + @$selected_radio17; $risk_analysis =$risk_analysis."%"; ?> <?php if ( isset($_POST['submit'])){ $query = "UPDATE client SETopt_analysis='{$opt_analysis}', risk_analysis='{$risk_analysis}' WHERE id='{$_SESSION['id']}'";$result=mysql_query($query,$connection); if ($result)header("Location:labTest.php?id={$_SESSION['id']}&opt_analysis={$opt_analysis}&risk_analysis={$risk_analysis}");if(!$result){ die("Database query failed as:".mysql_error());}} ?> <form action="createcleintm.php"method="post"> <table align="center"> <td width="361"><tablewidth="1200" border="1" align="center"> <tr> <td

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colspan="3" bgcolor="#FF0000"><div align="center"class="RED"> <div align="center"><font color="#0000FF"size="+1"><strong>*****DIAGNOSTIC PROCEDURE*****</strong></font></div> </div></td></tr><tr><td colspan="3"bgcolor="#FFFFFF"><div align="center"><fontcolor="#0000FF"><strong>HIV COUNSELLING AND TESTING: CLIENTINTAKE FORM</strong></font></div></td></tr><tr><tdcolspan="3" bgcolor="#FF0000"><div align="right"> <?php//Dateecho "Today is ".date("l F d, Y");?></div></td> </tr><tr><td colspan="3" bgcolor="#FF0000"><ahref="../staffpagec.php">BACK</a></td> </tr> <tr> <tdheight="120" colspan="3" bgcolor="#66FF33"><palign="center">CLIENT'S NAME: <input name="name"type="text" id="name" value="<?php echo$found_client["name"]?>" />AGE:<input name="age" type="text"id="age" value="<?php echo $found_client["age"]?>" />DATE OFVISIT:<input name="dov" type="text" id="dov" value="<?phpecho $found_client["dov"]?>" />STATE OF RESIDENCE:<input name="state" type="text"id="state" value="<?php echo $found_client["state"]?>" /></p> <p align="center">L.G.A OF RESIDENCE:<inputname="lga" type="text" id="lga" value="<?php echo$found_client["lga"]?>" />Marital Status: <inputname="status" type="text" id="status" value="<?php echo$found_client["status"]?>" maxlength="20"/> ContactNumber:<input name="number" type="text" id="number"value="<?php echo $found_client["number"]?>"maxlength="20"/>

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Sex:<input name="sex" type="text" id="sex" value="<?php echo$found_client["sex"]?>" maxlength="20"/></p> </td></table> <table width="1200" border="0"> <tr> <td colspan="4" bgcolor="#66FF00"><divalign="center">CLIENT IDENTIFICATION NUMBER:: <inputtype="text" name="id" id="id" value="<?php echo$found_client["id"]?>" readonly="readonly"/> </div></td></tr> <tr> <td colspan="2" bgcolor="#66FF00"><divalign="center"><strong><font color="#FF0000"size="+2">Knowledge Assessment</font></strong></div></td><tdcolspan="2" bgcolor="#66FF00"><div align="center"><fontcolor="#FF0000" size="+2">HIV RiskAnalysis</font></div></td> </tr> <tr> <td width="375" bgcolor="#66FF00">Previously TestedNegative to HIV?</font></td> <td width="186" bgcolor="#66FF00">YES <inputtype="radio" name="select" value="8" />NO <input type="radio" name="select" value="0" /></td><tdwidth="413" bgcolor="#66FF00">Ever Had Sexual intercourse?</font></td><td width="198" bgcolor="#66FF00">YES <inputtype="radio" name="select13" value="10" />NO <inputtype="radio" name="select13" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client informed about HIV transmissionroutes?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select2" value="8" />NO <inputtype="radio" name="select2" id="radio4" value="0" /></td><td bgcolor="#66FF00">Did you had any blood transfusion 3Month ago?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select14" value="10" />NO <inputtype="radio" name="select14" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client Informed about Risk Factors for

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HIV Transmission?</font></td> <td bgcolor="#66FF00">YES<input type="radio" name="select3" value="8" />NO <inputtype="radio" name="select3" id="radio" value="0" /></td><td bgcolor="#66FF00">Have more than one sexpartner?</font></td><td bgcolor="#66FF00">YES <inputtype="radio" name="select15" value="10" /> NO <inputtype="radio" name="select15" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client Informed on methods ofprevention?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select4" value="8" /> NO<input type="radio" name="select4" value="0" /></td> <tdbgcolor="#66FF00">Unprotected sex with casual partner in thelast 3 months</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select16" value="10" />NO <inputtype="radio" name="select16" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Client informed about possible testresult?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select5" value="10" />NO <inputtype="radio" name="select5" value="0" /></td> <tdbgcolor="#66FF00">Unprotected sex with regular partner inlast 3 months?</td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select17" value="0" /> NO <inputtype="radio" name="select17" value="10" /></td> </tr> <tr><td bgcolor="#66FF00">Client consent given for HIV testing?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select6" value="8" />NO<inputtype="radio" name="select6" value="0" /></td> <tdbgcolor="#66FF00">Have you ever been infected with anyS.T.I's?</font></td> <td bgcolor="#66FF00">YES<input type="radio" name="select18" value="10" />NO<inputtype="radio" name="select18" value="0" /></td> </tr> <tr>

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<td colspan="2" bgcolor="#66FF00"><divalign="center"><strong><font color="#FF0000"size="+2">Clinical TB Screening</font></strong></div></td><td colspan="2" bgcolor="#66FF00"><divalign="center"><strong><font color="#FF0000"size="+2">Syndromic STI Screening</font></strong></div></td></tr> <tr> <td bgcolor="#66FF00">Coughing for more thantwo weeks?</font></td> <td bgcolor="#66FF00">YES<input type="radio" name="select8" value="8" />NO<inputtype="radio" name="select8" value="0" /></td> <tdbgcolor="#66FF00">Notice of urethral discharge/burning whenurinating?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select20" value="10" />NO<inputtype="radio" name="select20" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Weight loss in last 4weeks?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select9" value="8" />NO<inputtype="radio" name="select9" value="0" /></td> <tdbgcolor="#66FF00">Notice of scrotal sweeling andpain?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select21" value="10" /> NO <inputtype="radio" name="select21" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Sweeling of the LymphNode?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select10" value="8" /> NO <inputtype="radio" name="select10" value="0" /></td> <tdbgcolor="#66FF00">Complain of genital sores with or withoutpain?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select22" value="10" />NO <inputtype="radio" name="select22" value="0" /></td> </tr> <tr><td bgcolor="#66FF00">Fever for more than two

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weeks?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select11" value="8" />NO<input type="radio" name="select11" value="0" /></td><td bgcolor="#66FF00">&nbsp;</td> <tdbgcolor="#66FF00">&nbsp;</td> </tr> <tr> <tdbgcolor="#66FF00">Night sweats fore more than 2weeks?</font></td> <td bgcolor="#66FF00">YES <inputtype="radio" name="select12" value="10" />NO <inputtype="radio" name="select12" value="0" /></td> <tdbgcolor="#66FF00">&nbsp;</td> <tdbgcolor="#66FF00">&nbsp;</td> </tr> <tr> <tdcolspan="4" bgcolor="#66FF00"><div align="right"><input name="submit" type="submit" id="submit"value="NEXT" /> </div></td> </tr> </table> <p align="center"><?php if(!empty($message)){echo "<fontcolor=\"#330033\">{$message} </font>"; }?> </p> <?php include("../includes/footer.php") ?>

RISK ANALYSIS AND OPPORTUNISTIC INFECTIONS ANALYSIS CODE<?phprequire_once("includes/session.php");?><?phprequire_once("includes/connection.php")?><p> <?phpinclude("includes/header.php") ?><?phpinclude("includes/function.php") ?><?php if (isset ($_GET['id'])){$id = $_GET['id'];}?><?php$id = @$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROMclient "; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1); ?> <?php

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$yes_status = 'unchecked'; $no_status = 'unchecked'; if(isset($_POST['submit'])){ $id = $_GET['id'];$selected_radio = @$_POST['answer']; if($selected_radio=='yes'){ $yes_status = 'checked'; }else if($selected_radio == 'no'){ $no_status = 'checked';} }?><?php if (@$selected_radio == 'no'){ header("Location:thanks.php"); }else{ if (@$selected_radio== 'yes') header("Location:det.php?id={$_SESSION['id']}");}if (isset($_POST['submit'])){ $id =$_GET['id']; $query1="SELECT * FROM client WHEREid='{$id}'";$id= $_GET['id']; $opt_analysis = @$_GET['opt_analysis'];$risk_analysis = @$_GET['risk_analysis']; $query = "UPDATEclient SET opt_analysis='{$opt_analysis}', risk_analysis='{$risk_analysis}' WHERE id='{$id}'";$result=mysql_query($query,$connection);if(!$result){ die("Database query failed as:".mysql_error());} if(mysql_affected_rows()==1){ $message="Update was successful!"; }else{

$message="Update Failed! ".mysql_error();}}?></p><table align="center"> <td width="361"><tablewidth="1200" border="1" align="center"> <tr> <tdcolspan="3" bgcolor="#FF0000"><div align="center"class="RED"><div align="center"><font color="#0000FF"size="+1"><strong>*****DIAGNOSTIC PROCEDURE*****</strong></font></div> </div></td> </tr> <tr> <tdcolspan="3" bgcolor="#FFFFFF"><div align="center"><fontcolor="#0000FF"><strong>HIV COUNSELLING AND TESTING: CLIENTINTAKE FORM</strong></font></div></td> </tr> <tr> <tdcolspan="3" bgcolor="#FF0000"><div align="right"> <?php//Date echo "Today is ".date("l F d, Y");

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?> </div></td> </tr> <tr> <td colspan="3"bgcolor="#FF0000"><a href="../staffpagec.php">BACK</a></td></tr> <tr> <td height="120" colspan="3"bgcolor="#66FF33"><p align="center">CLIENT'S NAME:<input name="name" type="text" id="name" value="<?php echo$found_client["name"]?>" />AGE: <input name="age"type="text" id="age" value="<?php echo $found_client["age"]?>" />DATE OF VISIT:<input name="dov" type="text" id="dov" value="<?php echo$found_client["dov"]?>" />STATE OF RESIDENCE: <input name="state" type="text"id="state" value="<?php echo $found_client["state"]?>" /></p> <p align="center">L.G.A OF RESIDENCE:<input name="lga" type="text" id="lga" value="<?php echo$found_client["lga"]?>" />Marital Status:<input name="status" type="text" id="status" value="<?phpecho $found_client["status"]?>" maxlength="20"/>ContactNumber: <input name="number" type="text" id="number"value="<?php echo $found_client["number"]?>"maxlength="20"/>Sex:<input name="sex" type="text" id="sex" value="<?php echo$found_client["sex"]?>" maxlength="20"/></p> </td></table> <table width="1200" border="0" align="center"><tr> <td colspan="4" bgcolor="#66FF00"><divalign="center">CLIENT IDENTIFICATION NUMBER:: <inputtype="text" name="id" id="id" value="<?php echo$found_client["id"]?>" readonly="readonly"/> </div></td></tr> <tr> <td width="327" rowspan="3"><imgsrc="images/images1.jpg" width="411" height="324"></td><td width="385"><div align="center"><fontcolor="#FFFFFF">THANKS FOR GIVING US YOUR

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TIME!!!</font></div></td> <td width="268"rowspan="3"><img src="images/imagesnnn.jpg" width="395"height="317"></td> </tr> <tr> <tdbgcolor="#66FF33"><div align="center"> <p>THE CLIENTOPPORTUNISTIC INFECTION ANALYSIS PRESENTS A <fontcolor="#FFFFFF"><?PHP echo @$_GET['opt_analysis'];?></font>POSSIBILITY, WHILE RISK ANALYSIS SHOWS A<fontcolor="#FFFFFF"> <?PHP echo@$_GET['risk_analysis'];?></font> POSSIBILITY!!!</p></div></td> </tr> <tr> <td bgcolor="#66FF33"><divalign="center"> HOWEVER, THE SURE WAY OF CONFIRMING YOUR STATUS IS BYLABORATORY TESTING AND CONFIRMATION, DO YOU WISH TO PERFORMA LABORATORY TEST <form name="form1"method="post" action="labTest.php"> <div align="center">Yes<input type="radio" name="answer" value="yes"> No<input type="radio" name="answer" value="no"> <br/><input type="submit" name="submit" value="OKAY"> <br/> </div></form> </p> <?phpinclude("includes/footer.php") ?>DETERMINE TEST KIT CODE<?php require_once("includes/session.php");?><?php require_once("includes/connection.php")?><?phpinclude("includes/header.php") ?><?php $positive_status = 'unchecked'; $negative_status ='unchecked'; $invalid_status = 'unchecked';$selected_radio=""; $status ="";

if (isset($_POST['submit'])){$selected_radio =$_POST['selection']; if ($selected_radio=='positive'){

$positive_status = 'checked'; }else if ($selected_radioclxxx

== 'negative'){ $negative_status = 'checked'; }else if($selected_radio == 'invalid'){ $invalid_status ='checked';} $lab_test = $selected_radio; $id =$_SESSION['id'];$query = "UPDATE client SET lab_test ='{$lab_test}' WHEREid='{$_SESSION['id']}'"; $result=mysql_query($query,$connection); if($result){ if($positive_status == 'checked'){header("Location:uni.php?id={$_SESSION['id']}");} elseif($negative_status == 'checked'){header("Location:finishn.php?id={$_SESSION['id']}");}else if($invalid_status == 'checked'){header("Location:det1.php?id={$id}");} } else{$message="The result could not berecorded".mysql_error()."<br/>";}} ?> <form name="form1"method="post" action="det.php"> <table width="1200"border="0" align="center"> <tr> <td width="250"bgcolor="#66FF00">&nbsp;</td> <td width="462" rowspan="2"bgcolor="#66FF00"><div align="center"> <p><fontcolor="#000000" size="+1"><strong>*****LABORATORYPROCEDURE*****</strong></font></p> <p> <input type="text" name="id" id="id" value= "<?php echo$_GET['id'];?>" align="middle" readonly/> </p></div></td> <td width="268" bgcolor="#66FF00">&nbsp;</td></tr> <tr> <td bgcolor="#66FF00"><divalign="right">HOME|| ||NEWS ||HELP</div></td> <tdbgcolor="#66FF00"><a href="staffpage.php">STAFF AREA</a> |||| <a href="home.php">LOGOUT</a></td> </tr> <tr> <tdheight="34" colspan="3" bgcolor="#66FF00"><p align="center"><p align="center"><font color="#FFFFFF"><strong>CHOOSE FROMTHE UNDERLISTED TEST KITS, THE EXACT ONE THAT LOOKS LIKEYOUR RESULT</strong></font></p> <div align="center">

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<p><br/> </p> </div> </tr> <tr><td bgcolor="#66FF00"><div align="center"><imgsrc="images/determine p.JPG" width="110" height="200"></div><td bgcolor="#66FF00"><div align="center"><imgsrc="images/determine n.JPG" width="110" height="200"></div><td bgcolor="#66FF00"><div align="center"><imgsrc="images/determine i.JPG" width="110" height="200"></div><tr> <td> <div align="center"> <inputtype="radio" name="selection" value="positive"> </div><td> <div align="center"> <input type="radio"name="selection" value="negative"> </div> <td><div align="center"> <input type="radio"name="selection" value="invalid"> </div> </tr><tr> <td colspan="3" bgcolor="#66FF00"><divalign="center"> <input type="submit" name="submit"value="SUBMIT RESULT"> </div> </form> <tdwidth="2"></td> </tr> <?php include("includes/footer.php") ?>UNI-GOLD TEST CODE<?php require_once("includes/session.php"); ?><?phprequire_once("includes/connection.php")?><?phpinclude("includes/header.php") ?> <?php$positive_status = 'unchecked'; $negative_status ='unchecked'; $invalid_status = 'unchecked';$selected_radio=""; $status =""; if(isset($_POST['submit'])){ $selected_radio =$_POST['selection']; if ($selected_radio=='positive'){$positive_status = 'checked';}else if ($selected_radio == 'negative'){ $negative_status ='checked'; }else if ($selected_radio == 'invalid'){ $invalid_status = 'checked';}$lab_test = $selected_radio;

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$id = $_SESSION['id']; $query = "UPDATE client SET lab_test='{$lab_test}' WHERE id='{$_SESSION['id']}'";$result=mysql_query($query,$connection); if($result){ if($positive_status == 'checked'){header("Location:finishp.php?id={$_SESSION['id']}");} elseif($negative_status == 'checked'){header("Location:stat.php?id={$_SESSION['id']}");} elseif($invalid_status == 'checked'){ header("Location:uni1.php?id={$_SESSION['id']}");}} } ?><form name="form1" method="post" action="uni.php"> <tablewidth="1200" border="0" align="center"> <tr> <tdwidth="250" bgcolor="#66FF00">&nbsp;</td> <tdwidth="462" rowspan="2" bgcolor="#66FF00"><divalign="center"> <p><font color="#FF0000"size="+1"><strong>*****LABORATORYPROCEDURE*****</strong></font></p> <p> <input type="text"name="id" id="id" value="<?php echo $_GET['id'];?>"align="middle" readonly/> </p> </div></td> <tdwidth="268" bgcolor="#66FF00">&nbsp;</td> </tr> <tr><td bgcolor="#66FF00"><div align="right">HOME|| ||NEWS ||HELP</div></td> <td bgcolor="#66FF00"><ahref="staffpage.php">STAFF AREA</a> || || <ahref="home.php">LOGOUT</a></td> </tr> <tr> <tdheight="34" colspan="3" bgcolor="#66FF00"><p align="center"><p align="center"><font color="#FFFFFF"><strong>CHOOSE FROMTHE UNDERLISTED TEST KITS, THE EXACT ONE THAT LOOKS LIKE THERESULT FROM YOUR DIAGNOSTIC </strong></font><strong><font color="#FFFFFF">BASELINE TEST</font></strong></p> <div align="center"> <p><br/></p> </div> </tr> <tr> <tdbgcolor="#66FF00"><div align="center"><img src="images/uni

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P.JPG" width="200" height="143"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/uniN.JPG" width="200" height="143"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/uniI.JPG" width="200" height="143"></div> <tr> <td> <divalign="center"> <input type="radio" name="selection"value="positive"> </div> <td> <div align="center"><input type="radio" name="selection" value="negative" </div><td> <div align="center"> <input type="radio"name="selection" value="invalid" </div> </tr> <tr> <tdcolspan="3" bgcolor="#66FF00"><div align="center" <inputtype="submit" name="submit" value="SUBMIT RESULT"> </div></form> <td width="2"></td> </tr> <?phpinclude("includes/footer.php") ?>STAT-PACK TEST CODE<?php require_once("includes/session.php");?><?php require_once("includes/connection.php")?> <?phpinclude("includes/header.php") ?><?php $positive_status = 'unchecked'; $negative_status ='unchecked'; $invalid_status = 'unchecked';$selected_radio=""; $status =""; if(isset($_POST['submit'])){ $selected_radio =$_POST['selection']; if ($selected_radio=='positive'){ $positive_status = 'checked';}else if ($selected_radio == 'negative'){ $negative_status ='checked'; }else if ($selected_radio == 'invalid'){ $invalid_status = 'checked';} $lab_test = $selected_radio;$id = $_SESSION['id'];$query = "UPDATE client SET lab_test ='{$lab_test}' WHEREid='{$_SESSION['id']}'"; $result=mysql_query($query,$connection); if($result){ if($positive_status == 'checked')

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{header("Location:finishp.php?id={$_SESSION['id']}"); }else if($negative_status == 'checked'){header("Location:finishn.php?id={$_SESSION['id']}");} elseif($invalid_status == 'checked'){header("Location:stat1.php?id={$_SESSION['id']}"); }}}?> <form name="form1" method="post" action="stat.php"><table width="1200" border="0" align="center"> <tr> <tdwidth="250" bgcolor="#66FF00">&nbsp;</td> <td width="462"rowspan="2" bgcolor="#66FF00"><div align="center"><p><font color="#FF0000" size="+1"><strong>*****LABORATORYPROCEDURE*****</strong></font></p> <p> <inputtype="text" name="id" id="id" value="<?php echo$_GET['id'];?>" align="middle" readonly/> </p></div></td> <td width="268" bgcolor="#66FF00">&nbsp;</td></tr> <tr> <td bgcolor="#66FF00"><divalign="right">HOME|| ||NEWS ||HELP</div></td><tdbgcolor="#66FF00"><a href="staffpage.php">STAFF AREA</a> |||| <a href="home.php">LOGOUT</a></td> </tr> <tr> <tdheight="34" colspan="3" bgcolor="#66FF00"><p align="center"><p align="center"><font color="#FFFFFF"><strong>CHOOSE FROMTHE UNDERLISTED TEST KITS, THE EXACT ONE THAT LOOKS LIKE THERESULT FROM YOUR DIAGNOSTIC </strong></font><strong><font color="#FFFFFF">BASELINE TEST</font></strong></p> <div align="center"><p><br/> </p> </div> </tr> <tr> <tdbgcolor="#66FF00"><div align="center"><img src="images/statP.JPG" width="127" height="160"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/statN.JPG" width="127" height="160"></div> <tdbgcolor="#66FF00"><div align="center"><img src="images/statI.JPG" width="127" height="160"></div> <tr> <td>

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<div align="center"> <input type="radio"name="selection" value="positive"> </div> <td><div align="center"> <input type="radio"name="selection" value="negative"> </div> <td><div align="center"> <input type="radio"name="selection" value="invalid"> </div> </tr> <tr><td colspan="3" bgcolor="#66FF00"><div align="center"><input type="submit" name="submit" value="SUBMIT RESULT"></div> </form> <td width="2"></td> </tr> <?phpinclude("includes/footer.php") ?>POSITIVE RESULT CODE<?phprequire_once("includes/session.php");?<?phprequire_once("includes/connection.php")?><?php include("includes/header.php") ?><?php $id =@$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROM client"; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1); $sex = $found_client["sex"];$opt_analysis = $found_client["opt_analysis"];$risk_analysis = $found_client["risk_analysis"]; ?> <?php if($sex == 'Male'){ $query4 = "SELECT * "; $query4 .= "FROMcount "; $query4 .= "WHERE sno = '0' "; $result4 =mysql_query($query4, $connection); $found_count =mysql_fetch_array($result4); $pmale = $found_count['pmale'];$pfemale = $found_count['pfemale']; $ptotal =$found_count['ptotal']; $ptotal = $ptotal + 1; $pmale =$pmale + 1; $ptotal = $pmale + $pfemale; $query5 = "UPDATEcount SET pmale ='{$pmale}', ptotal = '{$ptotal}' WHEREsno='0'"; $result5 = mysql_query($query5, $connection); }else if ($sex == 'Female'){ $query4 = "SELECT * "; $query4.= "FROM count "; $query4 .= "WHERE sno = '0' "; $result4 =

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mysql_query($query4, $connection); $found_count =mysql_fetch_array($result4); $pfemale =$found_count['pfemale']; $pmale = $found_count['pmale'];$ptotal = $found_count['ptotal']; $ptotal = $ptotal + 1;$pfemale = $pfemale + 1; $ptotal = $pmale + $pfemale;$query5 = "UPDATE count SET pfemale ='{$pfemale}', ptotal ='{$ptotal}' WHERE sno='0'"; $result5 = mysql_query($query5,$connection); } ?> <?php if ($opt_analysis >= 12.5 &&$risk_analysis >= 50){ $query0 = "SELECT * "; $query0 .="FROM count "; $query0 .= "WHERE sno = '0' "; $result0 =mysql_query($query4, $connection); $found_count =mysql_fetch_array($result0); $risk = $found_count['risk'];$risk = $risk + 1; $query0 = "UPDATE count SET risk='{$risk}' WHERE sno='0'"; $result0 = mysql_query($query0,$connection); } ?> <table width="1200" border="0"align="center"> <tr> <td width="262"bgcolor="#66FF00"><div align="right"></div></td> <tdwidth="619" bgcolor="#66FF00"><div align="center"> <p><fontcolor="#000000"size="+1"><strong><fontcolor="#FF0000">*****LABORATORYPROCEDURE*****</strong></font> </p> </div></td> <tdwidth="305" bgcolor="#66FF00">&nbsp;</td> </tr> <tr><td height="34" colspan="3" bgcolor="#66FF00"><palign="center"><font color="#FFFFFF"><strong>THANKS FORGIVING US YOUR TIME</strong></font> <p align="center"><strong><font color="#FFFFFF">YOUR RESULT DETAILS ARE ASSHOWN BELOW</font></strong> <palign="center"><strong><font color="#FFFFFF">ID NUMBER:<input name="id" type="text" id="id" value="<?php echo$_GET['id'];?>"> </font></strong><fontcolor="#FFFFFF">NAME:</font> <input name="name"

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type="text" id="name" value="<?php echo$found_client["name"]?>"> <font color="#FFFFFF"> HIVSTATUS: </font> <input name="lab_test" type="text"id="lab_test" value="<?php echo $found_client["lab_test"]?>"> <p align="center"><font color="#FFFFFF">YOUR TEST RESULTSHOWS THAT THE CLIENT IS POSITIVE TO HIV ANTIBODY</font> <palign="center"><font color="#FFFFFF">CLIENT SHOULD BEENROLLED FOR PROPER MEDICATION</font> <palign="center"><font color="#FF0000">AIDS IS REAL!!! HELPSPREAD THE NEWS </font> <div align="center"> <p><br/></p> </div> </tr> <tr> <td colspan="4"bgcolor="#66FF00"><div align="center"><ahref="createpatient.php">ENROL CLIENT</a></div> </form></tr> <?php include("includes/footer.php") ?>NEGATIVE RESULT CODE<?php require_once("includes/session.php");?> <?phprequire_once("includes/connection.php")?><?phpinclude("includes/header.php") ?><?php$id = @$_GET["id"]; $query1 = "SELECT * "; $query1 .= "FROMclient "; $query1 .= "WHERE id = '{$id}' "; $result1 =mysql_query($query1, $connection); $found_client =mysql_fetch_array($result1);?><table width="1200" border="0"align="center"> <tr> <td width="262"bgcolor="#66FF00"><div align="right"></div></td> <tdwidth="619" bgcolor="#66FF00"><div align="center"> <p><fontcolor="#000000" size="+1"><strong><fontcolor="#FF0000">*****LABORATORYPROCEDURE*****</strong></font> </p> </div></td> <tdwidth="305" bgcolor="#66FF00">&nbsp;</td> </tr> <tr><td height="34" colspan="3" bgcolor="#66FF00"><p

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align="center"><font color="#FFFFFF"><strong>THANKS FORGIVING US YOUR TIME</strong></font> <p align="center"><strong><font color="#FFFFFF">YOUR RESULT DETAILS ARE ASSHOWN BELOW</font></strong> <palign="center"><strong><font color="#FFFFFF">ID NUMBER:<input name="id" type="text" id="id" value="<?php echo$_GET['id'];?>"> </font></strong><fontcolor="#FFFFFF">NAME:</font><input name="name" type="text"id="name" value="<?php echo $found_client["name"]?>"> <fontcolor="#FFFFFF"> HIV STATUS: </font> <inputname="lab_test" type="text" id="lab_test" value="<?php echo$found_client["lab_test"]?>"> <p align="center"> <fontcolor="#FFFFFF">WE CONGRATULATE YOU AND ADVICE YOU TOPROTECT YOUR SELF AD STAY NEGATIVE.</font> <palign="center"><font color="#FF0000">AIDS IS REAL!!! HELPSPREAD THE NEWS </font> <div align="center"><p><br/> </p> </div> </tr> <tr> <tdcolspan="4" bgcolor="#66FF00"><div align="center"><ahref="staffpagec.php">GO HOME</a></div> </form></tr> <?php include("includes/footer.php") ?

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