While most people with AIDS do not yet have access to anti-retroviral drugs (ARVs), large ARV treatment programs are being rolled out in many areas in Sub-Saharan Africa. ARV programs have substantial data management needs, which electronic medical record systems (EMRs) are helping to address. While most sophisticated EMRs in low-income regions are in large cities, where infrastructure and staffing needs are more easily met, Partners In Health (PIH) has pioneered web-based EMRs for HIV and TB treatment in rural areas. The HIV-EMR, developed in Haiti [1], was deployed in two Rwandan health districts starting in August 2005. The addition of new features and adaptation to local needs is happening concurrently with the rapid scale-up and evolution of the medical program itself.