Introduction: Efficient use of health care resources in low-income countries by providers and local and national managers requires timely access to patient data. Objective: To implement electronic health records (EHRs) in HIV clinics in Kenya, Tanzania, and Uganda. Results: We initially developed and implemented an EHR in Kenya through a mature academic partnership. The EHR was then implemented in six HIV clinics in Tanzania and Uganda in collaboration with their National AIDS Control Programmes. All implementations were successful, but the system's use and sustainability varied depending on who controlled clinic funding. Conclusions: Successful EHR use and sustainability were enhanced by local control of funds, academic partnerships (mainly by leveraging research funds), and in-country technology support.