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Wexler C, Maloba M, Sliefert M, Babu S, Maosa N, Maliski E, Nicolay Z, Were F, Mbithi Y, Mugendi G, Thomas G, Acharya H, Finocchario-Kessler S. Assessing user preferences for design characteristics of oral dissolvable strips for pediatric HIV medication: a qualitative study. BMC Health Serv Res 2023; 23:1103. [PMID: 37845699 PMCID: PMC10580521 DOI: 10.1186/s12913-023-10078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Current infant antiretroviral therapy formulations pose barriers to daily adherence due to complex weight-based dosing, conspicuous preparation, and poor palatability. These adherence barriers jeopardize adherence, making patients vulnerable to virologic failure, development of drug resistance, and preventable mortality. Our team has previously established proof-of-principle for multi-drug oral dissolvable strips as alternative pediatric antiretroviral formulations with the potential to overcome these challenges and improve pediatric ART adherence and outcomes. The objective of this study was to assess caregiver and provider preferences for oral dissolvable strips and its packaging to inform its development. METHODS Guided by concepts of user-centered design, we conducted key informant interviews with 30 HIV care providers and focus group discussions targeting caregivers of children < 10 years of age living with HIV at 3 Kenyan hospitals. Key informant interviews and focus group discussions were audio recorded, translated/transcribed verbatim, and hand coded for a-priori and emergent themes. RESULTS A total of 30 providers and 72 caregivers (caring for 83 children, aged 5 months to 18 years) participated in the study. Caregivers and providers expressed a strong desire for an easier way to administer medication, especially among children too young to swallow tablets whole, and expressed enthusiasm around the idea of oral dissolvable strips. Key preferences included a pleasant taste; one strip per dose; small size with rapid dissolution; clear markings and instructions; and no special storage requirements. For packaging, stakeholders preferred individually wrapped strips within a dispenser. The individual packaging should be durable, waterproof, and easy to dispose of in communal spaces. They should also be easy to open, with clear indications where to open. The packaging holding the strips should be durable, re-usable, accommodating of various refill frequencies, and easy to use for children as young as 6. DISCUSSION The concept of oral dissolvable strips was highly acceptable to caregivers of children living with HIV and HIV care providers. By engaging stakeholders in an iterative design process starting from the early phases of design and development, we will maximize the likelihood of developing a product that is acceptable to the caregiver and infant, therefore leading to sustainable adherence.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Michala Sliefert
- School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | | | | | | | | | - Gregory Thomas
- School of Architecture and Design, University of Kansas, Lawrence, KS, USA
| | - Harshdeep Acharya
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Wexler C, Kamau Y, Muchoki E, Babu S, Maosa N, Maloba M, Brown M, Goggin K, Mabachi N, Gautney B, Finocchario-Kessler S. Implementing at-birth, point-of-care HIV testing in Kenya: a qualitative study using the Consolidated Framework for Implementation Research. Implement Sci Commun 2021; 2:89. [PMID: 34380567 PMCID: PMC8359118 DOI: 10.1186/s43058-021-00188-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND At-birth and point-of-care (POC) testing can expedite early infant diagnosis of HIV and improve infant outcomes. Guided by the Consolidated Framework for Implementation Research (CFIR), this study describes the implementation of an at-birth POC testing pilot from the perspective of implementing providers and identifies the factors that might support and hinder the scale up of these promising interventions. METHODS We conducted 28 focus group discussions (FGDs) with 48 providers across 4 study sites throughout the course of a pilot study assessing the feasibility and impact of at-birth POC testing. FGDs were audio-recorded, transcribed, and analyzed for a priori themes related to CFIR constructs. This qualitative study was nested within a larger study to pilot and evaluate at-birth and POC HIV testing. RESULTS Out of the 39 CFIR constructs, 30 were addressed in the FGDs. While all five domains were represented, major themes revolved around constructs related to intervention characteristics, inner setting, and outer setting. Regarding intervention characteristics, the advantages of at-birth POC (rapid turnaround time resulting in improved patient management and enhanced patient motivation) were significant enough to encourage provider uptake and enthusiasm. Challenges at the intervention level (machine breakdown, processing errors), inner settings (workload, limited leadership engagement, challenges with access to information), and outer setting (patient-level challenges, limited engagement with outer setting stakeholders) hindered implementation, frustrated providers, and resulted in missed opportunities for testing. Providers discussed how throughout the course of the study adaptations to implementation (improved channels of communication, modified implementation logistics) were made to overcome some of these challenges. To improve implementation, providers cited the need for enhanced training and for greater involvement among stakeholders outside of the implementing team (i.e., other clinicians, hospital administrators and implementing partners, county and national health officials). Despite provider enthusiasm for the intervention, providers felt that the lack of engagement from leadership within the hospital and in the outer setting would preclude sustained implementation outside of a research setting. CONCLUSION Despite demonstrated feasibility and enthusiasm among implementing providers, the lack of outer setting support makes sustained implementation of at-birth POC testing unlikely at this time. The findings highlight the multi-dimensional aspect of implementation and the need to consider facilitators and barriers within each of the five CFIR domains. TRIAL REGISTRATION ClinicalTrials.gov, NCT03435887 . Retrospectively registered on 19 February 2020.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Yvonne Kamau
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | | | | | - May Maloba
- Global Health Innovations - Kenya, Nairobi, Kenya
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brad Gautney
- Global Health Innovations - USA, Dallas, TX, USA
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Finocchario-Kessler S, Brown M, Maloba M, Nazir N, Wexler C, Goggin K, Dariotis JK, Mabachi N, Lagat S, Koech S, Gautney B. A Pilot Study to Evaluate the Impact of the HIV Infant Tracking System (HITSystem 2.0) on Priority Prevention of Mother-to-Child Transmission (PMTCT) Outcomes. AIDS Behav 2021; 25:2419-2429. [PMID: 33709212 PMCID: PMC8224224 DOI: 10.1007/s10461-021-03204-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
We assessed the preliminary impact of the adapted HIV Infant Tracking System (HITSystem v2.0) intervention on prevention of mother-to-child transmission (PMTCT) outcomes using a matched cluster randomized design in two Kenyan government hospitals. Between November 2017 and June 2019, n = 157 pregnant women with HIV were enrolled and followed from their first PMTCT appointment until 12-weeks postpartum. Data from 135 women were analyzed (HITSystem 2.0: n = 53, standard of care (SOC): n = 82), excluding eight deaths, eight pregnancy losses, and six transfers/moves. The primary outcome, complete PMTCT retention, is an aggregate measure of attendance at all scheduled antenatal appointments, hospital-based delivery, and infant HIV-testing before 7-weeks postnatal. HITSystem 2.0 participants were more likely to receive complete PMTCT services compared to SOC (56.6% vs. 17.1% p < 0.001). In multivariate modeling, HITSystem 2.0 was the strongest predictor of complete PMTCT retention (aOR 5.7, [1.2-90.8], p = 0.032). SOC participants had 1.91 increased hazard rate of PMTCT disengagement; (aHR 6.8, [2.2-21.1]; p < 0.001).
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Affiliation(s)
- Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Niaman Nazir
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, USA
- Schools of Medicine and Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jacinda K Dariotis
- Department of Human Development and Family Studies & Family Resiliency Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 4010, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA
| | | | - Sharon Koech
- Global Health Innovations, Nairobi, Kenya
- Ministry of Health, Nandi County, Kenya
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Wexler C, Maloba M, Goggin K, Kale SB, Maosa N, Muchoki E, Brown M, Gautney B, Finocchario-Kessler S. ART Initiation for Infants Diagnosed With HIV Through Point of Care and Conventional Polymerase Chain Reaction Testing in Kenya: A Case Series. Pediatr Infect Dis J 2021; 40:e151-e153. [PMID: 33464012 PMCID: PMC7954882 DOI: 10.1097/inf.0000000000003032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We sought to understand the sequence of testing and treatment among nine infants offered both conventional and point-of-care testing and diagnosed as HIV-positive by 6 months of age in Kenya. One infant received per protocol testing and treatment. Patient-level (late presentation and disengagement), provider-level (reluctance and error/oversight) and system-level (stock outs, errors) challenges delayed diagnosis and treatment. Early point-of-care testing can streamline testing; however, challenges mitigate benefits.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Kathy Goggin
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, MO
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO
| | | | | | | | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS
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