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Maaß L, Angoumis K, Freye M, Pan CC. Mapping Digital Public Health Interventions Among Existing Digital Technologies and Internet-Based Interventions to Maintain and Improve Population Health in Practice: Scoping Review. J Med Internet Res 2024; 26:e53927. [PMID: 39018096 PMCID: PMC11292160 DOI: 10.2196/53927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/31/2024] [Accepted: 05/15/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The rapid progression and integration of digital technologies into public health have reshaped the global landscape of health care delivery and disease prevention. In pursuit of better population health and health care accessibility, many countries have integrated digital interventions into their health care systems, such as web-based consultations, electronic health records, and telemedicine. Despite the increasing prevalence and relevance of digital technologies in public health and their varying definitions, there has been a shortage of studies examining whether these technologies align with the established definition and core characteristics of digital public health (DiPH) interventions. Hence, the imperative need for a scoping review emerges to explore the breadth of literature dedicated to this subject. OBJECTIVE This scoping review aims to outline DiPH interventions from different implementation stages for health promotion, primary to tertiary prevention, including health care and disease surveillance and monitoring. In addition, we aim to map the reported intervention characteristics, including their technical features and nontechnical elements. METHODS Original studies or reports of DiPH intervention focused on population health were eligible for this review. PubMed, Web of Science, CENTRAL, IEEE Xplore, and the ACM Full-Text Collection were searched for relevant literature (last updated on October 5, 2022). Intervention characteristics of each identified DiPH intervention, such as target groups, level of prevention or health care, digital health functions, intervention types, and public health functions, were extracted and used to map DiPH interventions. MAXQDA 2022.7 (VERBI GmbH) was used for qualitative data analysis of such interventions' technical functions and nontechnical characteristics. RESULTS In total, we identified and screened 15,701 records, of which 1562 (9.94%) full texts were considered relevant and were assessed for eligibility. Finally, we included 185 (11.84%) publications, which reported 179 different DiPH interventions. Our analysis revealed a diverse landscape of interventions, with telemedical services, health apps, and electronic health records as dominant types. These interventions targeted a wide range of populations and settings, demonstrating their adaptability. The analysis highlighted the multifaceted nature of digital interventions, necessitating precise definitions and standardized terminologies for effective collaboration and evaluation. CONCLUSIONS Although this scoping review was able to map characteristics and technical functions among 13 intervention types in DiPH, emerging technologies such as artificial intelligence might have been underrepresented in our study. This review underscores the diversity of DiPH interventions among and within intervention groups. Moreover, it highlights the importance of precise terminology for effective planning and evaluation. This review promotes cross-disciplinary collaboration by emphasizing the need for clear definitions, distinct technological functions, and well-defined use cases. It lays the foundation for international benchmarks and comparability within DiPH systems. Further research is needed to map intervention characteristics in this still-evolving field continuously. TRIAL REGISTRATION PROSPERO CRD42021265562; https://tinyurl.com/43jksb3k. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/33404.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Digital Health Section, European Public Health Association - EUPHA, Utrecht, Netherlands
| | - Konstantinos Angoumis
- University of Bielefeld, Bielefeld, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Merle Freye
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- University of Bremen, Institute for Information, Health and Medical Law - IGMR, Bremen, Germany
| | - Chen-Chia Pan
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- University of Bremen, Institute for Public Health and Nursing Research - IPP, Bremen, Germany
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Ali A, Clarke DF. Digital measures in epilepsy in low-resourced environments. Expert Rev Pharmacoecon Outcomes Res 2024; 24:705-712. [PMID: 37818647 DOI: 10.1080/14737167.2023.2270163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION Digital measures and digital health-care delivery have been rarely implemented in lower-and-middle-income countries (LMICs), contributing to worsening global disparities and inequities. Sustainable ways to implement and use digital approaches will help to improve time to access, management, and quality of life in persons with epilepsy, goals that remain unreachable in under-resourced communities. As under-resourced environments differ in human and economic resources, no one approach will be appropriate to all LMICs. AREAS COVERED Digital health and tools to monitor and measure digital endpoints and metrics of quality of life will need to be developed or adapted to the specific needs of under-resourced areas. Portable technologies may partially address the urban-rural divide. Careful delineation of stakeholders and their engagement and alignment in all efforts is critically important if these initiatives are to be successfully sustained. Privacy issues, neglected in many regions globally, must be purposefully addressed. EXPERT OPINION Epilepsy care in under-resourced environments has been limited by the lack of relevant technologies for diagnosis and treatment. Digital biomarkers, and investigative technological advances, may finally make it feasible to sustainably improve care delivery and ultimately quality of life including personalized epilepsy care.
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Affiliation(s)
- Amza Ali
- Department of Medicine, Faculty of Medical Sciences, Mona, Kingston, Jamaica
| | - Dave F Clarke
- Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Pediatric Epilepsy, Dell Children's Medical Center of Central Texas, Austin, TX, USA
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Secor AM, Célestin K, Jasmin M, Honoré JG, Wagner AD, Beima-Sofie K, Pintye J, Puttkammer N. Electronic Medical Record Data Missingness and Interruption in Antiretroviral Therapy Among Adults and Children Living With HIV in Haiti: Retrospective Longitudinal Study. JMIR Pediatr Parent 2024; 7:e51574. [PMID: 38488632 PMCID: PMC10986334 DOI: 10.2196/51574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Children (aged 0-14 years) living with HIV often experience lower rates of HIV diagnosis, treatment, and viral load suppression. In Haiti, only 63% of children living with HIV know their HIV status (compared to 85% overall), 63% are on treatment (compared to 85% overall), and 48% are virally suppressed (compared to 73% overall). Electronic medical records (EMRs) can improve HIV care and patient outcomes, but these benefits are largely dependent on providers having access to quality and nonmissing data. Objective We sought to understand the associations between EMR data missingness and interruption in antiretroviral therapy treatment by age group (pediatric vs adult). Methods We assessed associations between patient intake record data missingness and interruption in treatment (IIT) status at 6 and 12 months post antiretroviral therapy initiation using patient-level data drawn from iSanté, the most widely used EMR in Haiti. Missingness was assessed for tuberculosis diagnosis, World Health Organization HIV stage, and weight using a composite score indicator (ie, the number of indicators of interest missing). Risk ratios were estimated using marginal parameters from multilevel modified Poisson models with robust error variances and random intercepts for the facility to account for clustering. Results Data were drawn from 50 facilities and comprised 31,457 patient records from people living with HIV, of which 1306 (4.2%) were pediatric cases. Pediatric patients were more likely than adult patients to experience IIT (n=431, 33% vs n=7477, 23.4% at 6 months; P<.001). Additionally, pediatric patient records had higher data missingness, with 581 (44.5%) pediatric records missing at least 1 indicator of interest, compared to 7812 (25.9%) adult records (P<.001). Among pediatric patients, each additional indicator missing was associated with a 1.34 times greater likelihood of experiencing IIT at 6 months (95% CI 1.08-1.66; P=.008) and 1.24 times greater likelihood of experiencing IIT at 12 months (95% CI 1.05-1.46; P=.01). These relationships were not statistically significant for adult patients. Compared to pediatric patients with 0 missing indicators, pediatric patients with 1, 2, or 3 missing indicators were 1.59 (95% CI 1.26-2.01; P<.001), 1.74 (95% CI 1.02-2.97; P=.04), and 2.25 (95% CI 1.43-3.56; P=.001) times more likely to experience IIT at 6 months, respectively. Among adult patients, compared to patients with 0 indicators missing, having all 3 indicators missing was associated with being 1.32 times more likely to experience IIT at 6 months (95% CI 1.03-1.70; P=.03), while there was no association with IIT status for other levels of missingness. Conclusions These findings suggest that both EMR data quality and quality of care are lower for children living with HIV in Haiti. This underscores the need for further research into the mechanisms by which EMR data quality impacts the quality of care and patient outcomes among this population. Efforts to improve both EMR data quality and quality of care should consider prioritizing pediatric patients.
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Affiliation(s)
- Andrew M Secor
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kemar Célestin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Margareth Jasmin
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Nancy Puttkammer
- International Training and Education Center for Health, Seattle, WA, United States
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Osborne G, Valenti O, Jarvis J, Wentzel E, Vidaurre J, Clarke DF, Patel AD. Implementing American Academy of Neurology Quality Measures in Antigua Using Quality Improvement Methodology. Neurol Clin Pract 2024; 14:e200231. [PMID: 38152065 PMCID: PMC10751012 DOI: 10.1212/cpj.0000000000200231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 12/29/2023]
Abstract
Background and Objectives The American Academy of Neurology has developed quality measures related to various neurologic disorders. A gap exists in the implementation of these measures in the different health care systems. To date, there has been no electronic health care record nor implementation of quality measures in Antigua. Therefore, we aimed to increase the percent of patients who have epilepsy quality measures documented using standardized common data elements in the outpatient neurology clinic at Sir Lester Bird Medical Center from 0% to 80% per week by June 1, 2022 and sustain for 6 months. Methods We used the Institute for Health care Improvement Model for Improvement methodology. A data use agreement was implemented. Data were displayed using statistical process control charts and the American Society for Quality criteria to determine statistical significance and centerline shifts. Results Current and future state process maps were developed to determine areas of opportunity for interventions. Interventions were developed following a "Plan-Do-Study-Act cycle." One intervention was the creation of a RedCap survey and database to be used by health care providers during clinical patient encounters. Because of multiple interventions, we achieved a 100% utilization of the survey for clinical care. Discussion Quality improvement (QI) methodology can be used for implementation of quality measures in various settings to improve patient care outcomes without use of significant resources. Implementation of quality measures can increase efficiency in clinical delivery. Similar QI methodology could be implemented in other resource-limited countries of the Caribbean and globally.
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Affiliation(s)
- Gaden Osborne
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
| | - Olivia Valenti
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
| | - Juniella Jarvis
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
| | - Evelynne Wentzel
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
| | - Jorge Vidaurre
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
| | - Dave F Clarke
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
| | - Anup D Patel
- Neurology Department (GO, JJ), Sir Lester Bird Medical Centre, St. John's, Antigua, West Indies; The Center for Clinical Excellence (OV, ADP); Division of Neurology (EW, JV, ADP), Nationwide Children's Hospital, Columbus, OH; and Pediatric Neurology (DFC), Dell Medical School, the University of Texas at Austin
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Brewster RCL, Wu A, Carroll RW. Open source approaches for pediatric global health technologies. J Med Eng Technol 2023; 47:371-375. [PMID: 38717814 DOI: 10.1080/03091902.2024.2343682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/09/2024] [Indexed: 06/14/2024]
Abstract
Access to medical technologies is a critical component of universal access to care; however, the advancement of technologies for children has historically lagged behind those for adults. The small market size, anatomic and physiologic variability, and legal and ethical implications pose unique barriers to developing and commercialising paediatric biomedical innovations. These challenges are magnified in low-resource settings (LRS), which often lack appropriate regulatory oversight, support for service contracts, and supply chain capacity. The COVID-19 pandemic exposed shortcomings in the traditional industry model for medical technologies, while also catalysing open-source approaches to technology development and dissemination. Open-source pathways - where products are freely licenced to be distributed and modified - addressed key shortages in critical equipment. Relatedly, we argue that open-source approaches can accelerate paediatric global health technology development. Open-source approaches can be tailored to clinical challenges independent of economic factors, embrace low-cost manufacturing techniques, and can be highly customisable. Furthermore, diverse stakeholders, including families and patients, are empowered to participate in collaborative communities of practice. How to regulate the development, manufacture, and distribution of open-source technologies remains an ongoing area of exploration. The need for democratised innovation must be carefully balanced against the imperatives of safety and quality for paediatric-specific solutions. This can be achieved, in part, through close coordination between national regulatory agencies and decentralised networks where products can be peer-reviewed and tested. Altogether, there is significant potential for open source to advance more equitable and sustainable medical innovations for all children.
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Affiliation(s)
- Ryan C L Brewster
- Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Boston Medical Center, Boston, MA, USA
| | - Andrew Wu
- Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Ryan W Carroll
- Division of Critical Care Medicine, Massachusetts General Hospital for Children, Boston, MA, USA
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Mussi CC, Luz R, Damázio DDR, dos Santos EM, Sun V, Porto BSDS, Parma GOC, Cordioli LA, Birch RS, de Andrade Guerra JBSO. The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6971. [PMID: 37947529 PMCID: PMC10650123 DOI: 10.3390/ijerph20216971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.
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Affiliation(s)
- Clarissa Carneiro Mussi
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | - Ricardo Luz
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | - Dioni da Rosa Damázio
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | | | - Violeta Sun
- School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo 03828-000, Brazil;
| | | | - Gabriel Oscar Cremona Parma
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | - Luiz Alberto Cordioli
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
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Tun SYY, Madanian S. Clinical information system (CIS) implementation in developing countries: requirements, success factors, and recommendations. J Am Med Inform Assoc 2023; 30:761-774. [PMID: 36749093 PMCID: PMC10018272 DOI: 10.1093/jamia/ocad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Clinical Information System (CIS) usage can reduce healthcare costs over time, improve the quality of medical care and safety, and enhance clinical efficiency. However, CIS implementation in developing countries poses additional, different challenges from the developed countries. Therefore, this research aimed to systematically review the literature, gathering and integrating research findings on Success Factors (SFs) in CIS implementation for developing countries. This helps to integrate past knowledge and develop a set of recommendations, presented as a framework, for implementing CIS in developing countries. MATERIALS AND METHODS A systematic literature review was conducted, followed by qualitative data analysis on the published articles related to requirements and SF for CIS implementation. Eighty-three articles met the inclusion criteria and were included in the data analysis. Thematic analysis and cross-case analysis were applied to identify and categorize the requirements and SF for CIS implementation in developing countries. RESULTS Six major requirement categories were identified including project management, financial resources, government involvement and support, human resources, organizational, and technical requirements. Subcategories related to SF are classified under each major requirement. A set of recommendations is provided, presented in a framework, based on the project management lifecycle approach. CONCLUSION The proposed framework could support CIS implementations in developing countries while enhancing their rate of success. Future studies should focus on identifying barriers to CIS implementation in developing countries. The country-specific empirical studies should also be conducted based on this research's findings to match the local context.
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Affiliation(s)
- Soe Ye Yint Tun
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), Auckland 1010, New Zealand
| | - Samaneh Madanian
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), Auckland 1010, New Zealand
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Effects of a Digital Health Literacy Intervention on Porcine Cysticercosis Prevalence and Associated Household Practices in Iringa District, Tanzania. Pathogens 2023; 12:pathogens12010107. [PMID: 36678455 PMCID: PMC9862440 DOI: 10.3390/pathogens12010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
Digital health is considered an opportunity to engage a wider community in disease control for public health. It has been used in healthcare consultation, in medical treatments and in reporting emergencies. The current study developed digital health literacy content for public health education and assessed its effects on porcine cysticercosis prevalence, pig-keeping style and pig pen and latrine qualities. The intervention was designed and evaluated on the prevention and control of porcine cysticercosis in the Iringa District of southern Tanzania. A quasi-controlled field trial with pre-intervention and post-intervention assessments of porcine cysticercosis, pig-keeping style and pig pen and latrine qualities was conducted. A baseline cross-sectional study was followed immediately by digital health literacy intervention, which comprised educational messages on porcine cysticercosis shown on computer tablets or smartphones. Free internet access supported unsupervised community access. The 25-month post-intervention assessments revealed significantly increased pig confinement (20.1%) (p = 0.026) and pig pen quality (16.2%) (p = 0.025). However, the quality of household latrines (p = 0.453) was not improved, nor was there any significant effect on the prevalence of porcine cysticercosis (p = 0.231). The digital health literacy intervention suggests a strategy for wider and sustainable dissemination of educational messages for Taenia solium infection control.
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Basenero A, Neidel J, Ikeda DJ, Ashivudhi H, Mpariwa S, Kamangu JWN, Mpalang Kakubu MA, Hans L, Mutandi G, Jed S, Tjituka F, Hamunime N, Agins BD. Integrating hypertension and HIV care in Namibia: A quality improvement collaborative approach. PLoS One 2022; 17:e0272727. [PMID: 35951592 PMCID: PMC9371294 DOI: 10.1371/journal.pone.0272727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Hypertension (HTN) is highly prevalent among people with HIV (PWH) in Namibia, but screening and treatment for HTN are not routinely offered as part of HIV care delivery. We report the implementation of a quality improvement collaborative (QIC) to accelerate integration of HTN and HIV care within public-sector health facilities in Namibia. Methods Twenty-four facilities participated in the QIC with the aim of increasing HTN screening and treatment among adult PWH (>15 years). HTN was defined according to national treatment guidelines (i.e., systolic blood pressure >140 and/or diastolic blood pressure >90 across three measurements and at least two occasions), and decisions regarding initiation of treatment were made by physicians only. Teams from participating hospitals used quality improvement methods, monthly measurement of performance indicators, and small-scale tests of change to implement contextually tailored interventions. Coaching of sites was performed on a monthly basis by clinical officers with expertise in QI and HIV, and sites were convened as part of learning sessions to facilitate diffusion of effective interventions. Results Between March 2017 and March 2018, hypertension screening occurred as part of 183,043 (86%) clinical encounters at participating facilities. Among 1,759 PWH newly diagnosed with HTN, 992 (56%) were initiated on first-line treatment. Rates of treatment initiation were higher in facilities with an on-site physician (61%) compared to those without one (51%). During the QIC, facility teams identified fourteen interventions to improve HTN screening and treatment. Among barriers to implementation, teams pointed to malfunctions of blood pressure machines and stock outs of antihypertensive medications as common challenges. Conclusions Implementation of a QIC provided a structured approach for integrating HTN and HIV services across 24 high-volume facilities in Namibia. As rates of HTN treatment remained low despite ongoing facility-level changes, policy-level interventions—such as task sharing and supply chain strengthening—should be pursued to further improve delivery of HTN care among PWH beyond initial screening.
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Affiliation(s)
| | - Julie Neidel
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Daniel J. Ikeda
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | | | | | - Linea Hans
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Gram Mutandi
- U.S. Centers for Disease Control and Prevention, Windhoek, Namibia
| | - Suzanne Jed
- Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Pretoria, South Africa
| | | | | | - Bruce D. Agins
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- * E-mail:
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Robbiati C, Tosti ME, Mezzabotta G, Dal Maso F, Lulua Sachicola OM, Siene Tienabe P, Nsuka J, Simonelli M, Dente MG, Putoto G. Improving TB Surveillance and Patients' Quality of Care Through Improved Data Collection in Angola: Development of an Electronic Medical Record System in Two Health Facilities of Luanda. Front Public Health 2022; 10:745928. [PMID: 35433613 PMCID: PMC9009439 DOI: 10.3389/fpubh.2022.745928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/24/2022] [Indexed: 11/22/2022] Open
Abstract
TB Programs should promote the use of digital health platforms, like Electronic Medical Records (EMR) to collect patients' information, thus reducing data incompleteness and low accuracy and eventually improving patients' care. Nevertheless, the potential of digital health systems remains largely unexploited in low-resource settings. Angola is one of the 14 countries with a triple burden of TB, TB/HIV and MDR-TB (multidrug-resistant TB) and it is among the three countries, together with Congo and Liberia that have never completed a drug-resistance survey so far. The Sanatorium Hospital of Luanda and the Tuberculosis Dispensary of Luanda are the two reference health facilities in Luanda dealing with most of the TB cases, and they both rely entirely on paper-based data collection. The aim of this paper is to describe a three-stage process for the development of a TB EMR system in these two health facilities of Luanda and to share the lessons learned. The description is focused on the activities that took place from March 2019 to January 2020. Main lessons learned were identified in the importance of engaging all the stakeholders in the development process, in the mainstream of the “think digital” transition, in the promotion of a monitoring and evaluation (M&E) culture and in the planning of the system's sustainability. This approach may be replicated in similar contexts where the development of a TB EMR system is sought, and the lessons learned could assist and facilitate the programming of the interventions.
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Affiliation(s)
- Claudia Robbiati
- Doctors With Africa CUAMM, Padova, Italy
- *Correspondence: Claudia Robbiati
| | - Maria Elena Tosti
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | | | | | | | | | | | - Marco Simonelli
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
| | - Maria Grazia Dente
- National Center for Global Health, National Institute of Health (ISS), Rome, Italy
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Parrish C, Basu A, Fishman P, Koama JB, Robin E, Francois K, Honoré JG, Van Onacker JD, Puttkamme N. A sub-group evaluation of the multi-month dispensing strategy for differentiated HIV care: is personalization of care guidelines warranted in Haiti? BMC Health Serv Res 2022; 22:80. [PMID: 35034656 PMCID: PMC8761104 DOI: 10.1186/s12913-022-07475-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022] Open
Abstract
Background Differentiated care strategies are rapidly becoming the norm for HIV care delivery globally. Building upon an interest in tailoring antiretroviral therapy (ART) delivery for client-centered needs, the Ministry of Health and Population in Haiti formally endorsed multiple-month dispenses (MMD) in the 2016 national ART guidelines This study explores heterogeneity in retention in care with MMD for specific Haitian populations living with HIV and evaluates if a targeted algorithm for optimal ART prescription intervals is warranted in Haiti. Methods This study included ART-naïve individuals who started ART on or after January 1st, 2017 in Haiti. To identify subgroups in which to explore heterogeneity of retention, we implemented a double-lasso regression method to determine which individual characteristics would define the subgroups. Characteristics evaluated for potential subgroup definition included: sex, age category, WHO clinical stage, and body mass index category. We employed instrumental variable models to estimate the causal effect of increasing ART dispensing length on ART retention, by client subgroup. The outcome of interest was retention in care after one year in treatment. We then estimated the marginal effect of a 30-day increase to ART dispensing length to retention in care for each of these subgroups. Results There was evidence for heterogeneity in the effect of extending ART dispensing intervals on retention by WHO clinical stage. We observed significant improvements to retention in care at one year with a 30-day increase in ART dispense length for all subgroups defined by WHO clinical stages 1-4. The effects ranged from a 14.7% increase (95% CI: 12.4-17.0) to the likelihood of retention for people with HIV in WHO stage 1 to a 21.6% increase (95% CI: 18.7-24.5) to the likelihood of retention for those in WHO stage 3. Conclusions All the subgroups defined by WHO clinical stage experienced a benefit of extending ART intervals to retention in care at one year. Though the effect did differ slightly by WHO stage, the effects went in the same direction and were of similar magnitude. Therefore, a standardized recommendation for MMD among those living with HIV and new on ART is appropriate for Haiti treatment guidelines.
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Affiliation(s)
- Canada Parrish
- University of Washington, Magnuson Health Sciences Building, 1705 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Anirban Basu
- University of Washington, Magnuson Health Sciences Building, 1705 NE Pacific Street, Seattle, WA, 98195, USA
| | - Paul Fishman
- University of Washington, Magnuson Health Sciences Building, 1705 NE Pacific Street, Seattle, WA, 98195, USA
| | | | - Ermane Robin
- Programme National de Lutte contre le VIH/SIDA (PNLS), Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Kesner Francois
- Programme National de Lutte contre le VIH/SIDA (PNLS), Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Joëlle Deas Van Onacker
- Programme National de Lutte contre le VIH/SIDA (PNLS), Ministère de la Santé Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Nancy Puttkamme
- University of Washington, Magnuson Health Sciences Building, 1705 NE Pacific Street, Seattle, WA, 98195, USA
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Puttkammer N, Parrish C, Desir Y, Hyppolite N, Joseph N, Hall L, Honoré JG, Robin E, Perrin G, François K. Timely initiation of HIV antiretroviral therapy in Haiti 2004-2018: a retrospective cohort study. Rev Panam Salud Publica 2021; 45:e139. [PMID: 34815736 PMCID: PMC8603999 DOI: 10.26633/rpsp.2021.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe trends in timing of ART initiation for newly diagnosed people living with HIV before and after Haiti adopted its Test and Start policy for universal HIV antiretroviral therapy (ART) in July 2016, and to explore predictors of timely ART initiation for both newly and previously diagnosed people living with HIV following Test and Start adoption. METHODS This retrospective cohort study explored timing of ART initiation among 147 900 patients diagnosed with HIV at 94 ART clinics in 2004-2018 using secondary electronic medical record data. The study used survival analysis methods to assess time trends and risk factors for ART initiation. RESULTS Timely uptake of ART expanded with Test and Start, such that same-day ART initiation rates increased from 3.7% to 45.0%. However, only 11.0% of previously diagnosed patients initiated ART after Test and Start. In adjusted analyses among newly diagnosed people living with HIV, factors negatively associated with timely ART initiation included being a pediatric patient aged 0-14 years (HR = 0.23, p < 0.001), being male (HR = 0.92, p = 0.03), being 50+ years (HR = 0.87, p = 0.03), being underweight (HR = 0.79, p < 0.001), and having WHO stage 3 (HR = 0.73, p < 0.001) or stage 4 disease (HR = 0.49, p < 0.001). Variation in timely ART initiation by geographic department and health facility was observed. CONCLUSIONS Haiti has made substantial progress in scaling up Test and Start, but further work is needed to enroll previously diagnosed patients and to ensure rapid ART in key patient subgroups. Further research is needed on facility and geographic factors and on strategies for improving timely ART initiation among vulnerable subgroups.
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Affiliation(s)
- Nancy Puttkammer
- University of WashingtonWashingtonUnited States of AmericaUniversity of Washington, Washington, United States of America
| | - Canada Parrish
- University of WashingtonWashingtonUnited States of AmericaUniversity of Washington, Washington, United States of America
| | - Yrvel Desir
- National Association of State and Territorial AIDS DirectorsPort-au-PrinceHaitiNational Association of State and Territorial AIDS Directors, Port-au-Prince, Haiti
| | - Nathaelf Hyppolite
- Centre Haitien pour le Renforcement du Système de SantéPort-au-PrinceHaitiCentre Haitien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Nadjy Joseph
- National Association of State and Territorial AIDS DirectorsPort-au-PrinceHaitiNational Association of State and Territorial AIDS Directors, Port-au-Prince, Haiti
| | - Lara Hall
- United States Centers for Disease Control and PreventionPort-au-PrinceHaitiUnited States Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haitien pour le Renforcement du Système de SantéPort-au-PrinceHaitiCentre Haitien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Ermane Robin
- Ministère de Santé Publique et de la PopulationPort-au-PrinceHaitiMinistère de Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Georges Perrin
- United States Centers for Disease Control and PreventionPort-au-PrinceHaitiUnited States Centers for Disease Control and Prevention, Port-au-Prince, Haiti
| | - Kesner François
- Ministère de Santé Publique et de la PopulationPort-au-PrinceHaitiMinistère de Santé Publique et de la Population, Port-au-Prince, Haiti
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Adedeji T, Fraser H, Scott P. Implementing Electronic Health Records in Primary Care Using the Theory of Change: A Nigerian Case Study (Preprint). JMIR Med Inform 2021; 10:e33491. [PMID: 35969461 PMCID: PMC9412900 DOI: 10.2196/33491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/25/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Taiwo Adedeji
- School of Computing, University of Portsmouth, Portsmouth, United Kingdom
| | - Hamish Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, RI, United States
| | - Philip Scott
- Institute of Management and Health, University of Wales Trinity Saint David, Carmarthen, United Kingdom
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Parrish C, Basu A, Fishman P, Koama JB, Robin E, Francois K, Honoré JG, Van Onacker JD, Puttkammer N. Estimating the effect of increasing dispensing intervals on retention in care for people with HIV in Haiti. EClinicalMedicine 2021; 38:101039. [PMID: 34368659 PMCID: PMC8326717 DOI: 10.1016/j.eclinm.2021.101039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Multi-month dispensing (MMD) for antiretroviral therapy (ART) is a promising care strategy to improve HIV treatment adherence. The effectiveness of MMD in routine settings has not yet been evaluated within a causal inference framework. We analyzed data from a robust clinical data system to evaluate MMD in Haiti. METHODS We assessed 1-year retention in care among 21,880 ART-naïve HIV-positive persons who started ART on or after January 1, 2017, up until November 1, 2018. We used an instrumental variable analysis to estimate the causal impact of MMD. This approach was used to address potential selection into specific dispensing intervals because MMD is not randomly applied to individuals. FINDINGS We found that extending ART dispensing intervals increased the probability of retention at 12 months after ART initiation, with up to a 24·2%-point increase (95%CI: 21·9, 26·5) in the likelihood of retention with extending dispenses by 30 days for those receiving one-month dispenses. We observed statistically significant gains to retention with MMD with up to an approximately 4-month supply of ART; +5·1%-points (95%CI: 2·4,7·8). Increasing dispensing lengths for those already receiving ≥5-month supply of ART had a potentially negative effect on retention. INTERPRETATION MMD for ART is an effective service delivery strategy that improves care retention for new ART recipients. There is a potentially negative effect of increasing prescription lengths for those new ART recipients already receiving longer ART supplies, though more research is needed to characterize this effect given medication supplies of this length are not common for newer ART recipients.
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Affiliation(s)
- Canada Parrish
- University of Washington, 12054 42nd Ave S. Tukwila, Seattle, WA 98169, USA
| | - Anirban Basu
- University of Washington, 12054 42nd Ave S. Tukwila, Seattle, WA 98169, USA
| | - Paul Fishman
- University of Washington, 12054 42nd Ave S. Tukwila, Seattle, WA 98169, USA
| | | | - Ermane Robin
- Ministère de la Santé Publique et de la Population (MSPP), Programme National de Lutte contre le VIH/SIDA (PNLS), Port-au-Prince, Haiti
| | - Kesner Francois
- Ministère de la Santé Publique et de la Population (MSPP), Programme National de Lutte contre le VIH/SIDA (PNLS), Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Center Haïtien de Renforcement du Système Sanitaire (CHARESS), Port-au-Prince, Haiti
| | - Joëlle Deas Van Onacker
- Ministère de la Santé Publique et de la Population (MSPP), Programme National de Lutte contre le VIH/SIDA (PNLS), Port-au-Prince, Haiti
| | - Nancy Puttkammer
- University of Washington, 12054 42nd Ave S. Tukwila, Seattle, WA 98169, USA
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Providing Food and Nutrition Services during the COVID-19 Surge at the Javits New York Medical Station. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147430. [PMID: 34299881 PMCID: PMC8305190 DOI: 10.3390/ijerph18147430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation’s whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City’s (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city’s overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital’s opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.
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Celestin K, Allorant A, Virgin M, Marinho E, Francois K, Honoré JG, White C, Valles JS, Perrin G, De Kerorguen N, Flowers J, Balan JG, Koama JBT, Barnhart S, Puttkammer N. Short-Term Effects of the COVID-19 Pandemic on HIV Care Utilization, Service Delivery, and Continuity of HIV Antiretroviral Treatment (ART) in Haiti. AIDS Behav 2021; 25:1366-1372. [PMID: 33738698 PMCID: PMC7971405 DOI: 10.1007/s10461-021-03218-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
Introduction Our study describes changes in HIV care service delivery and continuity of HIV antiretroviral therapy (ART) for people living with HIV (PLHIV) during the 8 weeks before and after diagnosis of the first coronavirus disease 2019 (COVID-19) cases in Haiti on March 19, 2020. Methods Using data from 96 out of 167 health facilities offering ART services, we compared four ART program indicators: (1) count of HIV visits; (2) proportion of ART dispenses in community-based settings (DAC); (3) proportion of multi-month dispensing of ART medications > 6 months (> 6 m MMD); and (4) proportion of timely ART refills. We used uncontrolled interrupted time series (ITS) models to estimate slope and level changes in each indicator with the arrival of COVID-19. Results and Discussion From week 1 to week 16, the average number of HIV visits fell from 121.5 to 92.5 visits, the proportion of DAC rose from 22.7% to 36.7%, the proportion of > 6 m MMD rose from 29.4% to 48.4%, and the proportion of timely ART refills fell from 51.9% to 43.8%. The ITS models estimated abrupt increases of 36% in > 6 m MMD (p < 0.001) and 37% in DAC (p < 0.001) at the time of COVID-19 arrival, and no change after arrival of COVID-19. The was an abrupt decline of 18% in timely ART refills with the arrival of COVID-19 and a decline of 1% per week thereafter, both non-statistically significant changes. Conclusions The sudden changes in HIV service utilization represent dramatic adaptations needed to mitigate primary and secondary effects of the COVID-19 pandemic on PLHIV. This study underscores the urgency of optimizing ART delivery models in Haiti and beyond, in order to maintain progress toward HIV epidemic control.
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Toward Universal HIV Treatment in Haiti: Time Trends in ART Retention After Expanded ART Eligibility in a National Cohort From 2011 to 2017. J Acquir Immune Defic Syndr 2021; 84:153-161. [PMID: 32084052 DOI: 10.1097/qai.0000000000002329] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends universal antiretroviral therapy (ART) for persons living with HIV (PLWH), but evidence about effects of expanded ART access on ART retention in low-resource settings is limited. SETTING Haiti's Ministry of Health endorsed universal ART for pregnant women in March 2013 (Option B+) and for all PLWH in July 2016. This study included 51,579 ART patients from 2011 to 2017 at 94 hospitals and clinics in Haiti. METHODS This observational, retrospective cohort study described time trends in 6-month ART retention using secondary data, and compared results during 3 periods using an interrupted time series model: pre-Option B+ (period 1: 1/11-2/13), Option B+ (period 2: 3/13-6/16), and Test and Start (T&S, period 3: 7/16-9/17). RESULTS From the pre-Option B+ to the T&S period, the monthly count of new ART patients increased from 366/month to 877/month, and the proportion with same-day ART increased from 6.3% to 42.1% (P < 0.001). The proportion retained on ART after 6 months declined from 78.4% to 75.0% (P < 0.001). In the interrupted time series model, ART retention improved by a rate of 1.4% per quarter during the T&S period after adjusting for patient characteristics (adjusted incidence rate ratio = 1.014; 95% confidence interval: 1.002 to 1.026, P < 0.001). However, patients with same-day ART were 14% less likely to be retained compared to those starting ART >30 days after HIV diagnosis (adjusted incidence rate ratio = 0.86; 95% confidence interval: 0.84-0.89, P < 0.001). CONCLUSIONS Achieving targets for HIV epidemic control will require increasing ART retention and reducing the disparity in retention for those with same-day ART.
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Ekeland AG, Linstad LH. Elaborating Models of eHealth Governance: Qualitative Systematic Review. J Med Internet Res 2020; 22:e17214. [PMID: 33112247 PMCID: PMC7657726 DOI: 10.2196/17214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/23/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Large-scale national eHealth policy programs have gained attention not only for benefits but also for several unintended consequences and failed expectations. Given the complex and mixed accounts of the results, questions have been raised on how large-scale digitalization programs are governed to reach health policy goals of quality improvement and equal access along with necessary digital transformations. In this qualitative systematic review, we investigate the following question: How is governance implemented and considered in the studies included in the qualitative review? OBJECTIVE The aim of this study is to arrive at informed and recognizable conceptualizations and considerations of models of governance connected to eHealth, as presented and discussed in the scientific literature. In turn, we hope our results will help inform the discussion of how to govern such processes to obtain collectively negotiated objectives. METHODS A qualitative systematic review is a method for integrating or comparing with the findings from qualitative studies. It looks for "themes" or "constructs" that lie in or across individual qualitative studies. This type of review produces a narrative synthesis with thematic analysis and includes interpretive conceptual models. The goal is an interpretation and broadens the understanding of a particular phenomenon. We searched the PubMed database using predefined search terms and selected papers published from 2010 onwards. We specified the criteria for selection and quality assessment. RESULTS The search returned 220 papers. We selected 44 abstracts for full-text reading, and 11 papers were included for full-text synthesis. On the basis of the 11 papers, we constructed four governance models to categorize and conceptualize the findings. The models are political governance, normally depicting top-down processes; medical governance, which normally depicts bottom-up processes; the internet and global model, emphasizing international business strategies coupled with the internet; self-governance, which builds upon the development of the internet and Internet of Things, which has paved the way for personal governance and communication of one's own health data. CONCLUSIONS Collective negotiations between the nation-state and global policy actors, medical and self-governance actors, and global business and industry actors are essential. Technological affordances represent both positive and negative opportunities concerning the realization of health policy goals, and future studies should scrutinize this dynamic.
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Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services. Res Social Adm Pharm 2020; 16:1331-1343. [DOI: 10.1016/j.sapharm.2020.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/13/2019] [Accepted: 01/26/2020] [Indexed: 01/11/2023]
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Abstract
OBJECTIVE The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. METHODS A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. RESULTS By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders' attitudes, but not to evaluate specific implementations. CONCLUSION Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.
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Affiliation(s)
- Ursula H Hübner
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
| | - Nicole Egbert
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
| | - Georg Schulte
- Health Informatics Research Group, Dept. Business Management and Social Sciences Hochschule Osnabrück, Germany
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G3DMS: Design and Implementation of a Data Management System for the Diagnosis of Genetic Disorders. Healthcare (Basel) 2020; 8:healthcare8030196. [PMID: 32635303 PMCID: PMC7551506 DOI: 10.3390/healthcare8030196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023] Open
Abstract
Current health information systems used in genetic research centers and clinics in the Kingdom of Saudi Arabia have failed to enable researchers and health care physicians to utilize genetic and clinical data in their research. In this paper, we aim to design and implement a Genetic Disorders Diagnosis Data Management System (G3DMS) to support clinicians in the process of diagnosing genetic diseases and conducting genetic studies. A case study was undertaken to analyze a health information system in Saudi to understand its design problems via a brainstorming method. We then used the Barker’s system design method and a prototype to validate our proposed system via usability testing. This research has resulted in the development of the G3DMS that comprises: electronic data-capture forms for data entry; a customized query builder to display and modify patient data as well as form research queries; a module that allows historical data to be uploaded in the form of bulk data using a template; export data options to Excel and JavaScript Object Notation (JSON) format; and authorization access for healthcare researchers and clinicians. The G3DMS was implemented in the Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, Jeddah, KSA.
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Wang Y, Barnhart S, Francois K, Robin E, Kalou M, Perrin G, Hall L, Koama JB, Marinho E, Balan JG, Honoré JG, Puttkammer N. Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010-2017. BMC Infect Dis 2020; 20:283. [PMID: 32299389 PMCID: PMC7160963 DOI: 10.1186/s12879-020-04978-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Haiti initiated the scale-up of HIV viral load (VL) testing in 2015-2016, with plans to achieve 100% coverage for all patients on antiretroviral therapy (ART) for treatment of HIV/AIDS. In the absence of HIV drug susceptibility testing, VL testing is a key tool for monitoring response to ART and optimizing treatment results. This study describes trends in expanded use of VL testing, VL results, and use of second-line ART regimens, and explores the association between VL testing and second-line regimen switching in Haiti from 2010 to 2017. METHODS We conducted a retrospective cohort study with 66,042 patients drawn from 88 of Haiti's 160 national ART clinics. Longitudinal data from the iSanté electronic data system was used to analyze the trends of interest. We described patients' VL testing status in five categories based on up to two most recent VL test results: no test; suppressed; unsuppressed followed by no test; re-suppressed; and confirmed failure. Among those with confirmed failure, we described ART adherence level. Finally, we used Cox proportional hazards regression to estimate the risk of second-line regimen switching by VL testing status, after adjusting for other individual characteristics. RESULTS The number of patients who had tests done increased annually from 11 in 2010 to 18,828 in the first 9 months of 2017, while the number of second-line regimen switches rose from 21 to 279 during this same period. Compared with patients with no VL test, the hazard ratio (HR) for switching to a second-line regimen was 22.2 for patients with confirmed VL failure (95% confidence interval [CI] for HR: 18.8-26.3; p < 0.005) after adjustment for individual characteristics. Among patients with confirmed VL failure, 44.7% had strong adherence, and fewer than 20% of patients switched to a second-line regimen within 365 days of VL failure. CONCLUSIONS Haiti has significantly expanded access to VL testing since 2016. In order to promote optimal patient health outcomes, it is essential for Haiti to continue broadening access to confirmatory VL testing, to expand evidence-based initiatives to promote strong ART adherence, and to embrace timely switching for patients with confirmed ART failure despite strong ART adherence.
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Affiliation(s)
- Yu Wang
- Department of Global Health, University of Washington, Seattle, USA
| | - Scott Barnhart
- Departments of Medicine and Global Health, University of Washington, Seattle, USA
| | - Kesner Francois
- National AIDS Control Program, Haiti Ministry of Public Health and Population (PNLS/MSPP), Port-au-Prince, Haiti
| | - Ermane Robin
- National AIDS Control Program, Haiti Ministry of Public Health and Population (PNLS/MSPP), Port-au-Prince, Haiti
| | - Mireille Kalou
- Division of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Georges Perrin
- Division of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Lara Hall
- Division of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Jean Baptiste Koama
- Division of Global HIV and Tuberculosis Haiti, US Centers for Disease Control and Prevention, Atlanta, USA
| | - Elisma Marinho
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Jean Gabriel Balan
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé, Port-au-Prince, Haiti
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Seattle, USA
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Ikeda DJ, Basenero A, Murungu J, Jasmin M, Inimah M, Agins BD. Implementing quality improvement in tuberculosis programming: Lessons learned from the global HIV response. J Clin Tuberc Other Mycobact Dis 2019; 17:100116. [PMID: 31788558 PMCID: PMC6879975 DOI: 10.1016/j.jctube.2019.100116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The quality of care and treatment for tuberculosis (TB) is a major barrier in global efforts to end TB as a global health emergency. Despite a growing recognition of the need to measure, assure, and improve quality of TB services, implementation of quality improvement (QI) activities remains limited. Applying principles of systems thinking, continuous measurement, and root cause analysis, QI represents a proven approach for identifying and addressing performance gaps in healthcare delivery, with demonstrated success in low- and middle-income settings in the areas of HIV/AIDS, maternal, newborn, and child health, and infection control, among others. Drawing from lessons learned in the development of QI programming as part of the global response to HIV, we review key enablers to implementation that may assist NTPs in turning aspirations of high-quality service delivery into action. Under the umbrella of a formal quality management (QM) program, NTPs' attention to planning and coordination, commitment to tracking key processes of care, investment in QI capacity building, and integration of TB QI activities within efforts to advance universal health coverage provide a framework to sustainably implement QI activities.
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Affiliation(s)
- Daniel J Ikeda
- HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Joseph Murungu
- HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, Harare, Zimbabwe
| | - Margareth Jasmin
- HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | | | - Bruce D Agins
- HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.,Institute for Implementation Science in Public Health, City University of New York, New York, NY, USA
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