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Kuvuna B, Nyanchoka M, Guleid F, Ogutu M, Tsofa B, Nzinga J. Examining the development and utilisation of Community-Based Health Information Systems (CBHIS) in Africa: A Scoping Review. Wellcome Open Res 2024; 9:485. [PMID: 39285927 PMCID: PMC11403289 DOI: 10.12688/wellcomeopenres.22780.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2024] [Indexed: 09/19/2024] Open
Abstract
Introduction The community-based health information system (CBHIS) is a vital component of the community health system, as it assesses community-level healthcare service delivery and generates data for community health programme planning, monitoring, and evaluation. CBHIS promotes data-driven decision-making, by identifying priority interventions and programs, guiding resource allocation, and contributing to evidence-based policy development. Objective This scoping review aims to comprehensively examine the use of CBHIS in African countries, focusing on data generation, pathways, utilization of CBHIS data, community accessibility to the data and use of the data to empower communities. Methods We utilised Arksey and O'Malley's scoping review methodology. We searched eight databases: PubMed, EMBASE, HINARI, Cochrane Library, Web of Science, Scopus, Google Scholar, and grey literature databases (Open Grey and OAIster). We synthesized findings using a thematic approach. Results Our review included 55 articles from 27 African countries, primarily in Eastern and Southern Africa, followed by West Africa. Most of the studies were either quantitative (42%) or qualitative (33%). Paper-based systems are primarily used for data collection in most countries, but some have adopted electronic/mobile-based systems or both. The data flow for CBHIS varies by country and the tools used for data collection. CBHIS data informs policies, resource allocation, staffing, community health dialogues, and commodity supplies for community health programmes. Community dialogue is the most common approach for community engagement, empowerment, and sharing of CBHIS data with communities. Community empowerment tends towards health promotion activities and health provider-led approaches. Conclusion CBHIS utilizes both paper-based and electronic-based systems to collect and process data. Nevertheless, most countries rely on paper-based systems. Most of the CBHIS investments have focused on its digitization and enhancing data collection, process, and quality. However, there is a need to shift the emphasis towards enabling data utilisation at the community level and community empowerment.
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Affiliation(s)
- Beatrice Kuvuna
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Moriasi Nyanchoka
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Fatuma Guleid
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Michael Ogutu
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Liverpool School of Tropical Medicine, Liverpool, England, UK
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Rotejanaprasert C, Armatrmontree P, Chienwichai P, Maude RJ. Perspectives and challenges in developing and implementing integrated dengue surveillance tools and technology in Thailand: a qualitative study. PLoS Negl Trop Dis 2024; 18:e0012387. [PMID: 39141623 PMCID: PMC11324148 DOI: 10.1371/journal.pntd.0012387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Dengue remains a persistent public health concern, especially in tropical and sub-tropical countries like Thailand. The development and utilization of quantitative tools and information technology show significant promise for enhancing public health policy decisions in integrated dengue control. However, the effective implementation of these tools faces multifaceted challenges and barriers that are relatively underexplored. METHODS This qualitative study employed in-depth interviews to gain a better understanding of the experiences and challenges of quantitative tool development and implementation with key stakeholders involved in dengue control in Thailand, using a phenomenological framework. A diverse range of participants, including public health workers and dengue control experts, participated in these interviews. The collected interview data were systematically managed and investigated using thematic analysis to extract meaningful insights. RESULTS The ability to collect dengue surveillance data and conduct ongoing analyses were contingent upon the availability of individuals possessing essential digital literacy and analytical skills, which were often in short supply. Furthermore, effective space-time early warning and precise data collection were hindered by the absence of user-friendly tools, efficient reporting systems, and complexities in data integration. Additionally, the study underscored the importance of the crucial role of community involvement and collaboration among organizations involved in integrated dengue surveillance, control and quantitative tool development. CONCLUSIONS This study employed a qualitative approach to gain a deeper understanding of the contextual intricacies surrounding the development and implementation of quantitative tools, which, despite their potential for strengthening public health policy decisions in dengue control, remain relatively unexplored in the Thai context. The findings yield valuable insights and recommendations for the development and utilization of quantitative tools to support dengue control in Thailand. This information also has the potential to support use of such tools to exert impact beyond dengue to a broader spectrum of diseases.
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Affiliation(s)
- Chawarat Rotejanaprasert
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Peerut Chienwichai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Richard J. Maude
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- The Open University, Milton Keynes, United Kingdom
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Holeman I, Citrin D, Albirair M, Puttkammer N, Ballard M, DeRenzi B, O'Donovan J, Wasunna B. Building consensus on common features and interoperability use cases for community health information systems: a Delphi study. BMJ Glob Health 2024; 9:e014001. [PMID: 38663904 PMCID: PMC11043741 DOI: 10.1136/bmjgh-2023-014001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Information systems for community health have become increasingly sophisticated and evidence-based in the last decade and they are now the most widely used health information systems in many low-income and middle-income countries. This study aimed to establish consensus regarding key features and interoperability priorities for community health information systems (CHISs). METHODS A Delphi study was conducted among a systematically selected panel of CHIS experts. This impressive pool of experts represented a range of leading global health institutions, with gender and regional balance as well as diversity in their areas of expertise. Through five rounds of iterative surveys and follow-up interviews, the experts established a high degree of consensus. We supplemented the Delphi study findings with a series of focus group discussions with 10 community health worker (CHW) leaders. RESULTS CHISs today are expected to adapt to a wide range of local contextual requirements and to support and improve care delivery. While once associated with a single role type (CHWs), these systems are now expected to engage other end users, including patients, supervisors, clinicians and data managers. Of 30 WHO-classified digital health interventions for care providers, experts identified 23 (77%) as being important for CHISs. Case management and care coordination features accounted for more than one-third (14 of 37, 38%) of the core features expected of CHISs today, a higher proportion than any other category. The highest priority use cases for interoperability include CHIS to health management information system monthly reporting and CHIS to electronic medical record referrals. CONCLUSION CHISs today are expected to be feature-rich, to support a range of user roles in community health systems, and to be highly adaptable to local contextual requirements. Future interoperability efforts, such as CHISs in general, are expected not only to move data efficiently but to strengthen community health systems in ways that measurably improve care.
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Affiliation(s)
- Isaac Holeman
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - David Citrin
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Medic, San Francisco, CA, USA
- Department of Anthropology, University of Washington, Seattle, Washington, USA
| | - Mohamed Albirair
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nancy Puttkammer
- Department of Global Health, University of Washington, Seattle, Washington, USA
- International Training and Education Center for Health, University of Washington, Seattle, Washington, USA
| | - Madeleine Ballard
- Community Health Impact Coalition, New York, New York, USA
- Arnhold Institute for Global Health, Icahn School of Medicine, New York, New York, USA
| | - Brian DeRenzi
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Dimagi, Cape Town, Western Cape, South Africa
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Aranda Z, Vázquez S, Gopaluni A, Martínez L, Ramírez M, Jiménez A, Bernal D, Rodríguez AL, Chacón S, Vargas B, Fulcher IR, Barnhart DA. Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021. BMC Health Serv Res 2024; 24:97. [PMID: 38233915 PMCID: PMC10795220 DOI: 10.1186/s12913-024-10590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.
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Affiliation(s)
- Zeus Aranda
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México.
- Departamento de Salud, El Colegio de La Frontera Sur, San Cristóbal de Las Casas, Chiapas, México.
| | - Sandra Vázquez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Anuraag Gopaluni
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Mayra Ramírez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Ariwame Jiménez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Daniel Bernal
- Escuela de Gobierno y Transformación Pública, Instituto Tecnológico de Monterrey, Ciudad de Mexico, México
| | - Ana L Rodríguez
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Selene Chacón
- Instituto Nacional de Salud Pública/Escuela de Salud Pública de México, Cuernavaca, Morelos, México
| | - Bruno Vargas
- Partners In Health Mexico (Compañeros En Salud), Compañeros En Salud AC, Calle Primera Pte. Sur 25, Colonia Centro, Ángel Albino Corzo, 30370, Chiapas, México
| | - Isabel R Fulcher
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Harvard Data Science Initiative, Boston, MA, USA
| | - Dale A Barnhart
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Partners In Health Rwanda (Inshuti Mu Buzima), Kigali, Rwanda
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Nepal P, Subedee A, Shakya H, Poudel S, Joshi S, Karki K, Bajracharya D, Prentiss T, Kaljee L, Acharya Y. Protocol for a randomized controlled trial on community education and surveillance on antibiotics use among young children in Nepal. Contemp Clin Trials Commun 2023; 34:101177. [PMID: 37409187 PMCID: PMC10318443 DOI: 10.1016/j.conctc.2023.101177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the top ten threats to global health. There exists limited empirical evidence on effective approaches to address this threat. In low- and middle-income countries (LMICs), one of the primary drivers of AMR is easy access to antibiotics without prescriptions, in particular from community pharmacies. Interventions to reduce non-prescribed use of antibiotics and surveillance systems to track such usage are critically needed. This protocol describes a study that aims to test the effect of an educational intervention targeted to parents of young children on non-prescribed antibiotics consumption in Nepal and to track such consumption using a phone-based application. Methods The study is a clustered randomized controlled trial, in which we randomly assign 40 urban wards of Kathmandu Valley to either treatment group or control group, and randomly select 24 households in each ward. Households in the treatment group will receive an education intervention consisting of an "AMR pitch" (an in-person interaction that lasts up to an hour) by community nurses, videos and text messages on AMR every two weeks, and a brochure. We will conduct a survey at baseline with the parents of children ages 6 months to 10 years and track consumption of antibiotics and health care use among these children for a period of 6 months using a phone-based application. Conclusion While the study will primarily inform future policy and programmatic efforts to reduce AMR in Nepal, the study-both the education intervention and the surveillance system-can serve as a prototype for tackling AMR in other similar settings.
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Affiliation(s)
- Prajwol Nepal
- University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - Anup Subedee
- Public Health Concern Trust, Nepal & Kirtipur Hospital, Nepal
| | | | | | - Supriya Joshi
- The Pennsylvania State University, University Park, USA
| | - Kshitij Karki
- Group for Technical Assistance (G.T.A.) Foundation, Kathmandu, Nepal
| | | | - Tyler Prentiss
- Global Health Initiative, Henry Ford Health, Detroit, USA
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health, Detroit, USA
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Feldacker C, Pienaar J, Wasunna B, Ndebele F, Khumalo C, Day S, Tweya H, Oni F, Sardini M, Adhikary B, Waweru E, Wafula MB, Dixon A, Jafa K, Su Y, Sherr K, Setswe G. Expanding the Evidence on the Safety and Efficiency of 2-Way Text Messaging-Based Telehealth for Voluntary Medical Male Circumcision Follow-up Compared With In-Person Reviews: Randomized Controlled Trial in Rural and Urban South Africa. J Med Internet Res 2023; 25:e42111. [PMID: 37159245 DOI: 10.2196/42111] [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: 08/22/2022] [Revised: 12/22/2022] [Accepted: 02/24/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND There is a dearth of high-quality evidence from digital health interventions in routine program settings in low- and middle-income countries. We previously conducted a randomized controlled trial (RCT) in Zimbabwe, demonstrating that 2-way texting (2wT) was safe and effective for follow-up after adult voluntary medical male circumcision (VMMC). OBJECTIVE To demonstrate the replicability of 2wT, we conducted a larger RCT in both urban and rural VMMC settings in South Africa to determine whether 2wT improves adverse event (AE) ascertainment and, therefore, the quality of follow-up after VMMC while reducing health care workers' workload. METHODS A prospective, unblinded, noninferiority RCT was conducted among adult participants who underwent VMMC with cell phones randomized in a 1:1 ratio between 2wT and control (routine care) in North West and Gauteng provinces. The 2wT participants responded to a daily SMS text message with in-person follow-up only if desired or an AE was suspected. The control group was requested to make in-person visits on postoperative days 2 and 7 as per national VMMC guidelines. All participants were asked to return on postoperative day 14 for study-specific review. Safety (cumulative AEs ≤day 14 visit) and workload (number of in-person follow-up visits) were compared. Differences in cumulative AEs were calculated between groups. Noninferiority was prespecified with a margin of -0.25%. The Manning score method was used to calculate 95% CIs. RESULTS The study was conducted between June 7, 2021, and February 21, 2022. In total, 1084 men were enrolled (2wT: n=547, 50.5%, control: n=537, 49.5%), with near-equal proportions of rural and urban participants. Cumulative AEs were identified in 2.3% (95% CI 1.3-4.1) of 2wT participants and 1.0% (95% CI 0.4-2.3) of control participants, demonstrating noninferiority (1-sided 95% CI -0.09 to ∞). Among the 2wT participants, 11 AEs (9 moderate and 2 severe) were identified, compared with 5 AEs (all moderate) among the control participants-a nonsignificant difference in AE rates (P=.13). The 2wT participants attended 0.22 visits, and the control participants attended 1.34 visits-a significant reduction in follow-up visit workload (P<.001). The 2wT approach reduced unnecessary postoperative visits by 84.8%. Daily response rates ranged from 86% on day 3 to 74% on day 13. Among the 2wT participants, 94% (514/547) responded to ≥1 daily SMS text messages over 13 days. CONCLUSIONS Across rural and urban contexts in South Africa, 2wT was noninferior to routine in-person visits for AE ascertainment, demonstrating 2wT safety. The 2wT approach also significantly reduced the follow-up visit workload, improving efficiency. These results strongly suggest that 2wT provides quality VMMC follow-up and should be adopted at scale. Adaptation of the 2wT telehealth approach to other acute follow-up care contexts could extend these gains beyond VMMC. TRIAL REGISTRATION ClinicalTrials.gov NCT04327271; https://www.clinicaltrials.gov/ct2/show/NCT04327271.
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Affiliation(s)
- Caryl Feldacker
- Department of Global Health, University of Washington, Seattle, WA, United States
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA, United States
| | | | | | | | | | - Sarah Day
- Centre for HIV-AIDS Prevention Studies (CHAPS), Johannesburg, South Africa
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Hannock Tweya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | | | | | | | | | | | | | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Geoffrey Setswe
- Aurum Institute, Johannesburg, South Africa
- Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa
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Oliphant NP, Sy Z, Koné B, Berthé M, Beebe M, Samake M, Diabaté M, Tounkara S, Diarra B, Diarra AB, Diawara CH, Yakimova T, Florisse S, Jackson D, Ray N, Doherty T. Improving the efficiency of scale-up and deployment of community health workers in Mali: A geospatial analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000626. [PMID: 36962591 PMCID: PMC10021816 DOI: 10.1371/journal.pgph.0000626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Optimising the scale and deployment of community health workers (CHWs) is important for maximizing geographical accessibility of integrated primary health care (PHC) services. Yet little is known about approaches for doing so. We used geospatial analysis to model optimised scale-up and deployment of CHWs in Mali, to inform strategic and operational planning by the Ministry of Health and Social Development. Accessibility catchments were modelled based on travel time, accounting for barriers to movement. We compared geographic coverage of the estimated population, under-five deaths, and plasmodium falciparum (Pf) malaria cases across different hypothetical optimised CHW networks and identified surpluses and deficits of CHWs compared to the existing CHW network. A network of 15 843 CHW, if optimally deployed, would ensure that 77.3% of the population beyond 5 km of the CSCom (community health centre) and CSRef (referral health facility) network would be within a 30-minute walk of a CHW. The same network would cover an estimated 59.5% of U5 deaths and 58.5% of Pf malaria cases. As an intermediary step, an optimised network of 4 500 CHW, primarily filling deficits of CHW in the regions of Kayes, Koulikoro, Sikasso, and Ségou would ensure geographic coverage for 31.3% of the estimated population. There were no important differences in geographic coverage percentage when prioritizing CHW scale-up and deployment based on the estimated population, U5 deaths, or Pf malaria cases. Our geospatial analysis provides useful information to policymakers and planners in Mali for optimising the scale-up and deployment of CHW and, in turn, for maximizing the value-for-money of resources of investment in CHWs in the context of the country's health sector reform. Countries with similar interests in optimising the scale and deployment of their CHW workforce may look to Mali as an exemplar model from which to learn.
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Affiliation(s)
- Nicholas P. Oliphant
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Zeynabou Sy
- Faculty of Medicine, GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Brehima Koné
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l’Hygiène Publique, Bamako, Mali
| | - Mohamed Berthé
- Ministère de la Santé et du Développement Social du Mali, L’Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
| | - Madeleine Beebe
- Ministère de la Santé et du Développement Social du Mali, L’Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
| | - Moussa Samake
- Ministère de la Santé et du Développement Social du Mali, Cellule de Planification et de Statistique Secteur Santé, Développment Social et Promotion de la Famille, Bamako, Mali
| | - Mamoutou Diabaté
- Ministère de la Santé et du Développement Social du Mali, Direction National de la Santé, Bamako, Mali
| | - Salimata Tounkara
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l’Hygiène Publique, Bamako, Mali
| | - Borodjan Diarra
- Ministère de la Santé et du Développement Social du Mali, Direction Générale de la Santé et de l’Hygiène Publique, Bamako, Mali
| | - Amadou B. Diarra
- Ministère de la Santé et du Développement Social du Mali, L’Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
- MUSO, Bamako, Mali
| | - Cheickna H. Diawara
- Ministère de la Santé et du Développement Social du Mali, L’Unité de Mise en Œuvre de Renforcement du Système de Santé, Bamako, Mali
- MUSO, Bamako, Mali
| | - Tsvetana Yakimova
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Sonia Florisse
- The Global Fund to Fight AIDS, Tuberculosis, and Malaria, Geneva, Switzerland
| | - Debra Jackson
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- London School of Hygiene and Tropical Medicine (LSHTM), Centre for Maternal Adolescent Reproductive and Child Health (MARCH), London, United Kingdom
| | - Nicolas Ray
- Faculty of Medicine, GeoHealth group, Institute of Global Health, University of Geneva, Geneva, Switzerland
- Institute for Environmental Sciences, University of Geneva, Geneva, Switzerland
| | - Tanya Doherty
- University of the Western Cape, School of Public Health, Bellville, Republic of South Africa
- South African Medical Research Council, Health Systems Research Unit, Tygerberg, Republic of South Africa
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Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe. PLOS DIGITAL HEALTH 2022; 1:e0000066. [PMID: 36812548 PMCID: PMC9931231 DOI: 10.1371/journal.pdig.0000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
Abstract
Adult medical male circumcision (MC) is safe: global notifiable adverse event (AE) rates average below 2.0%. With Zimbabwe's shortage of health care workers (HCWs) compounded by COVID-19 constraints, two-way text-based (2wT) MC follow-up may be advantageous over routinely scheduled in-person reviews. A 2019 randomized control trial (RCT) found 2wT to be safe and efficient for MC follow-up. As few digital health interventions successfully transition from RCT to scale, we detail the 2wT scale-up approach from RCT to routine MC practice comparing MC safety and efficiency outcomes. After the RCT, 2wT transitioned from a site-based (centralized) system to hub-and-spoke model for scale-up where one nurse triaged all 2wT patients, referring patients in need to their local clinic. No post-operative visits were required with 2wT. Routine patients were expected to attend at least one post-operative review. We compare 1) AEs and in-person visits between 2wT men from RCT and routine MC service delivery; and 2) 2wT-based and routine follow-up among adults during the 2wT scale-up period, January to October 2021. During scale-up period, 5084 of 17417 adult MC patients (29%) opted into 2wT. Of the 5084, 0.08% (95% CI: 0.03, 2.0) had an AE and 71.0% (95% CI: 69.7, 72.2) responded to ≥1 daily SMS, a significant decrease from the 1.9% AE rate (95% CI: 0.7, 3.6; p<0.001) and 92.5% response rate (95% CI: 89.0, 94.6; p<0.001) from 2wT RCT men. During scale-up, AE rates did not differ between routine (0.03%; 95% CI: 0.02, 0.08) and 2wT (p = 0.248) groups. Of 5084 2wT men, 630 (12.4%) received telehealth reassurance, wound care reminders, and hygiene advice via 2wT; 64 (19.7%) were referred for care of which 50% had visits. Similar to RCT outcomes, routine 2wT was safe and provided clear efficiency advantages over in-person follow-up. 2wT reduced unnecessary patient-provider contact for COVID-19 infection prevention. Rural network coverage, provider hesitancy, and the slow pace of MC guideline changes slowed 2wT expansion. However, immediate 2wT benefits for MC programs and potential benefits of 2wT-based telehealth for other health contexts outweigh limitations.
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