Expanding Medical Education for Local Health Promoters Among Remote Communities of the Peruvian Amazon: An Exploratory Study of an Innovative Program Model

Feasibility of Training Community Health Workers to Use Smartphone-Attached Microscopy for Point-of-Care Visualization of Soil-Transmitted Helminths in the Peruvian Amazon

The prevalence of soil-transmitted helminths (STH) is high in communities within the Peruvian Amazon despite repeated mass-drug administration, demanding alternative strategies of control. Smartphone-attached microscopy (SAM) permits visualization of STH from a small portable microscope through a smartphone screen, potentially providing an inexpensive and rapid method of STH visualization in communities where diagnostic laboratories with microscopes are inaccessible. In this study, a total of 45 community health workers who work within the health systems of Loreto, Peru, attended a 1-day training session with lectures and practicums on STH and SAM. Participants received a pre- and post-intervention questionnaire. Post-intervention, participants were significantly more confident using SAM and identifying parasite images, symptoms, transmission, and treatment (P ≤ 0.0045). Post-intervention, participants correctly labeled a median of five of seven SAM apparatus components and five of eight steps of Kato-Katz technique, were less likely to choose taking medicine to prevent parasite infection (P = 0.0075), and were more likely to select Kato-Katz technique as a type of diagnostic test (P < 0.0001). Most participants felt ready to use SAM in their communities and stated that it could help rural communities far from health centers or laboratories (24%); provide faster identification, results, diagnosis (19%); permit at-home or on-the-spot visualization (14%); and save money (14%). Results show that community health workers show a high level of willingness and competency to learn about both STH and SAM and may be a yet-unexplored practical method of augmenting STH visualization, bringing healthcare to communities in Loreto with poor access to diagnostic laboratories and clinics.

The Laro Kwo Project: A train the trainer model combined with mobile health technology for community health workers in Northern Uganda

Community Health Workers (CHWs) in low and middle income countries (LMICs) provide invaluable health resources to their community members. Best practices for developing and sustaining CHW training programs in LMICs have yet to be defined using rigorous standards and measures of effectiveness. With the expansion of digital health to LMICs, few studies have evaluated the role of participatory methodologies combined with the use of mobile health (mHealth) for CHW training program development. We completed a three-year prospective observational study aligned with the development of a community-based participatory CHW training program in Northern Uganda. Twenty-five CHWs were initially trained using a community participatory training methodology combined with mHealth and a train-the-trainer model. Medical skill competency exams were evaluated after the initial training and annually thereafter to assess retention with use of mHealth. After three years, CHWs who advanced to trainer status redeveloped all program materials using a mHealth application and trained a new cohort of 25 CHWs. Implementation of this methodology coupled with longitudinal mHealth training demonstrated an improvement in medical skills over three years among the original cohort of CHWs. Further, we found that the train-the-trainer model with mHealth was highly effective, as the new cohort of 25 CHWs trained by the original CHWs exhibited higher scores when tested on medical skill competencies. The combination of mHealth and participatory methodologies can facilitate the sustainability of CHW training programs in LMIC. Further investigations should focus on comparing specific mHealth modalities for training and clinical outcomes using similar combined methodologies.