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Ndenkeh JJN, Nelson LE, Bogning A, Yumo H, Bediang G, Njih E, Fotso D, Abu-Ba'are GR, Kouanfack C, Ni Z. The Feasibility and Acceptability of Using Mobile Applications for HIV Testing, Prevention, and Treatment Among Adolescent Girls and Young Women in Cameroon: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:210-221. [PMID: 38569188 PMCID: PMC11037457 DOI: 10.1097/jnc.0000000000000469] [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] [Indexed: 04/05/2024]
Abstract
ABSTRACT Adolescent girls and young women (AGYW) are vulnerable populations to HIV/AIDS. We conducted a cross-sectional survey among 637 AGYW in Cameroon to study the feasibility and willingness to use mobile applications (apps) for HIV testing, prevention, and treatment. We found that phone ownership is high among AGYW, where 93.9% ( n = 598) of them (median age: 22 years, interquartile range: 21-24 years) had access to a smartphone, 49.5% ( n = 315) frequently searched for health information, and 48.9% ( n = 312) frequently used health-related apps. AGYW's willingness to use mobile apps for HIV testing, prevention, and treatment were 87.9% ( n = 560), 84.4% ( n = 538), and 84.9% ( n = 541), respectively. The high willingness to use apps was associated with older age, HIV testing, and searching for health information on a phone. Barriers to willingness included having no internet access, concerns about internet cost and privacy, and lack of consistent access to a smartphone.
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Affiliation(s)
- Jackson Jr Nforbewing Ndenkeh
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - LaRon E. Nelson
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Ange Bogning
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Habakkuk Yumo
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Georges Bediang
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Earnest Njih
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Durand Fotso
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Gamji Rabiu Abu-Ba'are
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Charles Kouanfack
- Jackson Jr Nforbewing Ndenkeh, PhD, MPH, is a Postdoctoral Associate, School of Nursing, Yale University, New Haven, Connecticut, USA
- LaRon E. Nelson, PhD, RN, FNP, FNAP, FNYAM, FAAN, is an Independence Foundation Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
- Ange Bogning, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Habakkuk Yumo, PhD, MD, is a Co-Founder, Research for Development (R4D) International, Yaounde, Cameroon & a Consultant, Transatlantic Health Solutions LLC, Texas, USA
- Georges Bediang, PhD, MPH, MD, is a Research Affiliate, Research for Development (R4D) International, Yaounde, Cameroon & a Senior Lecturer, Faculty of Medicine, and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
- Earnest Njih, PhD, MD, is a Senior Lecturer, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Durand Fotso, MD, MPH, is a Postgraduate, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Gamji Rabiu Abu-Ba'are, PhD, MPH, is an Assistant Professor, School of Nursing, University of Rochester, Rochester, New York, USA
- Charles Kouanfack, PhD, is a Professor, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
- Zhao Ni, PhD, BMed, RN, FAAN, is an Assistant Professor, School of Nursing and Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, USA
| | - Zhao Ni
- Corresponding author: Zhao Ni, e-mail:
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Bröcker E, Scheffler F, Suliman S, Olff M, Seedat S. Participants' experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting. Glob Ment Health (Camb) 2024; 11:e36. [PMID: 38572257 PMCID: PMC10988172 DOI: 10.1017/gmh.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
We explored participants' experiences of a counsellor-supported PTSD Coach mobile application intervention (PTSD Coach-CS) in a randomised controlled trial. PTSD Coach-CS participants, who received the intervention and self-completed a custom-designed questionnaire at intervention completion were included (n = 25; female = 20; ages 19-59; isiXhosa = 22). This questionnaire comprised questions regarding the feasibility, acceptability and potential impact of the PTSD Coach-CS intervention, and general psychological support in our setting. Data were analysed using Braun and Clarke's thematic analysis. Three main themes emerged. (i) Participants' largely positive experiences of treatment procedures included the safe space created by the counsellor support in combination with the PTSD Coach application, allowing them to learn about and understand their lived experiences, and to accept their PTSD diagnoses. (ii) Positive perceptions of the PTSD Coach application, yet raising important concerns (e.g., lack of family involvement) for future consideration. (iii) Intervention-specific and systemic treatment barriers (e.g., stigma) providing important information to inform and increase the usefulness of the PTSD Coach-CS intervention. The findings suggest that the PTSD Coach-CS intervention may help address the need for access to suitable care for South African adults with PTSD. Some contextual barriers must be considered in further intervention implementation.
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Affiliation(s)
- Erine Bröcker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Freda Scheffler
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sharain Suliman
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Zinck MJ, Minichiello SN, Fick CA, Sawry S, Fonner VA. Virtual case management: a differentiated approach to HIV prevention, treatment, and care. AIDS 2024; 38:145-151. [PMID: 37861692 PMCID: PMC10734782 DOI: 10.1097/qad.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
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Martyn E, O'Regan S, Harris P, Leonard M, Veitch M, Sultan B, Matthews PC, Ghosh I, Story A, Surey J. Hepatitis B virus (HBV) screening, linkage and retention-in-care in inclusion health populations: Evaluation of an outreach screening programme in London. J Infect 2024; 88:167-172. [PMID: 38159579 PMCID: PMC7615690 DOI: 10.1016/j.jinf.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES We evaluated a hepatitis B virus (HBV) screening programme, delivered by a specialist pan-London multidisciplinary outreach team, to understand population characteristics and care cascade among people who experience extreme social exclusion (Inclusion Health (IH) groups). METHODS Point-of-care HBV screening was performed in temporary accommodation for people experiencing homelessness (PEH) and people seeking asylum (initial accommodation centres, IACs) via a mobile unit staffed by peers with lived experience, nurses, and doctors. We analysed demographics and HBV characteristics of adults screened between May 2020 and January 2022. We ascertained linkage-to-care (LTC), retention-in-care (RIC) and loss-to-follow-up (LTFU). People LTFU were contacted by peers to re-engage in care. RESULTS 2473 people were screened: 809 in IACs, 1664 in other temporary accommodation. Overall hepatitis B surface antigen (HBsAg) prevalence was 1.7% (43/2473), highest in IACs (3.5%, 28/809). LTC within 3 months was 56% (24/43) and RIC, 87% (26/30). LTC was higher when referred to a local IH-specialist hepatitis service, compared to other services (77%, 17/22 vs 33%, 7/21; p = 0.006). LTFU was 30% (13/43), reduced to 21% (9/43) after intervention by peers. CONCLUSION Our findings support outreach screening among IH populations and peer-supported linkage to IH-specialist hepatitis services. We recommend increased HBV testing and HBV-specific IH specialist services.
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Affiliation(s)
- Emily Martyn
- London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK; The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK.
| | - Sive O'Regan
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Philippa Harris
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Mark Leonard
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Martha Veitch
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Binta Sultan
- Mortimer Market Centre, Central and North London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK; Institute of Global Health, University College London, Gower St, London WC1E 6BT, UK
| | - Philippa C Matthews
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK; Mortimer Market Centre, Central and North London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK; Division of Infection and Immunity, University College London, Gower St, London WC1E 6BT, UK; Department of Infectious Diseases, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK
| | - Indrajit Ghosh
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK; Mortimer Market Centre, Central and North London NHS Foundation Trust, Capper Street, London WC1E 6JB, UK
| | - Alistair Story
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK; Collaborative Centre for Inclusion Health, University College London, Gower St, London WC1E 6BT, UK
| | - Julian Surey
- Find & Treat Service, Division of Infection, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London NW1 2BU, UK; Institute of Global Health, University College London, Gower St, London WC1E 6BT, UK; Universidad Autonoma de Madrid, Ciudad Universitaria de Cantoblanco, Madrid 28049, Spain
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Kone N, Cassim N, Maposa I, George JA. Diabetic control and compliance using glycated haemoglobin (HbA1C) testing guidelines in public healthcare facilities of Gauteng province, South Africa. PLoS One 2023; 18:e0278789. [PMID: 37585388 PMCID: PMC10431606 DOI: 10.1371/journal.pone.0278789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/02/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This study aimed at evaluating diabetic control and compliance with testing guidelines, across healthcare facilities of Gauteng Province, South Africa, as well as factors associated with time to achieve control. South Africa's estimated total unmet need for care for patients with type 2 diabetes mellitus is 80%. RESEARCH DESIGN, METHODS AND FINDINGS The data of 511 781 patients were longitudinally evaluated. Results were reported by year, age category, race, sex, facility and test types. HbA1C of ≤7% was reported as normal, >7 - ≤9% as poor control and >9% as very poor control. The chi-squared test was used to assess the association between a first-ever HbA1C status and variables listed above. The Kaplan-Meier analysis was used to assess probability of attaining control among those who started with out-of-control HbA1C. The extended Cox regression model assessed the association between time to attaining HbA1C control from date of treatment initiation and several covariates. We reported hazard ratios, 95% confidence intervals and p-values. Data is reported for 511 781 patients with 705 597 laboratory results. Poorly controlled patients constituted 51.5%, with 29.6% classified as very poor control. Most poorly controlled patients had only one test over the entire study period. Amongst those who started with poor control status and had at least two follow-up measurements, the likelihood of achieving good control was higher in males (adjusted Hazard Ratio (aHR) = 1.16; 95% CI:1.12-1.20; p<0.001) and in those attending care at hospitals (aHR = 1.99; 95% CI:1.92-2.06; p<0.001). CONCLUSION This study highlights poor adherence to guidelines for diabetes monitoring.
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Affiliation(s)
- Ngalulawa Kone
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Naseem Cassim
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jaya Anna George
- Department of Chemical Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- National Health Laboratory Service (NHLS), Johannesburg, South Africa
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Cassim N, Olsen F, Stewart-Isherwood L, da Silva MP, Stevens WS. Assessing the cost and utilization of SMS printers by primary health care facilities: lessons learned from South Africa. J Public Health Afr 2023; 14:2253. [PMID: 37347071 PMCID: PMC10280246 DOI: 10.4081/jphia.2023.2253] [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: 06/24/2022] [Accepted: 08/03/2022] [Indexed: 06/23/2023] Open
Abstract
Background Historically, paper-based laboratory reports were delivered by couriers to health facilities resulting in post-analytical delays. As a result, short message service (SMS) printers were deployed to fill this gap, with the global data service platform (GDSP) being primarily used to facilitate deployment. In addition, these printers generate binary and quantitative information that can be used to assess utilization. Objective The objective of this study was to determine the costs and utilization of the SMS printer program in South Africa. Methods A cost analysis for 2020 was undertaken. We determined annual equivalent costs (AEC) for staffing, printers, fixed costs related to the national coordinator, consumables, travel costs, database support/hosting/dashboard development, printer repairs, and results transmission. The main outcome of interest was the cost per SMS printer result delivered. Data were extracted to assess utilization as follows: i) months active (based on internet protocol data); ii) signal; iii) battery strength. Results There were 4,450,116 results delivered to printers that were situated at 2232 primary health care facilities. An AEC of $687,727 was reported, with a cost per result delivered of $0.1618. The SMS printers contributed 73.52% to the total AEC. Overall, 90% of the printers were GDSP based, of which only 69.5% were determined to be active. The majority of active printers reported a signal strength of ≥60% and a battery strength of ≥6 volts. Conclusion Although the SMS printer program has the potential to reduce post-analytical delays, pathology services should migrate to an end-to-end electronic interface to improve patient care.
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Affiliation(s)
- Naseem Cassim
- Department of Molecular Medicine and Hematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
- National Health Laboratory Service, National Priority Programme, Johannesburg, South Africa
| | - Floyd Olsen
- National Health Laboratory Service, National Priority Programme, Johannesburg, South Africa
| | - Lynsey Stewart-Isherwood
- Department of Molecular Medicine and Hematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
| | - Manuel Pedro da Silva
- Department of Molecular Medicine and Hematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
- National Health Laboratory Service, National Priority Programme, Johannesburg, South Africa
| | - Wendy Susan Stevens
- Department of Molecular Medicine and Hematology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
- National Health Laboratory Service, National Priority Programme, Johannesburg, South Africa
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7
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Nicol E, Basera W, Mukumbang FC, Cheyip M, Mthethwa S, Lombard C, Jama N, Pass D, Laubscher R, Bradshaw D. Linkage to HIV Care and Early Retention in Care Rates in the Universal Test-and-Treat Era: A Population-based Prospective Study in KwaZulu-Natal, South Africa. AIDS Behav 2023; 27:1068-1081. [PMID: 36098845 PMCID: PMC10020822 DOI: 10.1007/s10461-022-03844-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/01/2022]
Abstract
HIV linkage, and retention are key weaknesses in South Africa's national antiretroviral therapy (ART) program, with the greatest loss of patients in the HIV treatment pathway occurring before ART initiation. This study investigated linkage-to and early-retention-in-care (LTRIC) rates among adults newly diagnosed with HIV in a high-HIV prevalent rural district. We conducted an observational prospective cohort study to investigate LTRIC rates for adults with a new HIV diagnosis in South Africa. Patient-level survey and clinical data were collected using a one-stage-cluster design from 18 healthcare facilities and triangulated between HIV and laboratory databases and registered deaths from Department of Home Affairs. We used Chi-square tests to assess associations between categorical variables, and results were stratified by HIV status, sex, and age. Of the 5,637 participants recruited, 21.2% had confirmed HIV, of which 70.9% were women, and 46.5% were aged 25-34 years. Although 82.7% of participants were linked-to-care within 3 months, only 46.1% remained-in-care 12 months after initiating ART and 5.2% were deceased. While a significantly higher proportion of men were linked-to-care at 3 months compared to women, a significant proportion of women (49.5%) remained-in-care at 12 months than men (38.0%). Post-secondary education and child support grants were significantly associated with retention. We found high linkage-to-care rates, but less than 50% of participants remained-in-care at 12 months. Significant effort is required to retain people living with HIV in care, especially during the first year after ART initiation. Our findings suggest that interventions could target men to encourage HIV testing.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa.
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa.
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - Carl Lombard
- Biostatistics, South African Medical Research Council, Cape Town, South Africa
| | - Ngcwalisa Jama
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
| | - Ria Laubscher
- Biostatistics, South African Medical Research Council, Cape Town, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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8
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Fischer AE, Abrahams M, Shankland L, Lalla-Edward ST, Edward VA, De Wit J. The evolution of HIV self-testing and the introduction of digital interventions to improve HIV self-testing. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1121478. [PMID: 36864847 PMCID: PMC9971956 DOI: 10.3389/frph.2023.1121478] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023] Open
Abstract
HIV self-testing (HIVST) complements traditional HIV testing programmes by removing barriers and increasing access to testing for key populations, and digital interventions have been developed for HIVST to improve the testing and linkage to care experience for users. The first HIVST kit was proposed in 1986, but it took 10 years for the home sample collection (HSC) HIVST to become available and another 16 years for rapid diagnostic test HIVST to be approved by the Federal Drug Administration. Since then, studies have shown high usability and performance of HIVST, which led the World Health Organization formally recommending HIVST in 2016, and currently almost 100 countries have incorporated HIVST into their national testing strategy. Despite the popularity, HIVST present challenges around pre-and post-test counselling, as well as the ability to report results and link users to care, and digital interventions for HIVST have been introduced to address these challenges. The first digital intervention for HIVST was introduced in 2014 and showed that digital interventions could be used to distribute HIVST kits, report results and link users to care. Since then, dozens of studies have been conducted, which have validated and expanded on these early findings, but many were pilot studies with small sample sizes and lacked the standardization of indicators required to aggregate data across platforms to prove impact at scale. For digital interventions for HIVST to be championed for scale-up, they must continue to show measurable impact at larger scales, while still maintaining and standardizing data security and integrity.
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Affiliation(s)
- Alex Emilio Fischer
- Aviro Health, Cape Town, South Africa
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, Netherlands
| | | | | | | | - Vinodh A. Edward
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, Netherlands
- The Aurum Institute, Johannesburg, South Africa
- School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - John De Wit
- Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, Netherlands
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Wirtz AL, Logie CH, Mbuagbaw L. Addressing Health Inequities in Digital Clinical Trials: A Review of Challenges and Solutions From the Field of HIV Research. Epidemiol Rev 2022; 44:87-109. [PMID: 36124659 PMCID: PMC10362940 DOI: 10.1093/epirev/mxac008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/29/2022] Open
Abstract
Clinical trials are considered the gold standard for establishing efficacy of health interventions, thus determining which interventions are brought to scale in health care and public health programs. Digital clinical trials, broadly defined as trials that have partial to full integration of technology across implementation, interventions, and/or data collection, are valued for increased efficiencies as well as testing of digitally delivered interventions. Although recent reviews have described the advantages and disadvantages of and provided recommendations for improving scientific rigor in the conduct of digital clinical trials, few to none have investigated how digital clinical trials address the digital divide, whether they are equitably accessible, and if trial outcomes are potentially beneficial only to those with optimal and consistent access to technology. Human immunodeficiency virus (HIV), among other health conditions, disproportionately affects socially and economically marginalized populations, raising questions of whether interventions found to be efficacious in digital clinical trials and subsequently brought to scale will sufficiently and consistently reach and provide benefit to these populations. We reviewed examples from HIV research from across geographic settings to describe how digital clinical trials can either reproduce or mitigate health inequities via the design and implementation of the digital clinical trials and, ultimately, the programs that result. We discuss how digital clinical trials can be intentionally designed to prevent inequities, monitor ongoing access and utilization, and assess for differential impacts among subgroups with diverse technology access and use. These findings can be generalized to many other health fields and are practical considerations for donors, investigators, reviewers, and ethics committees engaged in digital clinical trials.
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Affiliation(s)
- Andrea L Wirtz
- Correspondence to Dr. Andrea L. Wirtz, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 (e-mail: )
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10
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Maskew M, Technau K, Davies MA, Vreeman R, Fox MP. Adolescent retention in HIV care within differentiated service-delivery models in sub-Saharan Africa. Lancet HIV 2022; 9:e726-e734. [PMID: 36088915 PMCID: PMC9927242 DOI: 10.1016/s2352-3018(22)00137-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Abstract
Adolescents and young people living with HIV are at risk of disengaging from HIV care at all stages of the care cascade. Differentiated models of care offer simplified HIV-service delivery options in the hope of improving treatment outcomes, including retention on antiretroviral therapy. However, it remains unclear how successful and widespread these models are for adolescents in sub-Saharan Africa, where the burden of HIV is the greatest. Very few differentiated models of care specifically targeted to adolescents can be found and this priority group are currently ineligible from several models that exist. Where differentiated care has been made available to adolescents, data on the implementation and effectiveness of these interventions remain scarce. Despite this scarcity of evidence on the effectiveness of differentiated care among adolescent populations, several interventions, particularly community-based groups with peer navigators or supporters, might have potential to increase the reach, effectiveness, and adoption of differentiated care in adolescent HIV-care programmes.
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Affiliation(s)
- Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
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11
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Lepere P, Babington-Ashaye A, Martínez-Pérez GZ, Ekouevi DK, Labrique AB, Calmy A. How mHealth Can Contribute to Improving the Continuum of Care: A Scoping Review Approach to the Case of Human Immunodeficiency Virus in Sub-Saharan Africa. Public Health Rev 2022; 43:1604557. [PMID: 36211227 PMCID: PMC9537374 DOI: 10.3389/phrs.2022.1604557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: To determine mHealth’s contribution to improving the continuum of care in sub-Saharan Africa towards achieving treatment targets for human immunodeficiency virus (HIV) endorsed by the 2016 Political Declaration on ending acquired immunodeficiency syndrome (AIDS). Methods: PubMed, Medline, Embase, Web of Science Core Collection and Cochrane databases; three observatories and four repositories were searched to identify and select relevant articles, projects and guidelines published from 1 January 2017, to 30 April 2021. Records focusing on the use of mHealth related to HIV treatment cascade or healthcare provider/patient relationship were considered. Results: From 574 identified records, 381 (206 scientific manuscripts and 175 mHealth projects) were considered. After screening, 36 articles (nine randomized control trials, five cohort studies, 19 qualitative studies, and three economic studies) and 23 projects were included. Conclusion: The cross-cutting benefits of mHealth that enhance patient empowerment have been identified. Important challenges such as gaps between research and implementation, lack of transdisciplinary collaboration, and lack of economic evidence were identified to support future mHealth research and accelerate the achievement of treatment targets for HIV.
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Affiliation(s)
- Philippe Lepere
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- *Correspondence: Philippe Lepere,
| | - Awa Babington-Ashaye
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Didier Koumavi Ekouevi
- Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
- INSERM U1219 Bordeaux Population Health Centre Recherche (BPH), Bordeaux, France
| | - Alain Bernard Labrique
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of International Health, Johns Hopkins Bloomberg School of Public Health & Johns Hopkins University Global Digital Health Initiative, Baltimore, MD, United States
| | - Alexandra Calmy
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Service des Maladies Infectieuses, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
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12
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A Systematic Review of Linkage-to-Care and Antiretroviral Initiation Implementation Strategies in Low- and Middle-Income Countries Across Sub-Saharan Africa. AIDS Behav 2022; 26:2123-2134. [PMID: 35088176 PMCID: PMC9422958 DOI: 10.1007/s10461-021-03558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 01/29/2023]
Abstract
Linkage to care (LTC) and initiation of antiretroviral therapy (ART) are key components in the longitudinal care cascade for people living with HIV. Many strategies to optimize these stages of HIV care have been implemented, though there is a paucity of analyses comparing the outcomes of these efforts in low- and middle-income countries. We conducted a systematic review of studies assessing interventions along all stages of the HIV care continuum published between 2008 and 2020. A comprehensive search strategy reviewed five electronic databases to capture studies assessing HIV testing, LTC, ART initiation, ART adherence, and viral suppression. Of the 388 articles that met the inclusion criteria, 78 described interventions for improving LTC/ART initiation. Efforts focused on empowering patients through integrative approaches generally yielded more substantive results compared to provider-initiated non-adaptive LTC interventions or cash incentives. Specifically, tailoring care and incorporating ART initiation into existing infrastructures, such as maternal clinics, had a high impact across settings. Moreover, strategies such as home-based HIV counseling and testing (HBHCT) appear to be most effective when implemented in tandem with other approaches including motivational counseling and point-of-care CD4 testing.
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13
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Lalla-Edward ST, Mashabane N, Stewart-Isherwood L, Scott L, Fyvie K, Duncan D, Haile B, Chugh K, Zhou Y, Reimers J, Pan M, Venkatraman M, Stevens W. Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e26033. [PMID: 35107427 PMCID: PMC8851337 DOI: 10.2196/26033] [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: 11/25/2020] [Revised: 06/30/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. OBJECTIVE This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. METHODS Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. RESULTS Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants' phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. CONCLUSIONS Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life.
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Affiliation(s)
| | - Nonkululeko Mashabane
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | | | - Lesley Scott
- Molecular Medicine & Haematology, University of the Witwatersrand, Parktown, South Africa
| | - Kyle Fyvie
- Molecular Medicine & Haematology, University of the Witwatersrand, Parktown, South Africa
| | - Dana Duncan
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | - Betiel Haile
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | - Kamal Chugh
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | - Yiyong Zhou
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | | | - Matteus Pan
- Roche Molecular Systems, Inc, Pleasanton, CA, United States
| | | | - Wendy Stevens
- Molecular Medicine & Haematology, University of the Witwatersrand, Parktown, South Africa.,National Priorities Programme, National Health Laboratory Systems, Parktown, South Africa
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14
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Effectiveness of eHealth Interventions for HIV Prevention and Management in Sub-Saharan Africa: Systematic Review and Meta-analyses. AIDS Behav 2022; 26:457-469. [PMID: 34427813 PMCID: PMC8813706 DOI: 10.1007/s10461-021-03402-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 12/19/2022]
Abstract
HIV is still the leading cause of death in Sub-Saharan Africa (SSA), despite medical advances. eHealth interventions are effective for HIV prevention and management, but it is unclear whether this can be generalised to resource-poor settings. This systematic review aimed to establish the effectiveness of eHealth interventions in SSA. Six electronic databases were screened to identify randomised controlled trials (RCTs) published between 2000 and 2020. Meta-analyses were performed, following Cochrane methodology, to assess the impact of eHealth interventions on HIV-related behaviours and biological outcomes. 25 RCTs were included in the review. Meta-analyses show that eHealth interventions significantly improved HIV management behaviours (OR 1.21; 95% CI 1.05-1.40; Z = 2.67; p = 0.008), but not HIV prevention behaviours (OR 1.02; 95% CI 0.78-1.34; Z = 0.17; p = 0.86) or biological outcomes (OR 1.17; 95% CI 0.89-1.54; Z = 1.10; p = 0.27) compared with minimal intervention control groups. It is a hugely important finding that eHealth interventions can improve HIV management behaviours as this is a low-cost way of improving HIV outcomes and reducing the spread of HIV in SSA. PROSPERO registration number: CRD42020186025.
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15
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Etheredge HR, Fabian J. Communication in Healthcare: Global challenges in the 21st Century. Hamostaseologie 2022; 42:29-35. [PMID: 34991176 DOI: 10.1055/a-1685-7096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This article explores the communication challenges brought about by the digital revolution in the 21st century for healthcare professionals internationally. It particularly focuses on the use of content-generating and sharing platforms like social media. Globally, healthcare has been irrevocably altered by digital innovation and health professionals deploy an extensive range of social media and web-based tools on a daily basis. However, many healthcare professionals use these platforms in a regulatory vacuum-where there may not be specific legal or ethical guidance-and without an appreciation of the associated risks. Given the special protections afforded to the practitioner-patient relationship, and the importance of a health practitioners' reputation, it is vital that we understand how to traverse the many ethical and legal challenges of the digital interaction. A comprehensive set of recommendations (see "Guidelines for Good Digital Citizenship in the Health Professions" on page 5 ff.) to keep practitioners out of trouble is provided. These hinge on the notion of being a "good person and a good doctor" as a formative maxim for ethical and legal safety. The constituents of publication, and the consequences of falling foul of acceptable publication standards on social media, are specifically discussed. "Publication" involves sharing content with a third party, or a group of people, and social media refers to platforms on which content can be shared with more than one person. Hence, most information that we post on social media can be considered as "published," and as such may attach liability for health professionals who do not use these platforms with requisite care and sufficient forethought.
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Affiliation(s)
- Harriet Rosanne Etheredge
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - June Fabian
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Bröcker E, Olff M, Suliman S, Kidd M, Mqaisi B, Greyvenstein L, Kilian S, Seedat S. A clinician-monitored 'PTSD Coach' intervention: findings from two pilot feasibility and acceptability studies in a resource-constrained setting. Eur J Psychotraumatol 2022; 13:2107359. [PMID: 36212116 PMCID: PMC9542529 DOI: 10.1080/20008066.2022.2107359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The high prevalence of trauma exposure and consequent post-traumatic stress disorder (PTSD) is well documented in low- and middle-income countries, and most individuals with PTSD have limited access to treatment in these settings. Freely available internet-based interventions, such as PTSD Coach (web-based and mobile application), can help to address this gap and improve access to and efficiency of care. Objective: We conducted two pilot studies to evaluate the feasibility, acceptability, and preliminary effectiveness of PTSD Coach in a South African resource-constrained context. Method: Pilot 1: Participants with PTSD (n = 10) were randomized to counsellor-supported PTSD Coach Online (PCO) or enhanced treatment as usual. Pilot 2: Participants (n = 10) were randomized to counsellor-supported PTSD Coach Mobile App or self-managed PTSD Coach Mobile App. Feasibility and acceptability were assessed by comparing attrition rates (loss to follow-up), reviewing participant and counsellor feedback contained in fieldnotes, and analysing data on the 'Perceived helpfulness of the PTSD Coach App' (Pilot 2). PTSD symptom severity was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5), changes between treatment and control groups were compared, the reliable change index (RCI) was calculated, and clinically significant changes were determined. Results: Three participants in Pilot 1 and two participants in Pilot 2 were lost to follow-up. Fieldnotes indicated that PTSD Coach Mobile App addressed identified computer literacy challenges in Pilot 1 (PCO); and a shorter duration of intervention (from 8 to 4 weeks) was associated with less attrition. The RCI indicated that four participants in Pilot 1 and eight participants in Pilot 2 experienced significant improvement in PTSD symptom severity. Conclusions: The preliminary results suggest that both platforms can alleviate PTSD symptoms, and that the involvement of volunteer counsellors is beneficial. The use of PTSD Coach Mobile App may be more feasible than the online version (PCO) in our setting. HIGHLIGHTS Research on supported PTSD Coach interventions is limited in resource-constrained settings.Both volunteer counsellor-supported PTSD Coach Online and the PTSD Coach Mobile App showed preliminary reliable and clinically significant changes.The use of PTSD Coach Mobile App seems more feasible than the volunteer counsellor-supported PTSD Coach Online.
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Affiliation(s)
- Erine Bröcker
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Miranda Olff
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Sharain Suliman
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Busisiwe Mqaisi
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Greyvenstein
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sanja Kilian
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry and MRC Genomics of Brain Disorders Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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17
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Davies EH, Fieggen K, Wilmshurst J, Anyanwu O, Burman RJ, Komarzynski S. Demonstrating the feasibility of digital health to support pediatric patients in South Africa. Epilepsia Open 2021; 6:653-662. [PMID: 34310860 PMCID: PMC8633462 DOI: 10.1002/epi4.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/07/2021] [Accepted: 07/21/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Resources for management of epilepsy in Africa are extremely limited reinforcing the need to develop innovative strategies for optimizing care. Studies have shown that the prevalence of epilepsy in low- and middle-income countries is substantially greater than in more resourced countries. The objective of this report was to demonstrate that mobile Health (mHealth) technologies have the potential to improve the management of epilepsy in Africa. METHODS The feasibility of technology-based home monitoring was investigated in an observational study of 40 children with refractory epilepsy or epilepsy associated with intellectual disability and/or behavior difficulties in South Africa. Technology-based home monitoring was implemented for six months. Physical activity, sleep, and heart rate were continuously monitored with a wearable device. Caregivers completed regular mobile Patient Reported Outcomes (mPROs) and reported seizures and ad hoc events using a dedicated app. Feasibility was assessed and descriptively measured for recruitment, retention, and engagement of the participants. RESULTS The mHealth technology was able to capture important information that gives an impression of the overall experience of the children and their caregivers. Thirty-seven participants (94.9%) reported at least one clinical event. Seventy-nine percent of caregivers reported seizure events in their children, which were the primary event anticipated. Median engagement with the wearable device and monthly mPROs was 30.8% and 57.1%, respectively. However, most participants (87%) had to be given smartphones for them to have Bluetooth capabilities and access to the study app. Tolerability to the device was impacted by the difficult living circumstances of caregivers that induced fear of loss or theft. SIGNIFICANCE The study showed how the use of remote patient monitoring in the form of mHealth can benefit epilepsy patients, despite highly variable engagement with the technology. The combination of mPROs and wearable devices generated informative datasets that will allow clinicians but also the children and their caregivers to better understand and manage the disease.
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Affiliation(s)
| | - Karen Fieggen
- Division of Human GeneticsDepartment of MedicineUniversity of Cape TownObservatorySouth Africa
| | - Jo Wilmshurst
- Department of Paediatric NeurologyRed Cross War Memorial Children’s HospitalNeuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | | | - Richard Joseph Burman
- Department of Paediatric NeurologyRed Cross War Memorial Children’s HospitalNeuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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Informational support for depression and quality of life improvements in older patients with cancer: a systematic review and meta-analysis. Support Care Cancer 2021; 30:1065-1077. [PMID: 34415425 DOI: 10.1007/s00520-021-06494-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/07/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess and summarize the effects of informational support on depression and quality of life of older patients with cancer. METHODS PubMed, MEDLINE, and Web of Science were searched to identify articles written in English and published until March 2021. Studies within 10 years period (2010-2021) were included. Randomized controlled trials were included if they evaluated the impact of informational support on depression and quality of life. All analyses were performed with Review Manager 5.3. RESULTS Twelve studies with a total of 2374 participants met the inclusion criteria. Our primary outcomes included depression and quality of life. (1) Depression: results indicated no statistically significant difference and low heterogeneity [SMD = 0.28, 95% CI (- 0.24,0.80), p = 0.45; I2 = 0%], (2) Quality of life: in the subgroup analyses of EORTC QLQ-C30, results indicated a significant effect of informational support on quality of life [SMD = 2.84, 95% CI (0.63, 5.05), p = 0.03; I2 = 79%]; in the subgroup analyses of FACT and SF-36, there were no significance. CONCLUSIONS Informational support could reduce depression and did improve the quality of life in older cancer patients with statistical significance. The findings suggested that informational support was an effective approach to improve depression and quality of life in older patients with cancer.
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Murphy JP, Moolla A, Kgowedi S, Mongwenyana C, Mngadi S, Ngcobo N, Miot J, Evans D, Pascoe S. Community health worker models in South Africa: a qualitative study on policy implementation of the 2018/19 revised framework. Health Policy Plan 2021; 36:384-396. [PMID: 33367608 PMCID: PMC8128020 DOI: 10.1093/heapol/czaa172] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa’s Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents’ recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs’ work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.
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Affiliation(s)
- Joshua P Murphy
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Aneesa Moolla
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sharon Kgowedi
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sithabile Mngadi
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Nkosinathi Ngcobo
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Jacqui Miot
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sophie Pascoe
- Health Economics and Epidemiology Research Office (HE2RO), Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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20
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Fischer AE, Van Tonder T, Gumede SB, Lalla-Edward ST. Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study. JMIR Form Res 2021; 5:e25273. [PMID: 33956640 PMCID: PMC8130817 DOI: 10.2196/25273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/04/2020] [Accepted: 04/16/2021] [Indexed: 01/04/2023] Open
Abstract
Background In late March 2020, South Africa implemented a 5-stage COVID-19 Risk Adjusted Strategy, which included a lockdown that required all residents to remain home to prevent the spread of COVID-19. Due to this lockdown, individuals have been forced to find and use alternatives for accomplishing tasks including shopping, socializing, working, and finding information, and many have turned to the internet and their mobile devices. Objective This study aimed to describe how South Africans consume and internalize information surrounding the COVID-19 outbreak in order to determine whether the COVID-19 lockdown and social isolation have influenced technology behavior, particularly in terms of health communication and information. Methods From June 24 to August 24, 2020, people in South Africa were invited to complete a survey through the Upinion mobile app, an online data collection resource. The survey collected information on demographics, and technology use during the lockdown, and COVID-19 knowledge. Results There were 405 participants, of which 296 (73.06%) were female. A total of 320 (79.01%) participants had a tertiary school education, 242 (59.75%) were single, and 173 (42.72%) had full-time employment. The lockdown forced 363 (89.63%) participants to use more technology, especially for work (n=140, 24.05%) and social media/communication (n=133, 22.85%). Security or privacy issues (n=46, 38.98%) and unfamiliarity with technology (n=32, 27.12%) were identified as the most common issues faced by the 127 (31.36%) participants who were unsure about using technology prior to the lockdown. Almost all participants (n=392, 96.79%) stated that they would continue using technology after the lockdown. Multimedia (n=215, 53.09%), mobile phone content (n=99, 24.44%), and health organizations and professionals (n=91, 22.47%) were the main sources of COVID-19 information. Most participants (n=282, 69.63%) felt that they had enough information. Two-thirds (n=275, 67.90%) of participants stated that they had used their mobile phones for health information before the lockdown, with web searches (n=109, 26.91%), social media (n=58, 14.32%), and government and institutional websites (n=52; 12.84%) serving as their main sources of information. Overall, the mean COVID-19 knowledge score was 8.8 (out of 10), and 335 (82.72%) had adequate knowledge (scored ≥8). Males were less likely to identify the correct transmission routes, and single participants were less likely to identify the signs and symptoms of the coronavirus. Tertiary school graduates were 4 times more likely to correctly identify the routes and 2 times more likely to identify how to stop the spread of the virus. People aged 43-56 years were 4 times more likely to identify how the coronavirus can be prevented, and participants ≥57 years were 2.6 times more likely to obtain a knowledge score of 10 when compared to those under 29 years of age. Conclusions This study has shown that the COVID-19 lockdown has forced people to increase technology use, and people plan to continue using technology after the lockdown is lifted. Increased technology use was seen across a variety of fields; however, barriers including privacy, unfamiliarity, and data costs were identified. This population showed high COVID-19 knowledge, although the use of web searches and social media, instead of government and institutional websites, increases the potential for health misinformation to be spread.
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Affiliation(s)
- Alex Emilio Fischer
- Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Siphamandla B Gumede
- Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Samanta T Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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21
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Gárate FJ, Chausa P, Whetham J, Jones CI, García F, Cáceres C, Sánchez-González P, Wallitt E, Gómez EJ. EmERGE mHealth Platform: Implementation and Technical Evaluation of a Digital Supported Pathway of Care for Medically Stable HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063156. [PMID: 33803821 PMCID: PMC8003226 DOI: 10.3390/ijerph18063156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
In this article, we described a new mobile-Health (mHealth) supported clinical pathway of care for people living with medically stable HIV in terms of platform acceptability, usability and technical feasibility. The EmERGE mHealth platform was codesigned with clinicians and the community, developed using Scrum agile methodology, integrated with hospital information systems and validated in a large prospective cohort study of 2251 participants. The evaluation of this new paradigm of care was conducted using a tailored Health Technology Assessment: the Model for Assessment of Telemedicine Applications. Usability and acceptability were assessed through the System Usability Score and a Patient Reported Experience Measure. The EmERGE platform was successfully deployed across diverse care settings in five European countries and used by 2251 patients and more than 20 clinicians for up to 30 months. Results from the formal evaluation demonstrated that the EmERGE platform is feasible and acceptable, with a high level of usability (median System Usability Score (SUS) 85.0%) and very positive patient-reported experiences (94.2% would recommend to a friend). The EmERGE platform is a secure and General Data Protection Regulation (GDPR)-compliant system with a complete set of functionalities that could be easily adapted to other clinical conditions, clinical sites and health systems thanks to its modular technical architecture.
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Affiliation(s)
- Francisco J. Gárate
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Correspondence: (F.J.G.); (P.C.)
| | - Paloma Chausa
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Correspondence: (F.J.G.); (P.C.)
| | - Jennifer Whetham
- Department of Sexual Health and HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, BN2 5BE Brighton, UK;
| | | | - Felipe García
- Infectious Diseases Department, Fundacio Privada Clinic per a la Recerca Biomedica—IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - César Cáceres
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Computer Science Department, Universidad Rey Juan Carlos, 28933 Madrid, Spain
| | - Patricia Sánchez-González
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Centro de Investigación Biomédica en Red, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | | | - Enrique J. Gómez
- Biomedical Engineering and Telemedicine Centre, ETSI Telecomunicación, Center for Biomedical Technology, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.C.); (P.S.-G.); (E.J.G.)
- Centro de Investigación Biomédica en Red, Biomateriales y Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
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22
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Duthely LM, Sanchez-Covarrubias AP. Digitized HIV/AIDS Treatment Adherence Interventions: A Review of Recent SMS/Texting Mobile Health Applications and Implications for Theory and Practice. FRONTIERS IN COMMUNICATION 2020; 5:530164. [PMID: 33644162 PMCID: PMC7909469 DOI: 10.3389/fcomm.2020.530164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mobile health technologies (mHealth) are efficacious along the continuum of HIV/AIDS-from prevention of HIV transmission to those at the highest risk of acquiring infection, to adherence to HIV medical care, for those living with the disease-decreasing the public health burden of the disease. HIV/AIDS is a complex condition, as certain population subgroups are disproportionately affected. Furthermore, barriers experienced at the individual level (e.g., HIV stigma) and at the systems level (i.e., access to care) contribute to these disparities. Low cost, high penetration rates and ease of use mean mHealth SMS/texting solutions hold the biggest promise for curbing the global HIV/AIDS epidemic; yet these technologies have their own challenges. Our primary objective was to assess interventions that promote adherence, which are delivered via SMS/texting, and important design and ethical considerations of these technologies. Specifically, we evaluated the underlying frameworks underpinning intervention design, strategies to safeguard privacy and confidentiality, and measures taken to ensure equity and equitable access across different subgroups of persons living with HIV (PLWH). We also synthesized study outcomes, barriers/facilitators to adherence, and barriers/facilitators of technology to support HIV adherence. METHODS A scoping review methodology was utilized, searching the Medline database for recently published articles (January 2017 to June 2019). Two reviewers independently screened titles and abstracts for relevancy using the following eligibility criteria: (a) original research or protocol; (b) inclusion of persons living with HIV; (c) intervention delivery via SMS/text messaging; and, (d) intervention included HIV care adherence. RESULTS Seven (7) of the 134 articles met full criteria. The great majority (n = 6) did not report whether the interventions were developed under established behavioral change models or frameworks. Strategies to address privacy, confidentiality and equity/equitable access were taken in four (n = 4) studies. CONCLUSION Our mixed methods review determined that privacy and confidentiality remain a concern for PLWH. Provisions to accommodate literacy, infrastructure, technology and other challenges (e.g., access to smartphones and Wifi) are important ethical considerations that guarantee equity and equitable access. Further investigation will determine the contexts within which theoretical models and frameworks remain relevant in the rapidly evolving field of digitized interventions that support adherence.
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Affiliation(s)
- Lunthita M. Duthely
- Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States
- Correspondence: Lunthita M. Duthely,
| | - Alex P. Sanchez-Covarrubias
- Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States
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23
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Jiménez-Muñoz L, Gutiérrez-Rojas L, Porras-Segovia A, Courtet P, Baca-García E. Mobile applications for the management of chronic physical conditions: A systematic review. Intern Med J 2020; 52:21-29. [PMID: 33012045 DOI: 10.1111/imj.15081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/21/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic physical conditions (CPCs) decrease the quality of life of millions of people. In the absence of curative treatments, maintaining healthy lifestyle habits is one of the main pillars in their clinical management. Mobile-based interventions may help patients take care of their health and follow medical recommendations. The purpose of this review is to summarize the latest evidence about mobile phone applications (apps) for the management of CPC. METHODS We performed a systematic search of the PubMed and EMBASE databases to identify articles that explored apps for the management of CPCs, testing the apps empirically, and providing clear outputs on effectiveness and/or feasibility. 3528 articles were identified in the initial search. Following screening and selection process, 20 articles were finally included in the review. RESULTS Mobile apps for CPC are very heterogeneous. The condition with the greater number of apps available was diabetes, followed by cardiovascular diseases. Results of feasibility were generally positive, with high rates of study completion and user engagement. Some studies used incentives, monetary of otherwise. Some of the apps have been tested in randomized clinical trials showing effectiveness in improving symptoms and/or controlling analytical parameters. CONCLUSIONS Mobile apps are promising tools for the management of CPCs. Some apps have been sufficiently tested to propose their implementation in clinical practice. However, several barriers exist that can slow down the routine use of new technologies in healthcare settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Jiménez-Muñoz
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain.,Madrid Autonomous University, Madrid, Spain
| | | | - Alejandro Porras-Segovia
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain
| | - Philippe Courtet
- University of Montpellier, France.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Enrique Baca-García
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain.,Psychiatry Department, University of Granada, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Católica del Maule, Talca, Chile.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Deparment of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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24
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Lee SB, Valerius J. mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review. JMIR Mhealth Uhealth 2020; 8:e14739. [PMID: 32568720 PMCID: PMC7486676 DOI: 10.2196/14739] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 02/24/2020] [Accepted: 06/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Antiretrovirals (ARVs) are key in the management of HIV. Although no cure exists, ARVs help patients live healthy lives and prevent transmission to others. Adherence to complex regimens is paramount to outcomes and in avoiding the emergence of drug-resistant viruses. The goal of therapy is to reach an undetectable viral load. However, adherence is a common problem, stemming from issues such as mental health, chaotic home situations, and busy work schedules. Mobile health (mHealth) represents a new approach in improving medication adherence, and multiple studies have been performed in this area. Objective This study aims to review the current implementation of mHealth in the management of HIV among different groups of patients. Methods We used PubMed, Academic Search Elite, and 1 journal database with various search terms to review the current implementation of mHealth in HIV care. Results Titles and abstracts were screened, and 61 papers were identified and fully reviewed. The literature was divided into lower- and higher-income nations, as defined by the United Nations. A total of 20 studies with quantitative results were identified, with 10 being text- and SMS-based interventions (the majority of these being in lower-income countries) and 8 being smartphone-based apps (primarily in higher-income countries). The majority of these studies determined whether there was an effect on adherence or biochemical parameters (viral load and CD4 count). Various qualitative studies have also been conducted, and many have focused on determining the specific design of interventions that were successful (frequency of messaging, types of messages, etc) as well as priorities for patients with regard to mHealth interventions. Conclusions There seems to be a role of mHealth in the management of HIV in lower-income nations; however, the optimal design of an intervention needs to be delineated. In higher-income countries, where the 2 significant risk factors were injection drugs and men who have sex with men, the benefit was less clear, and more research is needed.
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Affiliation(s)
- Stephen B Lee
- Department of Medicine, Division of Infectious Diseases, University of Saskatchewan College of Medicine, Regina, SK, Canada.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
| | - Joanne Valerius
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, United States
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25
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Gous N, Fischer AE, Rhagnath N, Phatsoane M, Majam M, Lalla-Edward ST. Evaluation of a mobile application to support HIV self-testing in Johannesburg, South Africa. South Afr J HIV Med 2020; 21:1088. [PMID: 32670629 PMCID: PMC7343920 DOI: 10.4102/sajhivmed.v21i1.1088] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Human immunodeficiency virus self-testing (HIVST) reduces barriers associated with facility-based testing; however, no formal mechanism exists for users to self-report results or link to care. The AspectTM HIVST mobile application (app) was developed for use in South Africa. Objectives This study evaluated the acceptability and feasibility of the AspectTM HIVST app for individuals from the inner city of Johannesburg. Method This cross-sectional pilot, with a convenience sample of 300 adults, was conducted in July 2018. Participants were provided an OraQuick HIVST kit and a smartphone preloaded with the app, then asked to follow the in-app instructions for use (IFU) to complete the HIVST and upload results. Trained healthcare workers (HCWs) observed and recorded any deviations from the IFU, and conducted a post-test survey to assess acceptability. Feasibility was evaluated by the number of participants who agreed to participate, completed the self-test, and uploaded all information onto the app correctly. Results Most participants (98.7%) found the app easy to use. To reduce difficulties related to the IFU (26; 8.7%), participants suggested multimedia supplements (4; 1.3%), additional languages (4; 1.3%) and simplified instructions (5; 1.7%). All individuals approached, agreed to participate, 267 (89.0%) correctly completed all steps and 210 (78.7%) successfully captured all information on the app. Most errors (26; 8.7%) were testing errors and 1 (0.3%) was from the app sequence. Twelve (4.5%) errors were with test strip imaging and 72 (27.0%) discordances were with demographic information. Conclusion Despite some challenges with IFU interpretation and data capture via the app, this pilot showed that the AspectTM HIVST app is an acceptable way to upload mobile HIVST results and demographic information to a central database.
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Affiliation(s)
| | - Alex E Fischer
- Ezintsha, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Naleni Rhagnath
- Ezintsha, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Mothepane Phatsoane
- Ezintsha, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Mohammed Majam
- Ezintsha, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Samanta T Lalla-Edward
- Ezintsha, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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26
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DiAndreth L, Krishnan N, Elf JL, Cox S, Tilchin C, Nthulana M, Jarrett B, Kronis N, Dupuis E, Motlhaoleng K, Chon S, Martinson N, Golub JE. Formative research for an mHealth program to improve the HIV care continuum in South Africa. AIDS Care 2019; 32:744-748. [PMID: 31298566 DOI: 10.1080/09540121.2019.1640850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In South Africa, high attrition rates throughout the care continuum present major barriers to controlling the HIV epidemic. Mobile health (mHealth) interventions may provide innovative opportunities for efficient healthcare delivery and improving retention in care. In this formative research, we interviewed 11 patients and 28 healthcare providers in North West Province, South Africa, to identify perceived benefits, concerns and suggestions for a future mHealth program to deliver HIV Viral Load and CD4 Count test results directly to patients via mobile phone. Thematic analysis found that reduced workload for providers, reduced wait times for patients, potential expanded uses and patient empowerment were the main perceived benefits of an mHealth program. Perceived concerns included privacy, disseminating distressing results through text messages and patients' inability to interpret results. Participants felt that an mHealth program should complement face-to-face interactions and educational information to interpret results is needed. Providers identified logistical considerations and suggested protocols be developed. An mHealth program to deliver HIV test results directly to patients could mitigate multiple barriers to care but needs to be tested for efficacy. Concerns identified by patients and providers must be addressed in designing the program to successfully integrate with health facility workflow and ensure its sustainability.
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Affiliation(s)
- Lisa DiAndreth
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nandita Krishnan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica L Elf
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah Cox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carla Tilchin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Munei Nthulana
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Brooke Jarrett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nadya Kronis
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Elisa Dupuis
- Johns Hopkins School of Nursing, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katlego Motlhaoleng
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Sandy Chon
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil Martinson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Jonathan E Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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