Diagnostics literacy advocacy model for vulnerable populations

Evidence shows that vulnerable populations have lower levels of health literacy, resulting in poor health-seeking behavior and poor uptake of diagnostics. Being health literate promotes health care-seeking behavior and improves engagement with diagnostic services. In this editorial, I define health literacy in the context of access to technology for enabling disease screening, diagnosis and linkage to care. I refer to health literacy in this context as diagnostics literacy. The COVID-19 pandemic has taught us that vulnerable populations are disproportionately disadvantaged by the disruptive measures put in place to control the spread of the virus. Many vulnerable populations are still experiencing short-and longer-term socio-economic consequences. I propose a multi-level diagnostics literacy advocacy model to help improve diagnostic uptake among vulnerable populations.https://www.mdpi.com/journal/diagnosticsam2023School of Health Systems and Public Health (SHSPH

Mobile health applications for disease screening and treatment support in low-and middle-income countries

The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile phone penetration is increasing exponentially in low-and middle-income countries, hence using mobile phones for healthcare services could reach more people in resource-limited settings than the traditional forms of healthcare provision. The review presents recent literature on facilitators and barriers of implementing mHealth for disease screening and treatment support in low-and middle-income countries. We searched for relevant literature from the following electronic databases: MEDLINE; CINAHL with full text via EBSCOhost; Science Direct; PubMed; Google Scholar and Web of Science using the keywords for relevant studies. We searched for published studies from 2015 to August 2020 with no language limitations. A total of 721 articles identified, 125 articles met the inclusion criteria and were included in the qualitative synthesis. The review demonstrates relevant facilitators for the implementation of mHealth, which includes knowledge, attitudes, and perceptions of stakeholders on the use of mHealth and the performance of mHealth for disease diagnosis in low and-middleincome countries. Barriers and challenges hindering the implementation of mHealth applications were also identified. We proposed a framework for improving the implementation of mHealth for disease screening and treatment support in low-and middle-income countries.http://www.cell.com/heliyonam2022School of Health Systems and Public Health (SHSPH

Impact of COVID-19 on TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa

DATA AVALILABILITY : The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.We assessed the impact of the pandemic on TB diagnostics at primary healthcare clinics (PHCs) during the different stages of COVID-19 in eThekwini district, South Africa. Data from the District Health Information System (DHIS) were used to conduct an interrupted time series analysis that assessed the changes in TB investigations and confirmed TB cases during four pandemic periods: lockdown and the subsequent three peaks of infection compared to the two years prior (2018–2022). The initial lockdown resulted in − 45% (95% CI − 55 to − 31) and − 40% (95% CI − 59 to − 28) immediate declines in TB investigations and confirmed cases, respectively. Both indicators showed substantial recovery in the months after the first wave (p < 0.05). However, while TB investigations sustained smaller declines throughout the pandemic, they rebounded and surpassed pre-COVID-19 levels by the end of the investigation period. On the other hand, confirmed cases experienced reductions that persisted until the end of the investigation period. TB diagnostic services at PHCs were considerably disrupted by COVID-19, with the confirmation of cases being the most adversely affected throughout the pandemic. The reasons for these persistent declines in TB detection must be determined to inform the development of sustainable diagnostic systems that are capable of withstanding future pandemics.The National Research Foundation.https://www.nature.com/srepam2024School of Health Systems and Public Health (SHSPH)Non

Study protocol for developing a novel approach for improving supply chain management for SARS-CoV-2 point of care diagnostic services in resource-limited settings : a case study of Mopani District in Limpopo Province, South Africa

INTRODUCTION Recent evidence shows that point-of- care (POC) testing is a more feasible alternative for diagnosis of COVID-19 in settings that have poor access to laboratory diagnostic services. Equitable access to POC testing can be optimised through well-established supply chain management (SCM) systems. The proposed study aims to develop a novel approach for improving SCM for COVID-19 POC diagnostic services in resource-limited settings with poor access to laboratory diagnostic services, using Mopani District in Limpopo Province, South Africa as a study setting. METHODS AND ANALYSIS This study was guided by results of the scoping review. Following the scoping review, we propose a mixed-methods study, which will be implemented in three phases. First, we will perform a geospatial analysis to investigate the spatial distribution of COVID-19 testing services. Second, we will perform an audit of POC diagnostic services including its supply chain to evaluate the effect of SCM on accessibility of COVID-19 POC diagnostic services and reveal SCM barriers and enablers of accessibility of COVID-19 POC diagnostic services. Third, we will perform a nominal group technique to collaborate with key stakeholders in co-creation of a novel approach for improving SCM systems for COVID-19 POC diagnostic services. For the geospatial analysis we will employ the ArcGIS Software. For the analysis of quantitative and qualitative data that will be generated from the audit and nominal group discussion, we will employ Stata software and NVivo software, respectively. ETHICS AND DISSEMINATION This study has been ethically reviewed and approved by two institutional review boards: University of Pretoria Faculty of Health Sciences Research Ethics Committee (approval number 655/2021) and Limpopo Department of Health Research Ethics Committee (approval number LP-2021- 12- 007). The results of this study will be disseminated through national and international presentations and peer-reviewed publications.Partially funded by the National Research Foundation (NRF) & Ninety-One SA (Pty).http://bmjopen.bmj.comam2023School of Health Systems and Public Health (SHSPH

Editorial : Implementation of genomic medicine in Africa : one continent, one vision

The translation of genetic research from bench to bedside involves multiple choices related to clinician-patient shared decision-making, with ethical implications at every step of the way. Given the evolving evidence base and limited genomic data from African genomes, we were delighted to receive three reviews, one opinion article, three perspectives, six original papers, and a brief research report with a checklist for assessment of the readiness to implement public health genomics. The latter contribution by Jongeneel et al. included survey results previously generated in parallel to the development of a framework for implementation of genomic medicine in Africa, which was published in February 2021 on commission of the African Academy of Sciences (https://www.aasciences.africa/publications/policy-paper-frameworkimplementation- genomic-medicine-public-health-africa). The Policy Brief summarized this framework for personalized genomic medicine as the foundation of the current translational Research Topic, showcasing collated evidence of applied knowledge in Africa to enable translation of research into clinical practice, as the study endpoint. The wide range of methodologies used, and implementation approaches presented, were evaluated for evidence of transition from population to individualised risk stratification required for the application of personalised genomic medicine.http://www.frontiersin.org/Geneticsam2024School of Health Systems and Public Health (SHSPH)Non

The effect of a mobile-learning curriculum on improving compliance to quality management guidelines for HIV rapid testing services in rural primary healthcare clinics, KwaZulu-Natal, South Africa : a quasi-experimental study

BACKGROUND: Despite significant achievements made towards HIV testing, linkage to antiretroviral therapy treatment and viral load suppression, the Sub-Saharan region of Africa continues to be reported to have the highest prevalence of HIV/AIDS, with over 26 million people living with the disease. In light of the added burden on already overwhelmed health systems due to the Covid-19 pandemic, maintaining the reliability and accuracy of point-of-care diagnostics (POC) results is crucial to ensure the sustainability of quality service delivery. The integration of technology-based interventions into nurse education curricula is growing, to help prepare students for the current practice environment which requires access to large amounts of information. The aim of this study was to determine the effect of a Mobile Learning (mLearning) Curriculum on improving the quality of HIV rapid testing services in rural clinics of KwaZulu-Natal (KZN), South Africa. METHODS: To achieve the aim of this study, pre-test and post-test audits were conducted in a quasi-experimental design. Eleven clinics of KZN, with the highest availability and usage of POC diagnostics were selected from a cross-sectional study survey to constitute the sample of this study. The World Health Organization On-site Monitoring Checklist-Assessment of Quality System was adapted and used as an audit tool to evaluate four key quality components. The effect of the mLearning curriculum on HIV testing quality improvement was determined through statistically comparing pre-audit and post-audit results. The independent samples t-test and the Levene's test were employed to evaluate the equality of measured variables for the two groups. The relationships between variables were estimated using the Pearson pair wise correlation coefficient (p) and correlations were reported as significant at p < 0.05. RESULTS: A total of 11 clinics was audited at the pretest and 7 clinics were audited post-piloting of the mLearning curriculum. The estimated level of compliance of the participating clinics to quality HIV rapid testing guidelines ranged between poor and moderate quality. The mLearning curriculum was shown to have no statistically significant effect on the quality of POC diagnostic services provided in rural clinics of KZN. CONCLUSION: The mLearning curriculum was shown to have no statistically significant effect on the quality of HIV rapid testing services provided in participating clinics; however, multiple barriers to the full adoption of the piloted curriculum were identified. The provision of reliable technology devices and improved internet connection were recommended to enhance the adoption of technology-based interventions necessary to improve access to relevant learning material and updated information.http://www.biomedcentral.com/bmchealthservresNursing Scienc

Quality assurance for hepatitis C virus point-of-care diagnostics in sub-Saharan Africa

As part of a multinational study to evaluate the Bioline Hepatitis C virus (HCV) point-of- care (POC) testing in sub-Saharan Africa (SSA), this narrative review summarises regulatory standards and quality indicators for validating and approving HCV clinical diagnostics. In addition, this review also provides a summary of their diagnostic evaluations using the REASSURED criteria as the benchmark and its implications on the WHO HCV elimination goals 2030.https://www.mdpi.com/journal/diagnosticsam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Evaluation of a health education program for improving uptake of HIV self-testing by men in Rwanda : a pilot pragmatic randomized control trial

BACKGROUND: Health education interventions tailored to suit men have the potential to improve health outcomes for this underserved population. HIV self-testing (HIVST) is a promising approach to overcoming challenges associated with low HIV testing rates among men. The primary objective of this study is to assess the feasibility of conducting a definitive trial to determine the effectiveness of a locally adapted and optimized health education program (HEP) on the uptake of HIVST among men in Kigali, Rwanda. METHODS: This study employs a pilot pragmatic randomized controlled trial to evaluate an HIVST HEP for men. Participants were randomized to the intervention (HEP) arm or to the control arm. In the intervention group, the adapted HEP was administered in addition to routine health education. In the non-intervention group, only routine health education was offered. Participant data was collected first upon recruitment and then after 3 months’ follow-up using interviewer-administered questionnaires. RESULTS: There was a 100% response rate at enrollment and no loss to follow-up at exit. There was significant association between the study arm and knowledge of HIVST. Participants in the control arm had a mean knowledge score of 67% compared to 92% among participants in the intervention arm. There was an association between the study arm and HIVST uptake: 67% of the study participants in the intervention arm self-reported HIVST uptake compared to 23% of the participants in the control arm. DISCUSSION: This pilot study demonstrates the feasibility of a larger trial to assess the effectiveness of an HEP intervention on uptake of HIVST among men. We found preliminary evidence of increased uptake of HIVST in the intervention group.The University of KwaZulu-Natal, College of Health Sciences PhD Scholarship (award number: 641581) supported this study.https://pilotfeasibilitystudies.biomedcentral.compm2022Nursing Scienc

Availability and use of mobile health technology for disease diagnosis and treatment support by health workers in the Ashanti region of Ghana : a cross-sectional survey

Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The study’s main objective was to examine the availability and use of mHealth for disease diagnosis and treatment support by healthcare professionals in the Ashanti Region of Ghana. A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region with an adopted survey tool. We obtained data on the participants’ background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterise healthcare professionals’ demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to complete all the statistical analyses. Out of the 285 healthcare professionals, 64.91% indicated that mHealth is available to them, while 35.08% have no access to mHealth. Of the 185 healthcare professionals who have access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p < 0.05) identified that factors such as the availability of mobile wireless devices, phone calls, text messages, and mobile apps are associated with HIV, TB, medication adherence, clinic appointments, and others. There is a significant association between the availability of mobile wireless devices, text messages, phone calls, mobile apps, and their use for disease diagnosis and treatment compliance from the chi-square test analysis. The findings demonstrate a low level of mHealth use for disease diagnosis and treatment support by healthcare professionals at rural clinics. We encourage policymakers to promote the implementation of mHealth in rural clinics.SUPPLEMENTARY MATERIAL : File S1: Distribution of primary healthcare facilities sampled in the Ashanti Region, File S2: Survey tool, Table S1: Characteristics of participants from the 100 healthcare facilities surveyed in Ashanti Region, Table S2: Availability of mobile health for diagnostics and treatment support in the Ashanti Region, Table S3: Use of mobile health for diagnostics and treatment support in the Ashanti Region, Table S4: Chi-square test results of the relationship between the available health infrastructure or healthcare workforce competency and ownership of mobile wireless devices, Table S5: Chi-square test results of the relationship between the available health infrastructure or healthcare workforce competency and usefulness of mHealth applications, Table S6: Chi-square test results of the relationship between the available health infrastructure or healthcare workforce competency and ease of use of mHealth applications, Table S7: Chi-square test results of the relationship between the available health infrastructure or healthcare workforce competency and user satisfaction and behavioural intention to use mHealth, Figure S1: Odds ratio showing the association on the availability of mobile apps, toll-free, supply of power, support systems and others for disease diagnosis and treatment support by health workers in Ashanti Region, Ghana, Figure S2: Odds ratio showing the association on the use of mHealth applications for the management and treatment of hypertension, diabetes, cancer, malaria, monitor patients’ conditions and others by health workers in Ashanti Region, Ghana.https://www.mdpi.com/journal/diagnosticsam2022School of Health Systems and Public Health (SHSPH

A cross-sectional study on hypertension medication adherence in a high-burden region in Namibia : exploring hypertension interventions and validation of the Namibia Hill-Bone Compliance Scale

DATA AVAILABILITY STATEMENT : The data analyzed during the current study are available from the corresponding author on reasonable request.FILE S1: Blood pressure medication adherence questionnaire consisting of Section A: Socio-Demographic characteristics and Anthropometric measurements, Section B: Personal Medical History and Section C: Hill-bone Compliance to High Blood pressure therapy Scale.In Namibia, the prevalence of hypertension among women and men aged 35–64 years is high, ranging from 44% to 57%. In this study, we aimed to determine adherence and predictors to antihypertensive therapy in Khomas region, Namibia. A cross-sectional study was performed to consecutively sample 400 patients from urban and peri-urban settings in Namibia. Results were validated using the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Crude associations between predictors of adherence and compliance were tested using the Pearson chi-square test. A multivariable logistic regression analysis was then performed on adherence variables found to be significant to adjust for confounders, and the results are presented as adjusted odds ratios (aOR) with 95% confidence intervals. A total of 400 patients participated in this study. The participants’ mean age and standard deviation were Mean SD = 48.9 12.5. In this study, 351 (87.7%) patients were estimated to have good adherence. Education, employment, and the presence of other chronic diseases were associated with adherence. Following multivariate adjustment, the following factors were significantly associated and are therefore predictors of adherence (95%CI, p < 0.005): receiving enough medication at last check-up until next one (OR = 5.44, CI 1.76–16.85), lack of encouragement from family and friends (OR = 0.11 (0.03–0.42)), and attendance of follow-ups on schedule (OR = 8.49, CI = 3.82–18.85). The success of hypertension therapy is dependent on the healthcare systems and healthcare professionals in supplying enough medication, support of friends/family, and maintaining scheduled follow-ups. A combination of interventions using low-cost mobile technology led by healthcare professionals could be endorsed. To fully practice universal access to medication, public and private hospitals in Namibia should collaborate.https://www.mdpi.com/journal/ijerpham2023School of Health Systems and Public Health (SHSPH