Enhancing home based care for HIV patients using an advisory expert system

South Africa has one of the highest Human Immunodeficiency Virus (HIV) prevalence rates in the world. People living with HIV/AIDS experience many unrelieved symptoms. Nutritional care and support are important in preventing development of nutritional deficiencies. Home remedies can extend and improve the quality of their lives. Home remedies treatment involves eating healthy food, avoiding certain types of foods, psychological and emotional support and practicing hygiene to avoid skin infections (Sizani, Bandile; Nikiwe 2012). HIV/AIDS treatment and management strategies require ongoing management and support. In this research, we work with people from a clinic in Gugulethu Township in Western Cape, South Africa. The area has high prevalence of HIV (Ministry of health South Africa 2011). Most of the HIV patients in this area access medical information by walking long distances to the clinic. Most of these patients are poor and sometimes cannot afford to visit the clinic regularly for medical advice. In this township there is scarcity of health care workers (HCWs). The HCWs toil on many fronts to meet the enormous demand for the HIV/AIDS services but they are not able to meet the patients' needs. The aim of this research is to empower HIV-patients to self-manage the HIV-related symptoms which they experience. We investigated the way in which the HCWs deliver information to the patients. We interviewed the patients to understand what measures they take to manage the symptoms which they experienced. Consequently, we developed an advisory expert system to enhance Home-Based Care for HIV patients. An advisory expert system is defined as a computing system which is capable of representing and reasoning about some knowledge–rich domain, with a view to solving problems and giving advice (Gustafson et al. 1994). Since South Africa has high mobile phone penetration and most of the patients own them, we opted to use mobile phone as a tool to access the information provided by the advisory expert system. The system was then deployed at the clinic. We trained both HCWs and patients how to use the system. The findings were captured and reported after a six month deployment of the system. The results show that our system can be used as an effective tool to disseminate nutritional and psychological support information to HIV- patients in Gugulethu. The system is simple, yet practical. It helps the patients to self-manage the HIV-related symptoms which they experienced and at the same time, saves time and cost for both HCWs and the patients

Preemie Care: A Co-designed Digital Tool to Improve Communication Between Health Personnel and Parents of Preterm Infants

Communication between parents and health providers is essential in the Neonatal Intensive Care Unit (NICU) settings to ensure both parties collaborate in infant care. However, in most NICUs, the interaction between parents and NICU staff is strained, thus hindering communication. These communication challenges are due to language, medical vocabulary and cultural barriers between NICU staff and mothers. These challenges create communication gaps, which disempower parents and frustrate health staff. To bridge NICU communication gaps, several researchers have deployed digital health interventions. However, although the existing NICU technologies have effectively improved NICU communication, most parents struggle to interact with these interventions because they do not fit parents' technical and literacy capabilities. These design gaps arise because parents were not fully included in the design process of the existing NICU digital interventions. In this research, we sought to address the communication gaps within the NICU environment by employing a co-design approach to develop a digital intervention that supports infant care journey in a low-resource NICU setting. The co-design process included six research phases that spanned over 32 months. We engaged mothers of premature infants and NICU staff throughout this process while focusing on identifying how best to involve NICU stakeholders in a codesign process to ensure that the final intervention was usable and useful. The co-design process led to the development of MoM connect workflow which was disqualified by mothers and NICU staff because it did not meet mothers' needs. We further engaged NICU stakeholders in the co-design process and agreed on developing Preemie Care (PMC) system, an educational resource tool that disseminated digital health videos in multiple languages and through multiple technologies to empower parents and NICU staff to work together and advocate for their preterm infants. PMC system was deployed at Groote Schuur NICU for eight months where we interacted with users and monitored it usage logs to evaluate its efficacy. Our empirical evidence revealed that access to health information improved parents and their social networks medical vocabulary, thus empowering them to engage with their peers and NICU staff. We also learned that sharing health information in multiple languages does not resolve the language barriers among multilingual NICU parents. Instead, our results show that bilingual parents prefer accessing health information in multiple languages to improve their medical vocabulary and understandability, thus empowering them to engage in their infants' health care and decision-making. Hence, this research provides the design mechanisms for a NICU intervention to bridge communication gaps between bilingual parents and NICU staff. This work contributes to the field of Human-Computer Interaction(HCI) by highlighting the ethical and methodological considerations to engage NICU stakeholders interacting in a sensitive NICU setting in a collaborative co-design process. We also contribute to HCI knowledge by providing design mechanisms for a NICU intervention meant to bridge communication gaps between bilingual parents and NICU staff in a low-resource setting and design features of a digital NICU intervention that enhance family-centred care in the NICU setting

Enhancing Home Base Care provided for HIV patients using an Advisory Expert System in Gugulethu Township

Human immunodeficiency virus (HIV) / Acquired immune deficiency syndrome (AIDS) is a major global health problem. It is the greatest threat to the reconstruction and development of South Africa. Advances in Information and Communication Technology (ICTs) have facilitated development of medical expert systems. They have proved their usefulness since they can provide; precise, quick and inexpensive consultation. Advisory expert system is seen as enhancement tool in providing home-base care to people living with HIV/AIDS. In this paper we describe the development of advisory expert system used by HIV-patients in Gugulethu to self-manage the HIV-related symptoms they experienced. We also present the results obtained at the end of the research

Co-designing with Mothers and Neonatal Unit Staff: Use of Technology to Support Mothers of Preterm Infants

There are several digital technologies which have been designed and successfully used to support mothers of preterm infants. However, none have been designed for application in the developing world context. For the existing interventions, none have involved mothers (who are the intended beneficiaries of these technologies) in the design process. This paper reports on a process that involved Neonatal Intensive Care Unit (NICU) staff and mothers in the design of technological interventions that focus on enhancing communication between mothers and staff in the NICU context. We used the co-design approach, focusing on identifying methods that ensure participants fully participate in the design process despite facing co-design dynamics such as power imbalances and conflict. Our results demonstrate the benefits of choosing an approach that focuses on building trust with stakeholders before delving into co-design process and empowering participants thus enabling them to fully participate in a design process. We argue that while working with multiple stakeholders, co-design readiness is dependent on methodological choice, stakeholders’ relationship with the researcher and stakeholders’ cohesion

Ehealth advisory expert system for HIV/Aids patients in South Africa

Human immunodeficiency virus (HIV) / Acquired immune deficiency syndrome (AIDS) is a major global health problem. It is the greatest threat to the reconstruction and development of South Africa. Advances in Information and Communication Technology (ICT) have facilitated development of medical expert systems. They have proved their usefulness by providing precise, quick and inexpensive consultation. Advisory expert system is seen as an enhancement tool in providing home-base care to people living with HIV/AIDS. In this paper we discuss our research motives, related work and the design of the web-based advisory expert system that allows HIV patients to manage the HIV-related symptoms

Does mobile phone ownership matter? Insights on engagement in Health and e-government interventions from Southern Africa

The proliferation of mobile phones across the world has contributed to the rise of mHealth interventions as a complementary means for improving health outcomes in areas where health facilities are limited. However, community members who do not own or have access to mobile devices feel excluded from such interventions. In this paper, we seek to understand and explore engagement strategies that support the inclusion of non-mobile phone owners in Health interventions. We conducted a review of mHealth and community engagement literature to gauge the strategies different studies have employed to engage non-mobile phone owners and users. We further reflected on two Southern African case studies from health and citizen engagement sectors to gain insights on ways non-mobile phone owners may feel included in Health interventions. Through a process of thematic analysis, we have identified three areas that mHealth implementers could draw from when designing more inclusive Health interventions. These strategies include the need for sensitising communities, using multi-stakeholder and multi-sectoral collaboration, and embracing a braided approach to communication technologies. We hope that this paper will inform mHealth project implementers on different strategies they can use to include community members, regardless of whether they own mobile phones or not

The NICU Design Toolbox: Co-design through Empathic Relationship Building

Co-design in practice can be extremely difficult, especially when multiple stakeholders are involved. In this research, we reflect on ways to produce cooperation between low-income mothers, nurses, and doctors, as they work with researchers to co-design an artifact to alleviate communication gaps in a South African neonatal intensive care unit. We describe the strategies used to mediate and foster cooperation between these stakeholders; cooperative prototyping techniques can foster collaboration, disentangle participation and enhance participant creativity in spite of power differentials and initial feelings of disconnection. We argue for flexible, responsive design practices that foster readiness to design with other stakeholders

Prospective Changes in Serum Levels of Some Proinflammatory Cytokines and Erythropoietin among Anaemic HIV-infected Patients Attending Kenyatta National Hospital Comprehensive Care Centre

Between 70 to 80% of HIV infected patients develop anaemia which is a major complication in advanced HIV infection. The multifactorial etiology of the HIV-associated anaemia requires extensive studies on its unique pathophysiology as a step towards improving therapeutic options and disease management.The objective of this study is to monitor changes in serum levels of erythropoietin (Epo), Tumor necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6), C-Reactive Protein (CRP) and anaemia in HIV infected patients over six months’ period. This study is Longitudinal descriptive study and it was conducted at Kenyatta National Hospital, Kenyatta National Hospital can be considered as Comprehensive Care Centre.The study used one hundred and eighty-four (184) seropositive adults aged 18 to 60 years.The results shows that Blood cells exhibited pathologies ranging from: Rouleaux formation, round macrocytes, microcytic hypochromic cells and target cells in frequencies that decreased with increase in CD4+ cells. Normochromic, macrocytic normochromic and dimorphic anaemias were observed. Bicytopenia (erythrocytopenia and leucopenia), reactive thrombocytosis with giant platelets, neutrophil and eosinophil hypersegmentations were also observed. Persistent increase in Epo and CRP levels were demonstrated among subjects throughout the study period. Increases in TNF-α levels without corresponding increase in IL-6 levels were observed. Persistence anaemia in presence of high Epo levels is suggestive of hyposensitivity to Epo by erythroid precursors. Asynchronized increases in TNF-α and IL- 6 levels may have deprived the duo the synergy required to effectively inhibit Epo production further facilitating the escalating levels of Epo observed. High levels of CRP observed indicate enhanced inflammation processes associated with HIV infection. Iron studies to rule out the role of iron-restricted erythropoiesis in the development microcytic, dimorphic anaemias and the granulocytic hypersegmentations noted are recommended. Studies on the possibility of Epo hyposensitivity derailing the effectiveness of recombinant human Epo in the management of HIV – associated anaemia are recommended.       

Class III myosins shape the auditory hair bundles by limiting microvilli and stereocilia growth.

International audienceThe precise architecture of hair bundles, the arrays of mechanosensitive microvilli-like stereocilia crowning the auditory hair cells, is essential to hearing. Myosin IIIa, defective in the late-onset deafness form DFNB30, has been proposed to transport espin-1 to the tips of stereocilia, thereby promoting their elongation. We show that Myo3a(-/-)Myo3b(-/-) mice lacking myosin IIIa and myosin IIIb are profoundly deaf, whereas Myo3a-cKO Myo3b(-/-) mice lacking myosin IIIb and losing myosin IIIa postnatally have normal hearing. Myo3a(-/-)Myo3b(-/-) cochlear hair bundles display robust mechanoelectrical transduction currents with normal kinetics but show severe embryonic abnormalities whose features rapidly change. These include abnormally tall and numerous microvilli or stereocilia, ungraded stereocilia bundles, and bundle rounding and closure. Surprisingly, espin-1 is properly targeted to Myo3a(-/-)Myo3b(-/-) stereocilia tips. Our results uncover the critical role that class III myosins play redundantly in hair-bundle morphogenesis; they unexpectedly limit the elongation of stereocilia and of subsequently regressing microvilli, thus contributing to the early hair bundle shaping