Designing an architecture for secure sharing of personal health records : a case of developing countries

Includes bibliographical references.While there has been an increase in the design and development of Personal Health Record (PHR) systems in the developed world, little has been done to explore the utility of these systems in the developing world. Despite the usual problems of poor infrastructure, PHR systems designed for the developing world need to conform to users with different models of security and literacy than those designed for developed world. This study investigated a PHR system distributed across mobile devices with a security model and an interface that supports the usage and concerns of low literacy users in developing countries. The main question addressed in this study is: “Can personal health records be stored securely and usefully on mobile phones?” In this study, mobile phones were integrated into the PHR architecture that we/I designed because the literature reveals that the majority of the population in developing countries possess mobile phones. Additionally, mobile phones are very flexible and cost efficient devices that offer adequate storage and computing capabilities to users for typically communication operations. However, it is also worth noting that, mobile phones generally do not provide sufficient security mechanisms to protect the user data from unauthorized access

Determining the acceptability of a novel One Health vaccine for Rift Valley Fever prior to phase II/III clinical trials in Uganda.

Several vaccine candidates for Rift Valley Fever (RVF) are in development for use in humans. A promising candidate, ChAdOx1 RVF vaccine, has been developed for use in both humans and animals, and has undergone field trials in livestock in Kenya. We conducted a qualitative study to explore the acceptability of this novel One Health vaccine for Rift Valley Fever prior to phase II/III trials, in two rural Ugandan cohorts between January to June 2020. Data was obtained from 96 semi-structured interviews at Bwindi Impenetrable National Park (BINP) and Kyamulibwa, Kalungu District, in Southern Uganda. The study found that 42% of those interviewed were willing to receive a vaccine that was the same for both humans and animals. 45% of those interviewed said that they would not be willing to receive a One Health vaccine and a further 13% were unsure whether or not they would be happy to receive such a vaccine. Semi-structured interviews were conducted to explore their reasons for and against the acceptability of a novel One Health vaccine to highlight potential barriers to deployment once a vaccine candidate for RVF becomes available

Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

Background International and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda. Methods We did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15–49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population. Findings Between Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positive did not report antiretroviral therapy use, of whom 2652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. 446 transmission networks were reconstructed, including 293 linked pairs with inferred direction of transmission. Adjusting for incomplete sampling, an estimated 5·7% (95% credibility interval 4·4–7·3) of transmissions occurred within lakeside areas, 89·2% (86·0–91·8) within inland areas, 1·3% (0·6–2·6) from lakeside to inland areas, and 3·7% (2·3–5·8) from inland to lakeside areas. Interpretation Cross-community HIV transmissions between Lake Victoria hotspots and surrounding inland populations are infrequent and when they occur, virus more commonly flows into rather than out of hotspots. This result suggests that targeted interventions to these hotspots will not alone control the epidemic in inland populations, where most transmissions occur. Thus, geographical targeting of high prevalence areas might not be effective for broader epidemic control depending on underlying epidemic dynamics. Funding The Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Child Health and Development, the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the World Bank, the Doris Duke Charitable Foundation, the Johns Hopkins University Center for AIDS Research, and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention

Using particpatory design technique in the design of the mobile phone-based health application for patients: a case from Uganda

Mobile health represents a relatively new trend in the field of health and involves the use of mobile devices to support healthcare. Despite this, there are still open challenges with respect to design, functionality and implementation aspects. The aim of this paper is to illustrate how to involve patients in the design and testing of the mobile phone-based Personal Health Record (PHR) system called M-Health App, and report our two-hour participatory design sessions with patients at Allan Galpin Health Centre - Uganda. The paper further presents insightful results from our formative evaluations, which will be used in the further implementation of M-Health App

Secure and efficient mobile personal data sharing in resource constrained environments

This paper was presented at the IEEE 29th International Conference on Advanced Information Networking and Applications Workshop (WAINA) in 2015.Although personal health record (PHR) systems are widely used in the developed world, little has been done to explore the utility of these PHR systems in the developing world. One of the key reasons behind this is the fact that a lot of areas in the developing world suffer from technological impediments that are a result of poor infrastructure, low literacy, intermittent power connectivity, and unstable bandwidth connectivity. In technological resource constrained environments such as these, deploying standard PHR systems is challenging and so it makes sense to redesign these systems to cope with the environmental limitations in order to offer users a usable and reliable platform. Furthermore, healthcare data is inherently privacy and security sensitive so, in re-designing the PHR system the security and privacy requirements need also be taken into consideration. The idea in this case, is to opt for security mechanisms that offer the same levels of security as is the case in the standard PHR systems that are used in the developed world, but that are also lightweight in terms of performance and storage overhead. In this paper, based on the observation that mobile phone use is widely proliferated in developing countries, we propose an access control framework supported by identity-based encryption for a secure Mobile-PHR system. Results from our prototype evaluation (laboratory and field studies) indicate that the proposed IBE scheme effectively secures PHRs beyond the healthcare provider's security domain and is efficient performance-wise

Issues of Adoption: Can Health Services Designed for Developed Countries be adopted in Developing Countries?

This paper was presented and was part of the proceedings of the Tenth International Network Conference (INC2014) in July, Plymouth, UK.Electronic health record (EHR) systems are a popular mechanism for accessing health records in the developed world and have contributed towards improved and cost-effective health care management. However, the development of appropriate and scalable EHR systems in developing countries has been difficult to achieve because of certain limitations inherent in the technological infrastructure. For instance, bandwidth limitations and power outages make it difficult to guarantee dependability in terms of accessibility to the data. This paper presents a comparative study of 19 EHR systems in terms of the security and usability of these systems within the context of the developing world. The evaluation is based on a number of dimensions such as development environment, system platform, type and access control standards found in the National Institute for Standard and Technology (NIST) and Certification Commission for Health Information Technology (CCHIT). Our research indicates that all the systems evaluated require online access control decisions. Access to data on a central server is controlled by a mechanism that verifies/authenticates users or parties wanting to view/modify/edit patient records. However, solely relying on an online access control system is limiting, particularly in developing countries where access to the server can be disrupted by a number of disastrous events. Additionally, literature also reveals that all the evaluated tools were developed with the user contexts in the developed World and therefore do not represent the needs of the patients and medical practitioners in the developing countries

On the challenge of adopting standard EHR systems in developing countries

ACM Press the 3rd ACM Symposium - Bangalore, India (2013.01.11-2013.01.12)] Proceedings of the 3rd ACM Symposium on Computing for Development - ACM DEV '13Electronic health record (EHR) systems are a popular mechanism for accessing health records in the developed world and have contributed towards improved and cost-effective health care management. However, the development of appropriate and scalable EHR systems in developing countries has been difficult to achieve because of certain limitations inherent in the technological infrastructure. In this paper, we present a comparative study of 19 EHR systems in terms of the security and usability of these systems within the context of the developing world. Our aim was to investigate whether online health services designed for developed countries can be adopted for EHR systems in developing countries. The investigation was based on a number of dimensions such as development environment, system platform, type and access control standards found in the National Institute for Standard and Technology (NIST) and Certification Commission for Health Information Technology (CCHIT). Our research indicates that all the systems evaluated require online access control decisions. Solely relying on an online access control system is limiting, particularly in developing countries where access to the server can be disrupted by a number of disastrous events

An access control framework for protecting personal electronic health records

This paper was presented and part of the proceedings of The MAURICON 2018 International Conference on Intelligent and Innovative Computing Applications (ICONIC).The increasing expansion of wireless systems and the extensive popularity and usage of mobile devices such as mobile phones and wireless tablets represents a great opportunity to use mobile devices as widespread health data access tools. Unfortunately, some problems impeding the general acceptance of mhealth such as privacy protection, limitation of wireless networks and handheld devices are still common. Challenges such as unreliable data repositories and limited connection speeds in resource-limited environments are also evident. The inadequate capabilities of hand-held devices and wireless systems make these Public Key Cryptography based frameworks unsuitable for mobile networks. Moreover, these protocols were designed to preserve the customary flow of health data, which is vulnerable to attack and increase the user’s risk. This research drew its foundations from literature and theoretical review and used qualitative approaches. In this paper, the researchers build on existing concepts of Medical Information Systems and use of Symmetric Key Infrastructure to design a framework for secure access to personal electronic health records. The framework provides identity protection for a patient from all forms of unauthorised data access. The framework not only reduces the computational operations between the engaging parties, but also achieves privacy protection for the user. Validation results from ICT experts demonstrate that the designed framework is applicable to secure access to personal medical health records in resource-limited settings

Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

International audienceBackground: International and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda.Methods: We did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15-49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population.Findings: Between Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positive did not report antiretroviral therapy use, of whom 2652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. 446 transmission networks were reconstructed, including 293 linked pairs with inferred direction of transmission. Adjusting for incomplete sampling, an estimated 5·7% (95% credibility interval 4·4-7·3) of transmissions occurred within lakeside areas, 89·2% (86·0-91·8) within inland areas, 1·3% (0·6-2·6) from lakeside to inland areas, and 3·7% (2·3-5·8) from inland to lakeside areas.Interpretation: Cross-community HIV transmissions between Lake Victoria hotspots and surrounding inland populations are infrequent and when they occur, virus more commonly flows into rather than out of hotspots. This result suggests that targeted interventions to these hotspots will not alone control the epidemic in inland populations, where most transmissions occur. Thus, geographical targeting of high prevalence areas might not be effective for broader epidemic control depending on underlying epidemic dynamics.Funding: The Bill & Melinda Gates Foundation, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, the National Institute of Child Health and Development, the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases, the World Bank, the Doris Duke Charitable Foundation, the Johns Hopkins University Center for AIDS Research, and the President's Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention