Provider alerts and reminders to improve tuberculosis care among people living with HIV in Kenya: TB Tech formative report

People living with HIV (PLHIV) have a 20-fold higher risk of dying from tuberculosis (TB) than the general population. Reducing TB morbidity and mortality among PLHIV requires identifying those with active TB and treating them, as well as preventing new TB infections among those not infected. WHO recommends screening all HIV-infected patients for symptoms of active TB infection, testing those who show symptoms, treating those with positive TB tests, and providing isoniazid preventive therapy (IPT) for those who are either asymptomatic or whose TB test results are negative. WHO classifies Kenya among the “high burden” countries for TB and notes high rates of HIV-TB co-infection. Screening and testing of HIV-infected patients for TB is the focus of this report. The TB Tech study, under USAID’s HIVCore project led by the Population Council was initiated. The study team conducted research to address: preparedness of Academic Model Providing Access to Healthcare (AMPATH) facilities and providers to screen for TB symptoms and provide IPT for symptom-negative HIV-infected patients; preparedness of AMPATH Medical Record System (AMRS) to capture and report critical indicators of IPT/TB service performance; preparedness of AMRS and other data sources to capture and report critical indicators of reminder-system performance

Do clinical decision-support reminders for medical providers improve isoniazid preventative therapy prescription rates among HIV-positive adults? Study protocol for a randomized controlled trial

BACKGROUND: This document describes a research protocol for a study designed to estimate the impact of implementing a reminder system for medical providers on the use of isoniazid preventative therapy (IPT) for adults living with HIV in western Kenya. People living with HIV have a 5% to 10% annual risk of developing active tuberculosis (TB) once infected with TB bacilli, compared to a 5% lifetime risk in HIV-negative people with latent TB infection. Moreover, people living with HIV have a 20-fold higher risk of dying from TB. A growing body of literature suggests that IPT reduces overall TB incidence and is therefore of considerable benefit to patients and the larger community. However, in 2009, of the estimated 33 million people living with HIV, only 1.7 million (5%) were screened for TB, and about 85,000 (0.2%) were offered IPT. METHODS/DESIGN: This study will examine the use of clinical decision-support reminders to improve rates of initiation of preventative treatment in a TB/HIV co-morbid population living in a TB endemic area. This will be a pragmatic, parallel-group, cluster-randomized superiority trial with a 1:1 allocation to treatment ratio. For the trial, 20 public medical facilities that use clinical summary sheets generated from an electronic medical records system will participate as clusters. All HIV-positive adult patients who complete an initial encounter at a study cluster and at least one return encounter during the study period will be included in the study cohort. The primary endpoint will be IPT prescription at 3 months post the initial encounter. We will conduct both individual-level and cluster-level analyses. Due to the nature of the intervention, the trial will not be blinded. This study will contribute to the growing evidence base for the use of electronic health interventions in low-resource settings to promote high-quality clinical care, health system optimization and positive patient outcomes. Trial registration ClinicalTrials.gov NCT01934309, registered 29 August 2013

Do clinical decision-support reminders for medical providers improve isoniazid prescription rates among HIV-positive adults?

People living with HIV (PLHIV) are at increased risk of developing active tuberculosis (TB) and dying from TB. Isoniazid preventive therapy (IPT) can prevent this, but only a small fraction of HIV-positive individuals are on IPT. Previous research suggests that clinical decision support systems (CDSS)—electronic systems that use existing patient data and established algorithms to generate alerts, reminders, or recommendations intended to aid clinical decision-making—have the potential to improve provider adherence to diagnostic and treatment guidelines. Researchers conducted a cluster randomized controlled trial of a new CDSS intervention for TB screening, prevention, and treatment in a high HIV and TB prevalence setting to evaluate the effects of implementing a reminder system for medical providers to increase IPT for PLHIV. Specifically, the research objective was to determine if the intervention increases IPT prescription rates and decreases time from initial encounter to IPT initiation. The study was conducted as part of the HIVCore project, funded by the U.S. Agency for International Development and led by the Population Council

An evidence-based framework for integrating eHealth into more equitable health systems

The eHealth Equity, Governance, and Health Systems Integration evidence-based Framework provides a systematic approach to better integrate eHealth into equitable health systems. These fundamental principles are essential to future success of eHealth initiatives worldwide

Development and Assessment of Traditional and Innovative Media to Reduce Individual HIV/AIDS-Related Stigma Attitudes and Beliefs in India

Although stigma is considered a major barrier to effective response to the HIV/AIDS epidemic, there is a lack of evidence on effective interventions. This media intervention took place among key HIV-vulnerable communities in Southern India. Two HIV stigma videos were created using techniques from traditional film production and new media digital storytelling. A series of 16 focus group discussions were held in 4 rural and 4 urban sites in South India, with specific groups for sex workers, men who have sex with men, young married women, and others. Focus groups with viewers of the traditional film (8 focus groups, 80 participants) and viewers of the new media production (8 focus groups, 69 participants) revealed the mechanisms through which storyline, characters, and esthetics influence viewers’ attitudes and beliefs about stigma. A comparative pre-/post-survey showed that audiences of both videos significantly improved their stigma scores. We found that a simple illustrated video, produced on a limited budget by amateurs, and a feature film, produced with an ample budget by professionals, elicited similar responses from audiences and similar positive short-term outcomes on stigma

Development and Assessment of Traditional and Innovative Media to Reduce Individual HIV/AIDS-Related Stigma Attitudes and Beliefs in India

Although stigma is considered a major barrier to effective response to the HIV/AIDS epidemic, there is a lack of evidence on effective interventions. This media intervention took place among key HIV-vulnerable communities in Southern India. Two HIV stigma videos were created using techniques from traditional film production and new media digital storytelling. A series of 16 focus group discussions were held in 4 rural and 4 urban sites in South India, with specific groups for sex workers, men who have sex with men, young married women, and others. Focus groups with viewers of the traditional film (8 focus groups, 80 participants) and viewers of the new media production (8 focus groups, 69 participants) revealed the mechanisms through which storyline, characters, and esthetics influence viewers’ attitudes and beliefs about stigma. A comparative pre-/post-survey showed that audiences of both videos significantly improved their stigma scores. We found that a simple illustrated video, produced on a limited budget by amateurs, and a feature film, produced with an ample budget by professionals, elicited similar responses from audiences and similar positive short-term outcomes on stigma

Community Health Workers and Mobile Technology: A Systematic Review of the Literature

In low-resource settings, community health workers are frontline providers who shoulder the health service delivery burden. Increasingly, mobile technologies are developed, tested, and deployed with community health workers to facilitate tasks and improve outcomes. We reviewed the evidence for the use of mobile technology by community health workers to identify opportunities and challenges for strengthening health systems in resource-constrained settings.Methods We conducted a systematic review of peer-reviewed literature from health, medical, social science, and engineering databases, using PRISMA guidelines. We identified a total of 25 unique full-text research articles on community health workers and their use of mobile technology for the delivery of health services.Results Community health workers have used mobile tools to advance a broad range of health aims throughout the globe, particularly maternal and child health, HIV/AIDS, and sexual and reproductive health. Most commonly, community health workers use mobile technology to collect field-based health data, receive alerts and reminders, facilitate health education sessions, and conduct person-to-person communication. Programmatic efforts to strengthen health service delivery focus on improving adherence to standards and guidelines, community education and training, and programmatic leadership and management practices. Those studies that evaluated program outcomes provided some evidence that mobile tools help community health workers to improve the quality of care provided, efficiency of services, and capacity for program monitoring.Discussion Evidence suggests mobile technology presents promising opportunities to improve the range and quality of services provided by community health workers. Small-scale efforts, pilot projects, and preliminary descriptive studies are increasing, and there is a trend toward using feasible and acceptable interventions that lead to positive program outcomes through operational improvements and rigorous study designs. Programmatic and scientific gaps will need to be addressed by global leaders as they advance the use and assessment of mobile technology tools for community health workers

Literature Search Strategy.

<p>Literature Search Strategy.</p

Community Health Workers and Mobile Technology: A Systematic Review of the Literature

<div><p>Introduction</p><p>In low-resource settings, community health workers are frontline providers who shoulder the health service delivery burden. Increasingly, mobile technologies are developed, tested, and deployed with community health workers to facilitate tasks and improve outcomes. We reviewed the evidence for the use of mobile technology by community health workers to identify opportunities and challenges for strengthening health systems in resource-constrained settings.</p><p>Methods</p><p>We conducted a systematic review of peer-reviewed literature from health, medical, social science, and engineering databases, using PRISMA guidelines. We identified a total of 25 unique full-text research articles on community health workers and their use of mobile technology for the delivery of health services.</p><p>Results</p><p>Community health workers have used mobile tools to advance a broad range of health aims throughout the globe, particularly maternal and child health, HIV/AIDS, and sexual and reproductive health. Most commonly, community health workers use mobile technology to collect field-based health data, receive alerts and reminders, facilitate health education sessions, and conduct person-to-person communication. Programmatic efforts to strengthen health service delivery focus on improving adherence to standards and guidelines, community education and training, and programmatic leadership and management practices. Those studies that evaluated program outcomes provided some evidence that mobile tools help community health workers to improve the quality of care provided, efficiency of services, and capacity for program monitoring.</p><p>Discussion</p><p>Evidence suggests mobile technology presents promising opportunities to improve the range and quality of services provided by community health workers. Small-scale efforts, pilot projects, and preliminary descriptive studies are increasing, and there is a trend toward using feasible and acceptable interventions that lead to positive program outcomes through operational improvements and rigorous study designs. Programmatic and scientific gaps will need to be addressed by global leaders as they advance the use and assessment of mobile technology tools for community health workers.</p></div

Overview of Research Design & Methods.

<p>Overview of Research Design & Methods.</p