Preparing a financial incentive program to improve retention in HIV care and viral suppression for scale: using an implementation science framework to evaluate an mHealth system in Tanzania.
Preparing a financial incentive program to improve retention in HIV care and viral suppression for scale: using an implementation science framework to evaluate an mHealth system in Tanzania.
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DOI：
10.1186/s43058-021-00214-w
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发表时间：
2021-09-23
影响因子：
--
通讯作者：
McCoy SI
中科院分区：
文献类型：
--
作者：
Packel L;Fahey C;Kalinjila A;Mnyippembe A;Njau P;McCoy SI
病毒抑制是结束艾滋病毒流行的关键，然而在撒哈拉以南非洲地区，只有58%的艾滋病毒携带者(PLHIV)受到抑制。现金转移是提高护理保留率的有效战略，但对实施的优化知之甚少；例如，设计整合到现有诊所工作流程中的有效计划。我们研究了mHealth系统的实施，以提供现金转移来支持留住。我们进行了一项混合方法研究，评估移动健康现金转移研究的实施情况。这是一项规模更大的混合实施有效性随机对照试验的一部分，该试验评估了坦桑尼亚PLHIV启动抗逆转录病毒治疗的患者中以出诊次数为条件的现金转移。使用指纹识别和移动支付的mHealth系统被用来自动向符合条件的PLHIV支付移动货币。我们使用Proctor的框架，从PLHIV和临床医生的角度评估mHealth系统的实施情况。我们分析了mHealth系统的数据，对PLHIV、诊所和药房工作人员进行了调查(n=530)和深入访谈(n=25)(n=10)，并组织了临床观察(n=2293次访问)。1,651笔现金转账被交付给346PLHIV在现金部门，78%通过移动货币。在那些拥有现金的人中，81%的人在研究结束时在mHealth系统注册了他们的移动货币账户，这表明他们的被采用率很高。虽然指纹识别和移动支付在PLHIV中的可接受性很高，但采访显示出不同的看法：一些人担心隐私问题，而另一些人认为该系统安全准确，并为临床就诊提供了一些合法性。药剂师称赞了系统的效率，但对重复记录保存和额外工作的担忧也出现了。诊所工作人员对该系统将现金计划带给所有患者并简化工作流程的潜力表示兴奋；然而，对多个系统、人员配备和断断续续的连接的担忧冲淡了人们的热情，突显了计划范围以外的结构性问题。有组织的观察显示，学习曲线陡峭；随着系统的改进，重复指纹扫描和手动输入的次数减少了。大多数患者和工作人员都可以接受生物识别和移动支付。指纹识别在最初几个月的测试中遇到了一些可行性限制；然而，移动支付非常成功。生物识别和移动支付可以提供一种可扩展的机制来改进患者跟踪，并在低资源环境下高效地实施经济激励。注册中心名称：ClinicalTrials.gov试验注册编号：NCT03351556注册日期：2017年11月24日核对清单：Stari(包括在提交的文件中)。注：随机整群试验的CONTORT用于主要试验，但不直接适用于本手稿。网上版载有补充材料，可在10.1186/s43058021-00214-w查阅。
Viral suppression is key to ending the HIV epidemic, yet only 58% of people living with HIV (PLHIV) in sub-Saharan Africa are suppressed. Cash transfers are an effective strategy to improve retention in care, but little is known about optimization of implementation; for example, designing effective programs that integrate into existing clinic workflows. We studied implementation of an mHealth system to deliver cash transfers to support retention. We conducted a mixed-methods study assessing implementation of an mHealth cash transfer study. This was part of a larger, hybrid implementation-effectiveness randomized controlled trial evaluating cash transfers conditional on visit attendance for viral suppression among Tanzanian PLHIV initiating ART. An mHealth system using fingerprint identification and mobile payments was used to automatically disburse mobile money to eligible PLHIV. We used Proctor’s framework, assessing implementation of the mHealth system from the perspectives of PLHIV and clinicians. We analyzed mHealth system data and conducted surveys (n = 530) and in-depth interviews (n = 25) with PLHIV, clinic and pharmacy staff (n = 10), and structured clinic observations (n = 2293 visits). One thousand six hundred fifty-one cash transfers were delivered to 346 PLHIV in the cash arms, 78% through mobile money. Among those in the cash arms, 81% registered their mobile money account with the mHealth system by study end, signaling high adoption. While acceptability for fingerprinting and mobile payments was high among PLHIV, interviews revealed mixed views: some had privacy concerns while others felt the system was secure and accurate, and provided some legitimacy to the clinical visits. Pharmacists praised system efficiency, but concerns about duplicative recordkeeping and added work arose. Clinic staff voiced excitement for the system’s potential to bring the cash program to all patients and simplify workflows; yet concerns about multiple systems, staffing, and intermittent connectivity tempered enthusiasm, highlighting structural issues beyond program scope. Structured observations revealed a steep learning curve; repeat fingerprint scans and manual entry declined as the system improved. Biometric identification and mobile payments were acceptable to most patients and staff. Fingerprinting encountered some feasibility limitations in the first months of testing; however, mobile payments were highly successful. Biometric identification and mobile payments may provide a scalable mechanism to improve patient tracking and efficiently implement financial incentives in low-resource settings. Name of the registry: clinicaltrials.gov Trial registration number: NCT03351556 Date of registration: 11/24/2017 Checklists: StaRI (included with submission). Note CONSORT for cluster-randomized trials was used for the main trial but is not directly applicable to this manuscript. The online version contains supplementary material available at 10.1186/s43058-021-00214-w.
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影响因子：
4.4
作者：
Galarraga, Omar;Genberg, Becky L.;Martin, Rosemarie A.;Laws, M. Barton;Wilson, Ira B.
通讯作者：
Wilson, Ira B.
影响因子：
2.9
作者：
de Walque D;Dow WH;Nathan R;Abdul R;Abilahi F;Gong E;Isdahl Z;Jamison J;Jullu B;Krishnan S;Majura A;Miguel E;Moncada J;Mtenga S;Mwanyangala MA;Packel L;Schachter J;Shirima K;Medlin CA
通讯作者：
Medlin CA
影响因子：
3.7
作者：
Bastard M;Pinoges L;Balkan S;Szumilin E;Ferreyra C;Pujades-Rodriguez M
通讯作者：
Pujades-Rodriguez M
DOI：
10.1016/s2352-3018(20)30230-7
发表时间：
2020-11
期刊：
The lancet. HIV
影响因子：
--
作者：
Fahey CA;Njau PF;Katabaro E;Mfaume RS;Ulenga N;Mwenda N;Bradshaw PT;Dow WH;Padian NS;Jewell NP;McCoy SI
通讯作者：
McCoy SI
DOI：
10.1007/s10488-008-0197-4
发表时间：
2009-01
影响因子：
2.6
作者：
Proctor, Enola K.;Landsverk, John;Aarons, Gregory;Chambers, David;Glisson, Charles;Mittman, Brian
通讯作者：
Mittman, Brian