Expanding and Scaling Two-way Texting to Reduce Unnecessary Follow-Up and Improve Adverse Event Identification Among Voluntary Medical Male Circumcision Clients in the Republic of South Africa
扩大和扩大双向短信,以减少南非共和国自愿医疗男性包皮环切术客户中不必要的后续行动并改善不良事件识别
基本信息
- 批准号:10191053
- 负责人:
- 金额:$ 57.57万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2020
- 资助国家:美国
- 起止时间:2020-06-12 至 2025-03-31
- 项目状态:未结题
- 来源:
- 关键词:AIDS preventionAdherenceAdoptionAdverse eventAfrica South of the SaharaBlindedBudgetsCaringCellsClientClinicComplicationConsolidated Framework for Implementation ResearchCost AnalysisDataDetectionDiffusion of InnovationDisincentiveDissemination and ImplementationEconomicsEnsureGoalsGoldGuidelinesHealth systemHealthcare SystemsHourIndividualInterventionMaintenanceMale CircumcisionMeasuresMedicalMethodsModelingPatientsPersonsPhasePopulationPostoperative PeriodProcess MeasureProductivityProtocols documentationProviderProvincePublic HealthQuality of CareRandomizedReach, Effectiveness, Adoption, Implementation, and MaintenanceReportingResearchResearch DesignResearch PriorityResourcesRuralSafetySerious Adverse EventServicesSeveritiesSiteSouth AfricaSystemTestingTimeUncertaintyVisitWorkWorkloadZimbabwebasecontrol trialcost effectivecost estimatecost outcomesdesigndissemination strategyeconomic costeffectiveness evaluationevidence basefollow-uphealinghealth care qualityhigh standardimplementation researchimplementation scienceimplementation strategyimprovedinnovationinsightmHealthmenmicrocostingoutreachperi-urbanphase 1 testingpressurepreventive interventionprogramsprospectiveprovider adoptionresponseroutine carerural areascale upservice deliverysocialstandard caretreatment armtwo way textinguptakewasting
项目摘要
Male circumcision (MC) is a critical HIV prevention intervention with global support for expansion across sub-
Saharan Africa (SSA). MC is safe: routine programs in SSA report adverse event (AE) rates well under 2%.
Nevertheless, global MC guidelines require one or more follow-up visits within 14 days for AE detection. With
low AE rates, overstretched clinic staff waste invaluable resources conducting unnecessary routine reviews for
MC clients without complications. Men healing well needlessly pay for transport, miss work, and wait for reviews,
discouraging MC uptake. In weak healthcare systems in SSA, MC quality is buckling under pressure to provide
quality MC services and meet ambitious global targets of 5 million annual MCs. Our prior research in Zimbabwe
employed two-way texting (2wT) between patients and providers to focus follow-up on men with potential AEs,
allowing men healing without complication to opt-out of routine post-operative visits. 2wT safely reduced client
visits by 85%, suggesting that 2wT can make MC services dramatically more efficient while maintaining safety.
Whether 2wT can be replicated and scaled in other routine program settings is now a critical implementation
research question. The Republic of South Africa’s (RSA) MC context of high-volume urban clinics, remote service
delivery, and low AE identification threaten quality at scale. Across more than 500,000 annual MCs performed,
up to 1 million multi-stage, unnecessary MC reviews are likely conducted. In urban sites, this causes service
delivery bottlenecks; in rural areas, follow-up requires multiple, multi-hour trips, curtailing productivity. RSA
pressure for MC expansion and severe health system constraints, combined with good cell coverage, suggest
2wT’s impact would be significant for MC care quality and efficiency, especially in rural areas. Therefore, we
seek to develop an adaptable 2wT dissemination and implementation model at scale (2wT-2-SCALE) delivered
by routine MC teams, not research teams. First, a randomized control trial (RCT) (phase 1: test) will rigorously
evaluate how 2wT improves AE ascertainment and follow-up efficiency in urban and rural clinics. Then (phase
2: intensive), we scale (2wT-2-SCALE) via a one-year, quasi-experimental, step-wedge design with insights
gained from one additional year of 2wT with routine MC teams (phase 3: maintain). Guided by implementation
science, we employ mixed-methods to evaluate 2wT-2-SCALE’s impact on VMMC service quality. Our specific
aims are to 1) conduct an RCT to determine how 2wT increases AE ascertainment while reducing workload in
the RSA implementation context; 2) develop an effective dissemination and implementation strategy at scale
(2WT-2-SCALE) using RE-AIM to evaluate program reach, effectiveness, adoption, implementation, and
maintenance; and 3) use activity based micro-costing to estimate the payer-perspective budget and program
impact from 2wT scale-up compared to routine care. This implementation research is feasible, highly innovative
and systems-focused, establishing local evidence and timely, real-world data to support further adaptation,
adoption, and spread of 2wT to improve efficient, safe, high-quality MC services at scale in RSA and beyond.
男性包皮环切术(MC)是一项重要的艾滋病毒预防干预措施,全球支持在亚
撒哈拉非洲。MC是安全的:SSA的常规项目报告不良事件(AE)发生率远低于2%。
然而,全球MC指南要求在14天内进行一次或多次随访访视,以检测AE。与
不良事件发生率低,过度紧张的诊所工作人员浪费宝贵的资源进行不必要的例行审查,
MC客户没有并发症。康复良好的人不必要地支付交通费,错过工作,等待评论,
阻碍MC吸收。在SSA薄弱的医疗保健系统中,MC质量在提供
高质量的MC服务,并实现每年500万MC的宏伟全球目标。我们之前在津巴布韦的研究
在患者和提供者之间采用双向短信(2 wT),重点随访潜在AE的男性,
允许男性在没有并发症的情况下选择退出常规的术后访视。2 wT安全减少客户端
85%的访问量,这表明2 wT可以使MC服务在保持安全的同时大大提高效率。
2 wT是否可以在其他常规程序设置中复制和扩展,现在是一个关键的实现
研究问题。南非共和国(RSA)的MC背景下,大量的城市诊所,远程服务
交付和低AE识别威胁大规模质量。在超过50万个年度MC中,
可能会进行多达100万次多阶段、不必要的MC审查。在城市地区,这导致了服务
交付瓶颈;在农村地区,后续行动需要多次、数小时的旅行,降低了生产率。RSA
MC扩张的压力和严重的卫生系统限制,加上良好的细胞覆盖率,表明
2 wT的影响将是重大的MC护理质量和效率,特别是在农村地区。所以我们
寻求开发一个可适应的2 wT传播和实施模型(2 wT-2-SCALE)
由常规MC团队而不是研究团队首先,随机对照试验(RCT)(第1阶段:测试)将严格
评价2 wT如何提高城市和农村诊所的AE确定和随访效率。阶段(Phase)
2:密集型),我们通过为期一年的准实验性逐步楔形设计(2 wT-2-SCALE),
从常规MC团队的2 wT额外一年中获得(第3阶段:维持)。以执行为导向
科学,我们采用混合方法来评估2 wT-2-SCALE对VMMC服务质量的影响。我们的具体
目的是1)进行随机对照试验,以确定2 wT如何增加AE确定,同时减少工作量,
登记册系统管理人执行环境; 2)制定有效的大规模传播和执行战略
(2 WT-2-SCALE)使用RE-AIM评估项目覆盖范围、有效性、采用、实施和
维护; 3)使用基于活动的微观成本计算来估计付款人的预算和计划
与常规护理相比,2 wT规模扩大的影响。本实施研究具有可行性、创新性
以系统为重点,建立当地证据和及时的真实世界数据,以支持进一步的适应,
采用和推广2 wT,以在RSA及其他地区大规模提高高效、安全、高质量的MC服务。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Caryl Feldacker其他文献
Caryl Feldacker的其他文献
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{{ truncateString('Caryl Feldacker', 18)}}的其他基金
The Community-based ART REtention and Suppression (CARES) App: an innovation to improve patient monitoring and evaluation data in community-based antiretroviral therapy programs in Lilongwe, Malawi
基于社区的 ART 保留和抑制 (CARES) 应用程序:一项创新,旨在改善马拉维利隆圭社区抗逆转录病毒治疗项目中的患者监测和评估数据
- 批准号:
10402110 - 财政年份:2022
- 资助金额:
$ 57.57万 - 项目类别:
The Community-based ART REtention and Suppression (CARES) App: an innovation to improve patient monitoring and evaluation data in community-based antiretroviral therapy programs in Lilongwe, Malawi
基于社区的 ART 保留和抑制 (CARES) 应用程序:一项创新,旨在改善马拉维利隆圭社区抗逆转录病毒治疗项目中的患者监测和评估数据
- 批准号:
10543832 - 财政年份:2022
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10646808 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10856204 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10473616 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10673049 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10675910 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10063771 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Expanding and Scaling Two-way Texting to Reduce Unnecessary Follow-Up and Improve Adverse Event Identification Among Voluntary Medical Male Circumcision Clients in the Republic of South Africa
扩大和扩大双向短信,以减少南非共和国自愿医疗男性包皮环切术客户中不必要的后续行动并改善不良事件识别
- 批准号:
10380078 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi
双向短信 (2wT) 可提高患者保留率,同时减少马拉维高负担公共艾滋病毒诊所的医疗工作量
- 批准号:
10260647 - 财政年份:2020
- 资助金额:
$ 57.57万 - 项目类别:
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