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
• 负责人: Caryl Feldacker
• 金额: $ 4.19万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-11 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10473616
• 关键词: Address; Adherence; Adoption; Africa South of the Sahara; Back; Caring; Client; Clinic; Communication; Computerized Medical Record; Cost Savings; Coupled; Data; Drowning; Effectiveness; Enrollment; Epidemic; Fatal Outcome; Funding; HIV; HIV Infections; Health; Health Personnel; Healthcare; Healthcare Systems; Home visitation; Human; Hybrids; Individual; International; Intervention; Maintenance; Malawi; Methods; Motivation; Patient Care; Patients; Policies; Provider; Quasi-experiment; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Resources; Retrospective cohort; Services; System; Technology; Telephone; Testing; Text; Text Messaging; Time; Training and Education; Translating; Trust; United States National Institutes of Health; Universities; Viral; Viral Load result; Visit; Washington; Workload; antiretroviral therapy; base; cohort; comparison intervention; cost; cost effective; cost estimate; data quality; design; follow-up; improved; improved outcome; innovation; mHealth; novel; point of care; programs; prospective; research to practice; response; routine care; routine practice; scale up; standard care; success; therapy design; therapy outcome; two way texting; usability; visit adherence

In sub-Saharan Africa (SSA), retention of HIV-infection people in antiretroviral therapy (ART) is an increasing challenge. With only 67% retained on ART in SSA, over 7.5 million people are out of care, threatening both individual health and HIV epidemic control. With significant healthcare system constraints and formidable healthcare worker (HCW) shortages, ART services in SSA struggle to meet ambitious global targets of 90% retained in care. In research settings, text-based mHealth innovations show promise to increase ART retention and, therefore, reduce viral load (VL). However, few mHealth innovations have been tested or proven effective in real-world settings with severe human and financial resource constraints. mHealth innovations that successfully retain more patients on ART, at lower cost, within large-volume public ART clinics in SSA are urgently needed. Lighthouse Trust (LT), the largest public provider of ART in Malawi, operates two large clinics in Lilongwe with the Malawi Ministry of Health (MoH), Lighthouse Clinic (LH) and Martin Preuss Center (MPC), with a combined 35,000 ART patients. 12-month retention at Lighthouse is 67%, below the 90% global target for epidemic control. Both clinics employ a real-time electronic medical records system (EMRS) and implement a resource-intensive patient retention program, Back to Care (B2C). B2C aims to trace patients who miss ART visits by >14 days. MPC has over 7800 monthly ART visits, and more than 10% of clients are B2C-eligible. B2C demand, coupled with HCW constraints, results in tracing of only 33% of target clients. Lack of, or delayed, tracing reduces ART retention. Moreover, over 50% of traced B2C clients are found on ART, 60% of whom had transferred, demonstrating significant unnecessary tracing. Poor data quality reduces B2C effectiveness. Therefore, the University of Washington’s International Training and Education Center for Health (I-TECH) and LT, with support from MoH and Medic Mobile, seek to implement an innovative, proactive, patient retention system using two-way texting (2wT) between new ART patients and staff. 2wT will resolve potential retention issues before they occur and improve data quality (e.g. identifying transfers), reducing B2C workload. Using a quasi-experimental, pre-post design, this R21 (Aim 1) will test a hybrid 2wT intervention to provide adherence support for, and visit-focused communication with, new ART initiates at MPC clinic, comparing retention (ART outcomes, visit adherence, VL) and B2C referrals among two groups of new MPC ART clients: 2wT-supported (prospective intervention) and matched pre-2wT (retrospective comparison). After demonstrating improved retention at lower cost (Aim 2) using research teams (R21: years 1-2), 2wT integration into the EMRS (R33: years 3-5) will automate enrollment and management of 2WT for new clients in both LH and MPC using routine HCWs (Aim 3), assessing the transition of research to practice. The proposed mHealth study will significantly increase ART retention in public ART clinics using routine HCWs, reducing workload and costs. This innovative approach in high-volume, public settings in Malawi sets the stage for national or regional scale-up.

在撒哈拉以南非洲（SSA）中，抗逆转录病毒疗法（ART）的HIV感染人的保留量正在增加 挑战。 SSA只有67％的艺术品保留了67％的人，超过750万人失业，威胁 个人健康和艾滋病毒流行控制。具有重大的医疗保健系统限制和强大的 医疗保健工作者（HCW）短缺，SSA的艺术服务努力实现雄心勃勃的全球目标90％ 保留在护理中。在研究环境中，基于文本的MHealth创新有望增加艺术保留 因此，减少病毒载荷（VL）。但是，很少对MHealth创新进行测试或证明有效 在具有严重人力和财务资源限制的现实环境中。 MHealth创新 在SSA的大型公共艺术诊所内，成功保留更多的艺术患者，成本较低 迫切需要。马拉维最大的公共艺术提供商Lighthouse Trust（LT）经营两个大型诊所 在马拉维卫生部（MOH），灯塔诊所（LH）和马丁·普鲁斯中心（MPC），在利隆威（Lilongwe） 共有35,000名艺术患者。在灯塔的12个月保留率为67％，低于全球90％的目标 流行病控制。这两个诊所都采用实时电子病历系统（EMRS）并实施 资源密集型患者保留计划，重新护理（B2C）。 B2C旨在追踪错过艺术的患者 访问> 14天。 MPC每月进行7800多次访问，超过10％的客户符合B2C的资格。 B2C 需求，再加上HCW的约束，导致仅33％的目标客户追踪。缺乏或延迟 追踪可减少艺术保留。此外，在ART上发现了超过50％的追踪B2C客户，其中60％ 转移，证明了明显的不必要的追踪。数据质量差会降低B2C的有效性。 因此，华盛顿大学的国际培训与教育中心（I-Tech）和 在MOH和Medic Mobile的支持下，LT试图实施创新，积极主动的患者保留率 在新艺术患者和员工之间使用双向发短信（2WT）的系统。 2WT将解决潜在的保留率 问题发生之前，并提高数据质量（例如识别转移），减少B2C工作量。使用 准实验，前孔设计，此R21（AIM 1）将测试混合2WT干预措施以提供依从性 在MPC诊所的新艺术启动和以访问为中心的沟通中，比较保留率（艺术 结果，访问两组新MPC艺术客户的依从性，VL）和B2C推荐：2WT支持 （前瞻性干预）和匹配2WT（回顾性比较）。证明改进后 使用研究团队（R21：1-2），2WT集成到EMRS（R33：R33： 3-5年）将使用例行程序自动化LH和MPC的新客户的2WT注册和管理 HCWS（AIM 3），评估研究过渡到实践的过渡。拟议的MHealth研究将显着 使用常规HCWS增加公共艺术诊所的艺术保留率，减少工作量和成本。这种创新 在大批量的方法中，马拉维的公共场所为国家或区域规模奠定了基础。

项目成果

How much does it cost to retain antiretroviral therapy (ART) clients in care? Routine financial costs of retention interventions at Lighthouse Trust's Martin Preuss Centre (MPC) in Lilongwe, Malawi.

保留抗逆转录病毒治疗 (ART) 患者的护理费用是多少？

• DOI: 10.21203/rs.3.rs-3773952/v1
• 发表时间: 2023
• 期刊: Research square
• 作者: Weldemariam,Hiwot;Thawani,Agness;Kiruthu-Kamamia,Christine;Huwa,Jacqueline;Chipanda,Mirriam;Tweya,Hannock;Feldacker,Caryl
• 通讯作者: Feldacker,Caryl

Centering healthcare workers in developing digital health interventions: usability and acceptability of a two-way texting retention intervention in a public HIV clinic in Lilongwe, Malawi.

以医护人员为中心制定数字健康干预措施：马拉维利隆圭公共艾滋病毒诊所双向短信保留干预措施的可用性和可接受性。

• DOI: 10.1101/2023.01.09.23284326
• 发表时间: 2023
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Mureithi,Maryanne;Ng'aari,Leah;Wasunna,Beatrice;Kiruthu-Kamamia,Christine;Sande,Odala;Chiwaya,GeldertDavie;Huwa,Jacqueline;Tweya,Hannock;Jafa,Krishna;Feldacker,Caryl
• 通讯作者: Feldacker,Caryl

Centering healthcare workers in digital health design: Usability and acceptability of two-way texting to improve retention in antiretroviral therapy in a public HIV clinic in Lilongwe, Malawi.

以医疗保健工作者为中心进行数字健康设计：双向短信的可用性和可接受性，以提高马拉维利隆圭公共艾滋病毒诊所抗逆转录病毒治疗的保留率。

• DOI: 10.1371/journal.pdig.0000480
• 发表时间: 2024
• 期刊: PLOS digital health
• 作者: Mureithi,Maryanne;Ng'aari,Leah;Wasunna,Beatrice;Kiruthu-Kamamia,Christine;Sande,Odala;Chiwaya,GeldertDavie;Huwa,Jacqueline;Tweya,Hannock;Jafa,Krishna;Feldacker,Caryl
• 通讯作者: Feldacker,Caryl