CHAT: mHealth Innovation for HIV-MNCH Community Health Workers in South Africa

聊天：南非 HIV-MNCH 社区卫生工作者的移动医疗创新

• 批准号: 8330030
• 负责人: Lisa Michelle Butler
• 金额: $ 26.25万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-15 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8330030
• 关键词: 5 year old; Address; Adherence; Adult; Affect; Africa South of the Sahara; African; Age; Behavior; Caregivers; Caring; Cessation of life; Child; Child Care; Child Development; Child Mortality; Child Nutrition; Child health care; Childhood; Client; Clinic; Communication; Communities; Community Health; Computer software; Computers; Continuity of Patient Care; Country; Data; Development; Devices; Diarrhea; Dietary Intervention; Disease; Education; Effectiveness; Ensure; Evaluation; Goals; Growth; Guidelines; HIV; HIV Infections; Health; Health Personnel; Health Promotion; Health Services Accessibility; Health behavior; Health care facility; Health education; Healthcare; Home environment; Household; Hygiene; Immunization; Improve Access; Infant; Intervention; Knowledge; Learning; Life; Live Birth; Logic; Lower Respiratory Tract Infection; Malnutrition; Maternal and Child Health; Modeling; Mothers; Nutritional; Outcome; Participant; Play; Prevalence; Primary Health Care; Protocols documentation; Province; Quality of Care; Randomized Controlled Trials; Research; Resources; Role; Self-Help Devices; Services; South Africa; Supervision; Tablets; Technology; Testing; Training; Translating; Underserved Population; Validation; Work; animation; base; care seeking; care systems; community planning; cost; design; effective intervention; electronic data; evidence base; follow-up; health care service utilization; immune function; improved; information gathering; innovation; interest; meetings; mortality; nutrition; open source; patient home care; prevention service; programs; scale up; success

DESCRIPTION (provided by applicant): In South Africa (SA), an estimated 51,300 children between 1 month and 5 years old die every year. -- the majority (57%) due to HIV. Childhood malnutrition, associated with diminished immune function, is a major contributor to these deaths. Key interventions to reduce HIV- and nutrition- related child mortality include well- defined and evidence-based packages of care to improve survival of HIV-infected adult caregivers as well as HIV-exposed children. Community health workers (CHW), if appropriately supported, can play a critical role in improving access to care and supporting delivery of evidence-based HIV and maternal and child health and nutritional (MCHN) interventions. While prior studies have shown the feasibility of CHW-led models for MCHN health promotion and their impact on some maternal-child health outcomes, evaluations of non-HIV focused CHW programs have shown CHW adherence to protocols to decline rapidly after training. Thus, despite the recognized importance of CHW models, there is little research to address the effectiveness of strategies for training CHW or for ensuring quality of care and fidelity to evidence-based protocols. We propose a 3-year study to develop and test an mHealth innovation to support CHW in their delivery of home-based HIV and MCHN education, support, and referral in a high HIV prevalence community in KwaZulu Natal, SA. Community Health Worker Assistive Technologies (CHAT) will be developed on a handheld platform (i.e., a multi-function tablet computer) and will leverage available, low-cost devices and open source software. CHAT will provide CHW with sustained, integrated support including protocol training, powerful handheld technologies and accessible, media enhanced resources (e.g., health education videos and animations) that will promote interactive discussions with clients. It will enable electronic data capture that supports high quality information gathering using data validation and branching logic, and will support communication with clinic-based health providers and CHW supervisors. To test the impact of CHAT, we will conduct a small community randomized controlled trial (C-RCT) to investigate the impact of CHAT on 1) CHW quality of care as well as knowledge about HIV, nutrition, danger signs of childhood illness, and child development; 2) health care utilization of caregivers for children, and child-care-related behaviors (e.g., immunizations, hygiene practices); and 3) the preliminary impact of CHAT on child health including growth, disease, and development for HIV-affected children age 0 to 59 months old. Participants will include 60 CHW (30 intervention, 30 control) and 80 caregiver-child pairs (40 intervention and 40 control) who will be followed for one year and assessed at regular intervals for the outcomes of interest. We will also assess the acceptability and feasibility of CHAT, conducting health and developmental assessments at children's homes, and translate lessons learned in the development study into the design of a large C-RCT. PUBLIC HEALTH RELEVANCE: Community health workers (CHW) can play a critical role in improving access to and continuity of care and treatment for underserved populations. This project will develop and assess the preliminary impact of an mHealth intervention targeting CHW who provide home-based support for HIV-affected households in KwaZulu Natal Province, South Africa on 1) CHW knowledge about HIV, maternal and child health and nutrition, and child development and on quality of care; 2) caregiver health behaviors and health care utilization for HIV- affected children ages 0-59 months old; and 3) the preliminary impact of the intervention on child growth, disease and development of HIV-affected children ages 0-59 months old. Ultimately, the project has the potential to improve the ways in which community-based health care and prevention services are conceptualized and delivered throughout African communities by demonstrating the role of mHealth in improving CHW practice and improving the health of HIV-affected children and their caregivers.

描述（由申请人提供）：在南非（SA），估计每年有51,300名1个月至5岁的儿童死亡。——大多数（57%）是由于艾滋病毒。儿童营养不良与免疫功能下降有关，是造成这些死亡的主要原因。减少与艾滋病毒和营养有关的儿童死亡率的关键干预措施包括明确界定和以证据为基础的一揽子护理，以提高感染艾滋病毒的成年护理人员和感染艾滋病毒的儿童的存活率。如果得到适当的支持，社区卫生工作者可以在改善获得护理的机会和支持提供基于证据的艾滋病毒和妇幼保健与营养干预措施方面发挥关键作用。虽然先前的研究表明，卫生工作者领导的妇幼保健促进模式的可行性及其对一些妇幼保健结果的影响，但对非艾滋病毒卫生工作者项目的评估表明，卫生工作者在培训后对协议的依从性迅速下降。因此，尽管认识到CHW模型的重要性，但很少有研究解决培训CHW策略的有效性或确保护理质量和对循证协议的忠诚。我们建议进行一项为期3年的研究，以开发和测试移动医疗创新，以支持卫生保健人员在南非夸祖鲁纳塔尔省艾滋病毒高发社区提供基于家庭的艾滋病毒和母婴保健教育、支持和转诊。社区卫生工作者辅助技术（CHAT）将在手持平台（即多功能平板电脑）上开发，并将利用现有的低成本设备和开源软件。CHAT将为卫生保健中心提供持续的综合支持，包括协议培训、强大的手持技术和可获得的媒体增强资源（例如卫生教育视频和动画），这些资源将促进与客户进行互动讨论。它将实现电子数据捕获，支持使用数据验证和分支逻辑进行高质量的信息收集，并将支持与基于诊所的保健提供者和卫生保健监督员的通信。为了测试CHAT的影响，我们将进行一项小型社区随机对照试验（C-RCT），以调查CHAT对以下方面的影响：1)CHW的护理质量以及对艾滋病毒、营养、儿童疾病危险迹象和儿童发育的了解；2)儿童照护者的卫生保健利用情况，以及与儿童照护有关的行为（如免疫接种、卫生习惯）；3) CHAT对0至59个月感染艾滋病毒儿童的生长、疾病和发育等儿童健康的初步影响。参与者将包括60名CHW（30名干预组，30名对照组）和80对照顾者-儿童（40名干预组和40名对照组），他们将被跟踪一次