Usability and Feasibility of a Phone-based Decision Support Tool for Option B+

选项 B 的基于电话的决策支持工具的可用性和可行性

• 批准号: 9116602
• 负责人: Sarah Odell Gimbel
• 金额: $ 21.91万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2018-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9116602
• 关键词: Adherence; Adopted; Affect; Africa South of the Sahara; Anti-Retroviral Agents; Area; CD4 Lymphocyte Count; Caring; Clinic; Cluster randomized trial; Complex; Computers; Counseling; Country; Data; Developing Countries; Effectiveness; Environment; Evaluation; Family; Focus Groups; Future; Group Interviews; Guidelines; HIV; Health; Health Services; Health system; Human Resources; Human immunodeficiency virus test; Infant; Intervention; Investments; Kenya; Knowledge; Life; Link; Maternal and Child Health; Measures; Medicine; Monitor; Mother-to-child HIV transmission; Mothers; Mozambique; Nurse' s Role; Nurses; Participant; Patients; Pregnancy; Pregnant Women; Process; Provider; Questionnaires; Recovery; Research; Research Personnel; Review Literature; SERPINI2 gene; Scientific Advances and Accomplishments; Services; Structure; System; Systems Analysis; Techniques; Telephone; Testing; Thinking; Training; Translations; Universities; Update; Visit; Woman; World Health Organization; base; clinical care; control trial; cost; experience; feeding; improved; literacy; mobile application; pediatric human immunodeficiency virus infection; prevent; prophylactic; public health relevance; satisfaction; screening; support tools; tool; usability

 DESCRIPTION (provided by applicant): Despite the availability of low-cost, efficacious interventions to prevent mother-to-child HIV transmission (pMTCT), and significant investments to increase their availability, the translation of scientific advances into practice has been sub-optimal. In highly affected regions in sub-Saharan Africa (sSA), HIV-infected pregnant women navigate a complex, sequential cascade of pMTCT services. Due to this complex care cascade, pediatric HIV infection remains largely uncontrolled, including in Mozambique and Kenya. To simplify the cascade and improve pMTCT, the World Health Organization (WHO) released updated guidelines in 2013 to include "Option B+", in which HIV-infected women initiate life-long anti-retroviral therapy (ART) during pregnancy regardless of CD4 count. Option B+ was adopted in Mozambique and Kenya in 2014, but initial results show sub-optimal ARV adherence and retention. Multiple health system challenges to Option B+ implementation exist; including the need to support the expanded role of nurses in service management and clinical care of Option B+ eligible mother-infant pairs. Decision-support tools tailored to nurses are needed to help their identification of systems inefficiencies and solutions across the HIV care cascade. As part of a cluster randomized trial of a systems analysis and improvement approach to assess and iteratively improve pMTCT in three sSA countries, we developed and evaluated an Excel(r)-based pMTCT cascade analysis tool (PCAT) that provides a systems-level view for nurses to rapidly and independently track patient flow through the pMTCT cascade. When combined with continuous quality improvement, the intervention was associated with a 4-5 fold greater rate of increase in coverage of maternal ARV provision and HIV-exposed infant screening. But the PCAT's usability was inhibited by low computer availability and literacy, and use was led by study nurses rather than facility personnel. Option B+-specific steps (e.g. retention in care and adherence), were also not part of the PCAT. Provider decision- support tools that are easily managed by health workers are more acceptable, usable and have more potential to improve management of complex health services. Tools tailored to specific environments with engagement from clinic staff are more likely to be implemented. In this study, we plan to adapt and refine a beta-tested version of a phone-based PCAT application, and test its usability and feasibility in Mozambique and Kenya. This study will collect preliminary data to inform a larger, controlled trial of the mobile PCAT application for Option B+ (mPCAT) and build capacity to conduct this trial in both countries. Aims include: 1) Identify Option B+-specific cascade measures and incorporate into the mPCAT; 2) Assess the usability of the mPCAT among nurses experienced with systems analysis and improvement for Option B+; 3) Feasibility test the mPCAT as part of a broader systems analysis and improvement approach.

 描述（由适用提供）：尽管有低成本，有效的干预措施可防止母亲到孩子的艾滋病毒传播（PMTCT），并进行了大量投资以提高其可用性，但将科学进步的转换转化为实践，这是最佳的。在撒哈拉以南非洲（SSA）受影响的地区，艾滋病毒感染的孕妇在PMTCT服务中导航复杂的，顺序的级联级联。由于这种复杂的护理级联，小儿艾滋病毒感染在很大程度上是不受控制的，包括在莫桑比克和肯尼亚。为了简化级联并改善PMTCT，世界卫生组织（WHO）在2013年发布了最新的指南，包括“选项B+”，其中艾滋病毒感染的妇女在怀孕期间在怀孕期间启动终生的抗逆转录病毒疗法（ART），无论CD4计数如何。 2014年在莫桑比克和肯尼亚采用了选项B+，但最初的结果显示出次优的ARV依从性和保留率。存在多个卫生系统对选项B+实施的挑战；包括需要支持护士在服务管理和临床护理B+合格的母亲对的临床护理中的扩大作用。需要针对护士量身定制的决策支持工具来帮助他们 识别艾滋病毒护理级联的系统效率低下和解决方案。作为系统分析和改进方法的群集随机试验的一部分，以评估和迭代改善三个SSA国家 /地区的PMTCT，我们开发并评估了基于Excel（R）基于Excel（R）的PMTCT CASCADE分析工具（PCAT），该工具（PCAT）为护士提供了系统级别的视图，以使护士快速，独立地跟踪患者流过PMTCT Cascade。当结合持续质量改善时，干预措施与母体ARV提供的覆盖率和艾滋病毒暴露的婴儿筛查的覆盖率增加4-5倍。但是，PCAT的可用性受到低计算机的可用性和识字性的抑制，并且使用由研究护士而不是设施人员领导。选项B+特定步骤（例如，保留和依从性）也不是PCAT的一部分。卫生工作者容易管理的提供者决策工具更容易接受，可用，并且具有改善复杂卫生服务管理的更多潜力。诊所工作人员参与到特定环境中量身定制的工具更有可能实施。在这项研究中，我们计划适应和完善基于电话的PCAT应用程序的Beta测试版本，并测试其在莫桑比克和肯尼亚的可用性和可行性。这项研究将收集初步数据，以告知对选项B+（MPCAT）的移动PCAT应用程序的更大，对照试验，并建立在这两个国家 /地区进行此试验的能力。目的包括：1）确定选项B+特定的级联测量值并将其纳入MPCAT； 2）评估MPCAT在系统分析和选项B+改进的护士中的可用性； 3）可行性测试MPCAT作为更广泛的系统分析和改进方法的一部分。