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
• 负责人: Caryl Feldacker
• 金额: $ 2.8万
• 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 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675910
• 关键词: Adherence; Adoption; Africa South of the Sahara; Back; Car Phone; Caring; Client; Clinic; Complement; Computer software; Computerized Medical Record; Coupled; Data; Development; Education; Educational Materials; Effectiveness; Enrollment; Ensure; Epidemic; Funding; Generations; Grant; HIV; HIV Infections; Health; Health Personnel; Healthcare; Hour; Human; Individual; Institutional Review Boards; International; Intervention; Malawi; Measures; Outcome; Ownership; Parents; Participant; Pathway interactions; Patient Education; Patients; Persons; Phase; Procedures; Process; Provider; Randomized; Randomized Controlled Trials; Request for Applications; Resources; Risk; Selection Bias; Site; Speed; System; Target Populations; Testing; Text Messaging; Time; TimeLine; Training and Education; Trust; Universities; Update; Visit; Washington; Workload; antiretroviral therapy; arm; cost; data quality; design; improved; innovation; interoperability; mHealth; minimal risk; operation; parent grant; programs; recruit; response; routine care; scale up; standard of care; study population; success; therapy outcome; trial comparing; two way texting; visit adherence

In sub-Saharan Africa, retention of HIV-infection people in antiretroviral therapy (ART) is an increasing challenge. However, few mobile health 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 (Lighthouse (LH) and Martin Preuss Clinic (MPC)) with the Malawi Ministry of Health (MoH) with a combined 35,000 ART patients. 12-month retention at Lighthouse is 72%, 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. LT has over 7800 monthly ART visits, and more than 10% of clients are B2C-eligible. B2C demand, coupled with healthcare worker constraints, results in tracing of only 33% of target clients. Moreover, poor data quality reduces B2C effectiveness. Therefore, LT and the University of Washington’s International Training and Education Center for Health (I-TECH), with support from MoH and Medic, implemented an innovative, proactive, patient retention system using two-way texting (2wT) between new ART patients and staff (1R21TW011658-01). 2wT aimed to resolve potential retention issues before they occur and improve data quality (e.g. identifying transfers), reducing B2C workload. 2wT participants had higher retention estimates (95%, 95% CI 91-975) at 3 months post ART initiation compared to non 2wT patients (86%, 95% CI 82-89%). Preliminary results on retention improvements and workload reduction from R21 phase at MPC were welcomed by MoH. In support of widespread adoption and scale up, MoH requests rigorous evidence from a 2wT randomized control trial (RCT). In R33 year 1, the proposed mHealth study supplement will conduct an RCT at LH and MPC clinics, using the established 2wT system and the existing 2wT operations team, minimizing costs while maximizing evidence generation. RCT compares outcomes among 410 new ART patients randomized 1:1 into 2wT (intervention) and control (standard B2C). RCT outcomes reflect shortened timeline (6- vs. 12-months), but same outcomes: retention (ART outcomes, visit adherence) and B2C referrals. In parallel, parent R33 quasi-experimental, pre-post design (R33 TW011658) will focus on 2wT/EMRs interoperability (Y3) and 2wT enrollments at MPC (Year 3) before expanding to LH (Year 3-4). RCT will contribute to R33 enrollments and generate rigorous evidence in response to MoH requests without changing the proven 2wT intervention or the R33 timeline. This small supplement brings large gains in evidence generation and strengthened MoH partnership. .

在撒哈拉以南非洲，让艾滋病毒感染者继续接受抗逆转录病毒疗法是一个日益严峻的挑战。 然而，很少有移动的健康创新在现实世界的环境中进行了测试或证明是有效的， 人力和财政资源限制。mHealth创新，成功地留住更多的患者接受ART， 在撒哈拉以南非洲地区的大规模公共ART诊所内，迫切需要降低成本。Lighthouse Trust（LT）是世界上最大的 马拉维的一家公共抗逆转录病毒疗法提供商，在利隆圭经营着两家大型诊所（Lighthouse（LH）和Martin Preuss 2010年，该中心与马拉维卫生部合作，共治疗了35 000名抗逆转录病毒治疗患者。12-月留存 灯塔医院为72%，低于全球90%的疫情控制目标。两家诊所都采用实时电子 医疗记录系统（EMRS），并实施资源密集型患者保留计划，回到护理 （B2C）。B2C旨在追踪错过ART访问> 14天的患者。LT每月有超过7800次ART访问， 超过10%的客户符合B2C条件。B2C需求，加上医疗工作者的限制，导致 仅追踪到33%的目标客户。此外，糟糕的数据质量降低了B2C的有效性。因此，LT和 华盛顿大学国际健康培训和教育中心（I-TECH）， 来自卫生部和Medic，采用双向短信（2wT）实施了一种创新的、主动的患者保留系统 新ART患者与工作人员之间的关系（1R21TW 011658 - 01）。2wT旨在解决潜在的保留问题 在它们发生之前，提高数据质量（例如识别传输），减少B2C工作量。2wT参与者 与非2wT相比，在ART开始后3个月时的保留估计值更高（95%，95% CI 91 - 975） 患者（86%，95% CI 82 - 89%）。R21保留改进和工作量减少的初步结果 MPC阶段受到卫生部的欢迎。为了支持广泛采用和扩大规模，卫生部要求严格 来自2wT随机对照试验（RCT）的证据。在R33第1年，拟议的mHealth研究补充 将在LH和MPC诊所进行随机对照试验，使用已建立的2wT系统和现有的2wT操作 团队，最大限度地降低成本，同时最大限度地提高证据生成。RCT比较了410种新ART的结果 患者以1：1的比例随机分为2wT（干预）和对照（标准B2C）。RCT结果反映了缩短的 时间轴（6个月与12个月），但结局相同：保留（ART结局，访视依从性）和B2C转诊。 与此同时，父R33准实验性、前后设计（R33 TW 011658）将侧重于2wT/EMR 互操作性（Y3）和MPC（3年级）的2wT入学，然后扩展到LH（3 - 4年级）。RCT将有助于 R33登记，并根据卫生部的要求生成严格的证据，而不改变已证明的 2wT干预或R33时间轴。这一小部分补充在证据生成方面带来了很大的收益， 加强卫生部伙伴关系。 .