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，抗逆转录病毒疗法（ART）保留艾滋病毒感染者是一个日益严重的挑战。 但是，在严重的现实环境中，很少有移动健康创新经过测试或证明有效 人力和财务资源约束。成功保留更多艺术患者的MHealth创新，at 在SSA的大型公共艺术诊所内，迫切需要较低的成本。灯塔信托（LT），最大的 马拉维艺术公共提供商，在莉隆韦（LH）和马丁·普鲁斯（Martin Preuss）经营两家大型诊所 马拉维卫生部（MOH）的诊所（MPC），共有35,000名ART患者。保留12个月 在灯塔为72％，低于全球流行病的90％目标。两家诊所都采用实时电子 医疗记录系统（EMR）并实施一项资源密集的患者保留计划，重新护理 （B2C）。 B2C的目的是追踪错过14天的艺术访问的患者。 LT每月有7800多个艺术访问，并且 超过10％的客户符合B2C的资格。 B2C需求，加上医护人员的限制，导致 追踪仅33％的目标客户。此外，数据质量差会降低B2C的有效性。因此，LT和 华盛顿大学的国际培训与教育中心（I-Tech），并得到支持 来自MOH和Medic，使用双向发短信（2WT）实施了创新的，积极主动的患者保留系统 在新的艺术患者和员工（1R21TW011658-01）之间。 2WT旨在解决潜在的保留问题 在发生并提高数据质量（例如识别转移）之前，减少了B2C的工作量。 2WT参与者 与非2WT相比 患者（86％，95％CI 82-89％）。从R21的保留改进和减少工作量的初步结果 MOH欢迎MPC的阶段。为了支持宽度采用和扩大规模，MOH要求严格 来自2WT随机对照试验（RCT）的证据。在R33年度，拟议的MHealth研究补充 将使用已建立的2WT系统和现有的2WT操作在LH和MPC诊所进行RCT 团队，最大程度地减少成本，同时最大化证据生成。 RCT比较410种新艺术的结果 患者将1：1随机分为2WT（干预）和对照（标准B2C）。 RCT结果反映了缩短 时间轴（6-与12个月相比），但相同的结果：保留（艺术成果，访问依从性）和B2C推荐。 同时，父r33准实验，前post设计（R33 TW011658）将重点放在2WT/EMR上 MPC（3年级）的互操作性（Y3）和2WT入学率在扩展到LH（3-4年）之前。 RCT将做出贡献 对于R33的入学率并为响应MOH请求而产生严格的证据，而无需更改验证 2WT干预或R33时间轴。这种小补充剂在证据产生和 加强了MOH合作伙伴关系。 。