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: 10856204
• 负责人: Caryl Feldacker
• 金额: $ 26.46万
• 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/10856204
• 关键词: Adoption; Advocate; Africa South of the Sahara; Back; Caring; Characteristics; Client; Clinic; Complement; Cost Analysis; Coupled; Data; Decision Aid; Drops; Focus Groups; Funding; HIV; HIV/AIDS; Health; Health Personnel; Healthcare; International; Interruption; Intervention; Interview; Malawi; Masks; Methods; Modeling; Outcome; Parents; Pathway interactions; Patients; Pattern; Persons; Population Characteristics; Probability; Provider; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Recommendation; Reporting; Request for Applications; Resource Allocation; Resources; Risk; Specific qualifier value; Suggestion; System; Telephone; Testing; Time; Training; Training and Education; Trust; Universities; Visit; Washington; Workload; antiretroviral therapy; arm; cohort; cost; cost effective; data quality; design; digital health; electronic medical record system; experience; follow-up; implementation science; improved; informant; innovation; mHealth; mathematical model; meetings; parent grant; patient retention; predictive modeling; preference; programs; retention rate; scale up; standard of care; timeline; tool; two way texting; usability; visit adherence

In sub-Saharan Africa (SSA), retention of people living with HIV/AIDS (PLHIV) in antiretroviral therapy (ART) is an increasing challenge. Retention is not stagnant: PLHIV cycle into and out of ART over time. Few mHealth innovations have been tested or proven effective in real-world, public SSA settings. mHealth innovations that successfully retain more clients 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) with a combined 36,000 ART clients. Both clinics employ a real-time electronic medical records system (EMRS) and implement a resource-intensive client retention program, Back to Care (B2C). B2C aims to trace clients who miss ART visits by >14 days. B2C demand, coupled with healthcare worker (HCW) constraints and poor data, results in tracing delays, interrupted treatment, and lost to follow-up (LTFU). 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, client retention system using two-way texting (2wT) between new ART clients and HCWs (R21/R33TW011658). 2wT aims to resolve potential retention issues before they occur and improve data quality (e.g. identifying transfers), reducing B2C workload. Initial 2wT results from the 468 clients in the parent study found that 86% were alive six months post ART initiation compared to 76% in standard of care with reminder calls from buddy supporters (SoC). The probability of being alive and on ART at 6 months was 93.9% (95% CI 89.8-95.1) for 2wT clients and 83.1% (95% CI 79.3-86.2%) in SoC. Patients in 2wT arm were 64% less likely to drop out compared to SoC clients (RR 0.36, 95% CI 0.23-0.55). 2wT appears to lower 12-month retention costs over SoC. This proposed supplement in R33 year 2, will amplify the implementation science (IS) focus and deepen understanding of for whom, where, how and at what cost can retention be optimized? This supplement aims to: 1) Use secondary EMRs and 2wT data to describe retention patterns and cycles in care among 2wT and LT's overall cohort over time and by client characteristic, building mathematical models to guide retention optimization over a 5-year period; 2) Qualitatively explore diverse LT client perspectives, preferences, and experiences with 2wT and complementary retention efforts, gaining understanding of differential retention support needs over time; and 3) Strengthen retention costing analysis to reflect actual cycles of 2wT care engagement, tracing, and reengagement (visit adherence and retention in ART) over time to advocate for appropriate resources and inform an optimized, cost-effective retention approach. We engage MoH and other stakeholders in a participatory approach, presenting preliminary results at 6 months to jointly define 12-month outcomes. At 12- months, we will deliver 2wT recommendations and a retention improvement package that balances scare resources, reflects client retention realities, and specifies retention strategy based on patient characteristics.

在撒哈拉以南非洲，艾滋病毒/艾滋病感染者继续接受抗逆转录病毒治疗的情况 越来越大的挑战。保留不是停滞的：随着时间的推移，艾滋病毒感染者进入和退出抗逆转录病毒治疗。少数mHealth 这些创新已经在现实世界的公共SSA环境中进行了测试或证明是有效的。移动健康创新， 在撒哈拉以南非洲地区大量公共抗逆转录病毒治疗诊所内， needed.马拉维最大的公共抗逆转录病毒疗法提供者灯塔信托基金会（LT）在马拉维经营着两家大型诊所， 利隆圭与马拉维卫生部合作，共有36，000名抗逆转录病毒疗法患者。两家诊所都聘请了 实时电子病历系统（EMRS），并实施资源密集型客户端保留 回到护理（B2C）。B2C旨在追踪错过ART访问超过14天的客户。B2C需求，耦合 由于医护人员（HCW）的限制和数据不足，导致追踪延迟、治疗中断， 失访（LTFU）。因此，LT和华盛顿大学的国际培训和教育 卫生中心（I-TECH）在卫生部和医疗保健部门的支持下，实施了一项创新的、积极主动的客户端 在新ART客户和HCW之间使用双向短信（2 wT）的保留系统（R21/R33 TW 011658）。2重量 旨在在潜在的保留问题发生之前解决这些问题，并提高数据质量（例如，识别传输）， 减少B2C工作量。在父母研究中，468名患者的初始2 wT结果发现，86%的患者存活 ART启动后6个月，而标准治疗中为76%，有伙伴支持者的提醒电话 （SoC）。对于2 wT患者，6个月时存活并接受ART的概率为93.9%（95%CI 89.8-95.1 SoC组为83.1%（95% CI 79.3-86.2%）。与SoC组相比，2 wT组患者脱落的可能性降低64% 客户（RR 0.36，95% CI 0.23-0.55）。2 wT似乎比SoC更低12个月的保留成本。 R33第2年的补充，将扩大实施科学（IS）的重点，并加深理解 为谁、在何处、如何以及以何种成本可以优化保留？本补充资料旨在：1）使用 二次EMR和2 wT数据，用于描述2 wT和LT总体的保持模式和护理周期 随着时间的推移和客户的特点，建立数学模型，以指导保留优化， 为期5年; 2）Qualcomm通过2 wT探索不同的LT客户观点、偏好和经验 和补充保留工作，了解随着时间的推移不同的保留支持需求; 和3）加强保留成本分析，以反映2 wT护理参与、跟踪和 随着时间的推移重新参与（访视ART依从性和保留率），以倡导适当的资源， 提供优化的、经济高效的保留方法。我们让卫生部和其他利益相关者参与， 参与式方法，在6个月时提出初步结果，共同确定12个月的成果。十二岁的时候- 我们将提供2 wT建议和保留改进包， 资源，反映客户保留的现实，并根据患者的特点指定保留策略。