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（SSA）中，保留艾滋病毒/艾滋病（PLHIV）在抗逆转录病毒疗法（ART）的人是 越来越多的挑战。保留不会停滞不前：随着时间的推移，PLHIV循环进出艺术品。很少的MHealth 在现实世界中的公共SSA环境中，已经对创新进行了测试或证明有效。 MHealth创新 在SSA的大批量公共艺术诊所内，成功保留更多的艺术客户，较低的成本是 需要。马拉维最大的公共艺术提供商Lighthouse Trust（LT）经营两个大型诊所 莉隆威（Lilongwe）与马拉维卫生部（MOH）一起，共有36,000名艺术客户。两家诊所都使用 实时电子病历系统（EMRS）并实施资源密集的客户保留率 程序，返回护理（B2C）。 B2C旨在追踪那些错过14天以上艺术访问的客户。 B2C需求，耦合 随着医疗保健工作者（HCW）的限制和数据差，导致追踪延迟，中断治疗和 迷失了后续（LTFU）。因此，LT和华盛顿大学的国际培训与教育 卫生中心（I-Tech）在MOH和Medic的支持下，实施了创新，积极主动的客户 使用新艺术客户和HCWS（R21/R33TW011658）之间使用双向发短信（2WT）的保留系统。 2wt 旨在在发生潜在的保留问题并提高数据质量（例如识别转移）之前解决潜在的保留问题， 减少B2C工作量。在父母研究中，来自468个客户的最初2WT结果发现86％还活着 艺术后六个月的启动后，标准的护理标准为76％，并提供了好友支持者的提醒电话 （SOC）。 2WT客户的活着和6个月的艺术的可能性为93.9％（95％CI 89.8-95.1） SOC中的83.1％（95％CI 79.3-86.2％）。与SOC相比 客户（RR 0.36，95％CI 0.23-0.55）。 2WT似乎比SOC降低了12个月的保留成本。这提出了 R33年级的补充将扩大实施科学（IS）的重点并加深理解 在哪里，在哪里，如何以及以什么成本可以优化保留？此补充旨在：1）使用 次要EMR和2WT数据描述了2WT和LT之间的保留模式和周期的保留模式和周期 随着时间的推移和客户特征，构建数学模型以指导保留优化 5年； 2）定性地探索不同的LT客户观点，偏好和2WT的经验 以及互补的保留工作，了解随着时间的流逝，了解差异保留支持需求； 3）加强保留成本分析以反映2WT护理参与，跟踪和 随着时间的推移，重新接触（请访问遵守和保留艺术），以倡导适当的资源和 告知一种优化的，具有成本效益的保留方法。我们参与MOH和其他利益相关者 参与式方法，在6个月时提出初步结果，共同定义了12个月的结果。在12- 几个月，我们将提供2WT建议和保留改进方案，以平衡恐慌 资源，反映客户保留现实，并根据患者特征指定保留策略。