Reducing Provider Workload While Preserving Patient Safety: A 2-Way Texting Intervention in Zimbabwe’s Voluntary Medical Male Circumcision Program

减少提供者的工作量，同时保护患者安全：津巴布韦自愿医疗男性包皮环切计划的双向短信干预

• 批准号: 9341021
• 负责人: Caryl Feldacker
• 金额: $ 19.01万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-11 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9341021
• 关键词: Adoption; Adverse event; Africa South of the Sahara; African; Age; Blinded; Car Phone; Caring; Cellular Phone; Child Care; Client; Clinic; Complication; Control Groups; Cost Savings; Country; Deterioration; Development; Epidemic; Female; Future; HIV; HIV-1; Health; Health Personnel; Health care facility; Healthcare; Healthcare Systems; Hour; International; Intervention; Interview; Kenya; Lead; Location; Male Circumcision; Medical; Operative Surgical Procedures; Outcome; Ownership; Patient Self-Report; Patients; Persons; Postoperative Period; Procedures; Productivity; Provider; Quality of Care; Randomized Controlled Trials; Research; Research Personnel; Risk; Safety; Services; Severe Adverse Event; Site; System; Systems Integration; Technology; Testing; Text; Time; Training and Education; Universities; Visit; Washington; Work; Workload; Zimbabwe; arm; base; cost; follow-up; healing; innovation; mHealth; male; meetings; men; open source; outreach; patient safety; personalized approach; programs; prospective; relative cost; routine care; scale up; standard care; success; transmission process

Because male circumcision (MC) reduces the risk of female-to-male HIV-1 transmission by up to 60%, nearly 10.4 million voluntary medical male circumcision (VMMC) procedures were performed in sub- Saharan Africa where the HIV epidemic is most concentrated. VMMC is safe: the average rate of moderate and severe adverse events (AEs) at the country level is 0.8%, corresponding to 99% of men healing without incident. To reach the global target of 20 million by 2018, VMMC productivity needs to double in countries already plagued by severe healthcare worker shortages like Zimbabwe. The ZAZIC consortium partners with the Zimbabwe Ministry of Health and Child Care (MoHCC) and performed over 120,000 VMMCs. Current VMMC care in Zimbabwe requires in-person, follow-up visits at post-operative days 2,7, and 42. Over 95% adhere to multiple follow-up visits within 14 days of VMMC. ZAZIC’s program has an overall AE rate of 0.4%; therefore, overstretched clinic staff conducted more than 200,000 unnecessary reviews for VMMC clients without complications. High mobile phone ownership, severe healthcare worker shortages, and rapid VMMC scale up make ZAZIC’s VMMC program an ideal setting to test a mobile health (mHealth) intervention to reduce provider workload while safeguarding patient safety. Through an un-blinded, prospective, randomized, control trial (RCT) in high-volume facilities providing VMMC, ZAZIC will implement an interactive, two-way texting (2wT) intervention to identify men healing without complication, allowing them to decline routine in-person follow up visits. 2wT will simultaneously identify men with any sign of an adverse event, encouraging rapid in-person follow-up when an AE is suspected on any day, reducing unnecessary visits while maintaining quality care. We aim to 1) determine if 2wT can safely reduce VMMC follow-up visits; 2) estimate the cost savings associated with 2wT over routine VMMC follow-up; and 3) assess the acceptability and feasibility of 2wT for further scale-up. It is expected that this intervention with be as safe as routine care while providing distinct advantages in terms of efficiency, costs, and reduced healthcare worker burden. This approach is innovative as it focuses on using a low-cost mHealth intervention to reduce provider workload without deterioration in quality care. The success of this intervention could lead to adoption of this intervention at the national level, increasing efficiency of VMMC scale up and reducing burdens on providers and patients. ZAZIC’s international, interdisciplinary team will build the capacity among local research colleagues and MoHCC collaborators, helping the Zimbabwean team become future leaders in mHealth research.

由于男性包皮环切术（MC）将女性对男性的HIV-1传播风险降低了60%， 近1040万自愿医疗男性包皮环切术（VMMC）程序进行了亚， 撒哈拉非洲是艾滋病疫情最集中的地区。VMMC是安全的：中度 严重不良事件（AE）在国家一级为0.8%，相当于99%的男性愈合， 事件为了实现到2018年达到2000万的全球目标，各国的VMMC生产率需要翻一番 已经受到津巴布韦等严重的医护人员短缺的困扰。ZAZIC财团合作伙伴 与津巴布韦卫生和儿童保健部合作，进行了120，000多例VMMC。 目前，津巴布韦的VMMC护理需要在术后第2、7和42天进行亲自随访。 超过95%的患者在VMMC后14天内坚持多次随访。ZAZIC的计划有一个整体 不良事件发生率为0.4%;因此，过度紧张的诊所工作人员进行了超过20万次不必要的审查 对于VMMC客户来说，没有并发症。高移动的手机拥有率，重度医护人员 短缺和快速VMMC规模使ZAZIC的VMMC计划成为测试移动的 健康（mHealth）干预，以减少提供者的工作量，同时保障患者的安全。通过 在提供VMMC的大容量机构中进行的揭盲、前瞻性、随机、对照试验（RCT）， ZAZIC将实施一种互动的双向短信（2 wT）干预，以确定男性愈合，而不 并发症，使他们能够拒绝例行的亲自随访。2 wT将同时识别 有任何不良事件体征的男性，当怀疑发生AE时，鼓励快速亲自随访， 任何一天，减少不必要的访问，同时保持高质量的护理。我们的目标是1）确定2 wT是否可以 安全地减少VMMC随访访视; 2）估计与常规相比，2 wT相关的成本节约 VMMC随访; 3）评估2 wT进一步扩大的可接受性和可行性。预计 这种干预与常规护理一样安全，同时在以下方面提供明显的优势： 效率、成本和减轻的医护人员负担。这种方法是创新的，因为它侧重于使用 低成本的移动健康干预措施，可减少提供者的工作量，而不会降低护理质量。的 这一干预措施的成功可能导致在国家一级采用这一干预措施， 提高VMMC的效率，减轻供应商和患者的负担。ZAZIC的国际化， 跨学科团队将在当地研究同事和MoHCC合作者之间建立能力， 帮助津巴布韦团队成为移动健康研究的未来领导者。