Two-way Texting (2wT) to Improve Patient Retention While Reducing the Healthcare Workload in High-Burden Public HIV Clinics in Malawi

在撒哈拉以南非洲(SSA)，艾滋病毒感染者在抗逆转录病毒疗法(ART)中的存留率正在增加 挑战。在SSA，只有67%的人保留了抗逆转录病毒治疗，超过750万人失去了护理，威胁到了这两个人 个人健康和艾滋病毒流行控制。具有重大的医疗系统限制和强大的 医护人员(HCW)短缺，SSA的ART服务难以实现90%的雄心勃勃的全球目标 留在看守所里。在研究环境中，基于文本的mHealth创新显示出增加ART保留率的前景 因此，降低病毒载量(VL)。然而，很少有移动健康创新被测试或被证明有效 在人力和财政资源严重受限的现实环境中。移动健康创新 在SSA的大容量公共ART诊所内，以较低的成本成功保留更多的ART患者 急需之物。灯塔信托(LT)是马拉维最大的抗逆转录病毒治疗公共提供者，经营着两家大型诊所 在利隆圭与马拉维卫生部、灯塔诊所和马丁·普赖斯中心(MPC)合作， 总共有35,000名抗逆转录病毒治疗患者。灯塔12个月的保留率为67%，低于 疫情控制。两间诊所均采用实时电子病历系统(EMRS)，并实施 资源密集型患者保留计划，返回护理(B2C)。B2C旨在追踪错过ART的患者 在14天内到访。MPC每月有超过7800次艺术访问，超过10%的客户符合B2C条件。B2C 需求加上HCW限制，导致仅跟踪33%的目标客户。缺乏或延迟， 描摹减少了艺术品的留存。此外，超过50%的追踪B2C客户是在ART上找到的，其中60%的客户 转移，显示出重大的不必要的追踪。糟糕的数据质量会降低B2C的有效性。 因此，华盛顿大学的国际卫生培训和教育中心(i-tech)和 在卫生部和Medicc Mobile的支持下，LT寻求实施创新的、主动的、耐心的保留 在新的抗逆转录病毒治疗患者和工作人员之间使用双向短信(2wT)的系统。2wT将解决潜在的保留问题 并提高数据质量(例如识别传输)，减少B2C工作负载。使用 准试验性、开机后前设计，此R21(目标1)将测试混合式2wT干预以提供依从性 对MPC诊所的新ART启动者提供支持，并与其进行以访问为重点的交流，比较保留率(ART 两组新的MPC ART客户之间的结果、访问依从性、VL)和B2C转介：2wT支持 (前瞻性干预)和配对的2周前(回溯性比较)。在展示了改进后 以较低成本保留(目标2)使用研究团队(R21：1-2年)，2wt整合到EMRS(R33： 年第3-5年)将使用例程为新客户在1H和MPC中自动注册和管理2WT 人权委员会(目标3)，评估研究向实践的转变。拟议的移动健康研究将显著 增加公共艺术诊所使用常规医疗中心的ART保留量，减少工作量和成本。这是一项创新 马拉维高容量公共环境中的方法为国家或区域的扩大奠定了基础。

In sub-Saharan Africa (SSA), retention of HIV-infection people in antiretroviral therapy (ART) is an increasing challenge. With only 67% retained on ART in SSA, over 7.5 million people are out of care, threatening both individual health and HIV epidemic control. With significant healthcare system constraints and formidable healthcare worker (HCW) shortages, ART services in SSA struggle to meet ambitious global targets of 90% retained in care. In research settings, text-based mHealth innovations show promise to increase ART retention and, therefore, reduce viral load (VL). However, few mHealth 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 with the Malawi Ministry of Health (MoH), Lighthouse Clinic (LH) and Martin Preuss Center (MPC), with a combined 35,000 ART patients. 12-month retention at Lighthouse is 67%, 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. MPC has over 7800 monthly ART visits, and more than 10% of clients are B2C-eligible. B2C demand, coupled with HCW constraints, results in tracing of only 33% of target clients. Lack of, or delayed, tracing reduces ART retention. Moreover, over 50% of traced B2C clients are found on ART, 60% of whom had transferred, demonstrating significant unnecessary tracing. Poor data quality reduces B2C effectiveness. Therefore, the University of Washington’s International Training and Education Center for Health (I-TECH) and LT, with support from MoH and Medic Mobile, seek to implement an innovative, proactive, patient retention system using two-way texting (2wT) between new ART patients and staff. 2wT will resolve potential retention issues before they occur and improve data quality (e.g. identifying transfers), reducing B2C workload. Using a quasi-experimental, pre-post design, this R21 (Aim 1) will test a hybrid 2wT intervention to provide adherence support for, and visit-focused communication with, new ART initiates at MPC clinic, comparing retention (ART outcomes, visit adherence, VL) and B2C referrals among two groups of new MPC ART clients: 2wT-supported (prospective intervention) and matched pre-2wT (retrospective comparison). After demonstrating improved retention at lower cost (Aim 2) using research teams (R21: years 1-2), 2wT integration into the EMRS (R33: years 3-5) will automate enrollment and management of 2WT for new clients in both LH and MPC using routine HCWs (Aim 3), assessing the transition of research to practice. The proposed mHealth study will significantly increase ART retention in public ART clinics using routine HCWs, reducing workload and costs. This innovative approach in high-volume, public settings in Malawi sets the stage for national or regional scale-up.