ICF: Use of Unmanned Aerial vehicles (Medical Drones) to Support Differentiated Service Delivery Models for Elimination of HIV in Uganda

生活在岛屿上的渔民很难获得他们的艾滋病毒药物和其他药物，他们不得不乘船长途跋涉到最近的医疗机构。非洲正在测试小型无人驾驶飞机（医疗无人机），以便在距离保健中心很远或公路运输有限的地区运送药品和其他医疗用品。这项研究希望比较使用小型无人驾驶飞机（医疗无人机）向乌干达（Kalangala）一个由84个岛屿组成的岛屿地区的艾滋病毒感染者运送药物的情况。我们的目标是看看通过这种方法给药是否能帮助人们更好地控制他们的艾滋病毒。这将通过观察他们血液中的艾滋病毒水平（病毒载量）来衡量，这可以表明他们是否在服药，对药物的反应是否良好。如果我们不能在他们的血液中检测到艾滋病毒，这是一个很好的迹象，表明他们将遭受与艾滋病毒有关的最小健康问题，并且不会将其传染给他们的性伴侣。我们还将调查艾滋病毒感染者是否正在接受艾滋病毒检查。我们还将进行研究，看看艾滋病毒感染者和卫生工作者是否愿意使用医疗无人机，以及他们认为无人机可以用于哪些其他医疗用途。此外，我们将比较使用无人机与船只的财务成本。我们还将介绍不同类型的无人机，包括看起来像公众广泛使用的摄影无人机的无人机，以及看起来更像小型飞机的大型无人机。我们还将尝试一种主要由纸板制成的可回收无人机。我们将比较使用电池的无人机与使用汽油发动机的船只的碳使用情况。b)潜在的应用和益处人们可能会问为什么需要这项研究。无人机不就是像汽车或船只一样的运输工具吗？只要它们能走得远，我们为什么还要直接比较研究它们呢？无人机是一种新产品，并没有广泛用于运送医疗用品。广泛采用无人机的一个关键障碍是缺乏严格的数据来检验无人机的影响及其成本。原因在于，任何干预措施的实际实施几乎总是与预期不同。各种医疗和社会干预都是如此，医疗无人机很可能也是如此。这项研究使用严格的方法，将使我们能够记录无人机对现实世界的影响，而不是人们迄今为止用来证明医疗无人机的估计。在过去的12个月里，我们在卡兰加拉区建立了一个小型医疗无人机试点项目。在那之前的三年里，我们收集了病人去医疗中心遇到的困难，以及他们到那里获得药物时遇到的问题的数据。根据我们对患者获得稳定药品供应的重大障碍的观察，我们寻求卫生部和其他当局（包括民航局和国防部）的许可，开展一个小型医疗无人机项目。为了测试和评估这种项目在这种情况下是否可行，我们已经设法通过医疗无人机向99名艾滋病毒感染者运送了艾滋病毒药物。其中，我们在2022年9月使用医疗无人机完成了为期12个月的63人交付。我们已经到达5个岛屿，并向17个同伴支持小组提供服务，这些小组的领导人接受过安全无人机送药培训。现在是时候进行更有力的研究了。如果这项研究表明，患者可以放心地通过无人机接受药物治疗，或者节省资金，或者通过使用比船只更少的汽油来帮助环境，那么我们相信，医疗无人机可以在世界上许多人们难以获得药物的地方使用。我们将首先尝试将医疗无人机扩展到东非，然后转移到非洲的其他地点进行进一步的工作。

Context of Aims & Objectives:Fishing populations living on islands struggle to get their HIV medication and other medications, they have to travel long distances by boat to the closest health facility. Small unmanned aircraft (medical drones) are being tested in Africa for delivering medication and other medical supplies in areas where there are long distances to health centres or limited road transport.This research study hopes to compare the use of small unmanned aircraft (medical drones) to deliver medicines to people living with HIV in an island district in Uganda (Kalangala) that consists of 84 islands. We aim to see if delivering medicines by this method helps people to better manage their HIV. This will be measured by looking at the level of HIV in their blood (viral load) which gives an indication if they are taking their medicine, reacting well to their medicine. If we cannot detect HIV in their blood it is a good indication that they will suffer minimal health problems related to their HIV, and cannot pass it on to their sexual partners. We will also look to see whether people living with HIV are attending appointments for their HIV. We will also conduct research to see if people living with HIV and health workers are comfortable with using medical drones and what other medical uses, they think the drone could be helpful for. In addition, we will compare the financial costs of using drones versus boats. We will also look at different types of drones, including ones that look like the photography drones widely used by the public, to a large one that looks more like a small plane. We will also try a recyclable drone made mainly of cardboard. We will look at the carbon use of drones (which use batteries) compared to boats with petrol motors.b) Potential applications and benefitsOne may be tempted to ask why this study is needed. Aren't drones just transport vehicles like cars or boats? As long as they can travel the distance, why do we need to study them in a direct comparison? Drones are new and not widely used to carry medical goods. A key barrier to wider adoption has been the lack of rigorous data examining the impact of drones and their costs. The reason is that the real-life implementation of any intervention is almost always different than predicted. This has been the case for all kinds of medical and social interventions and is likely to be the case for medical drones. This study using rigorous methods, will allow us to document the real-world impact of drones beyond the estimations that people have used to justify medical drones so far.Over the last 12 months, we established a small medical drones pilot project in the Kalangala District. For three years before that, we collected data on patients' challenges getting to health centres and any problems in getting medication when they get there. Based on our observations of significant barriers to patients getting steady medicine supplies, we sought permission from the Ministry of Health and other authorities, including Civil Aviation Authority and the Ministry of Defence, to do a small medical drones project. To test to assess whether this kind of project is possible in this setting, we have managed to deliver HIV drugs to 99 people living with HIV by medical drone. Of these, we completed 12 months of delivery to 63 people using medical drones in September 2022. We have reached 5 islands and delivered to 17 peer support groups whose leaders have trained on safe drone drug delivery.It is now time for a more robust study. If this study shows that patients are comfortable receiving their medication by drone, or saves money, or helps the environment by using less petrol than boats, then we believe that medical drones could be used in many places around the world where it is difficult for people to get their medication. We would first try to extend the medical drones in East Africa and then move to other sites in Africa for further work.