CHAT: mHealth Innovation for HIV-MNCH Community Health Workers in South Africa

在南非（SA），每年估计有51，300名1个月至5岁的儿童死亡。大多数（57%）是由于艾滋病毒。儿童营养不良与免疫功能下降有关，是造成这些死亡的主要原因。减少与艾滋病毒和营养有关的儿童死亡率的关键干预措施包括明确界定和以证据为基础的一揽子护理，以改善感染艾滋病毒的成年照顾者以及感染艾滋病毒的儿童的生存。社区卫生工作者（CHW）如果得到适当的支持，可以在改善获得护理和支持提供基于证据的艾滋病毒和妇幼保健和营养干预措施方面发挥关键作用。虽然先前的研究表明，CHW领导的模式MCHN健康促进的可行性及其对一些母婴健康结果的影响，非艾滋病毒重点CHW方案的评估表明，CHW遵守协议培训后迅速下降。因此，尽管公认的重要性，CHW模型，有很少的研究，以解决的有效性的战略，培训CHW或确保质量的护理和忠实于循证协议。 我们提出了一项为期3年的研究，以开发和测试移动健康创新，以支持他们在夸祖鲁纳塔尔，SA的艾滋病毒高流行率社区提供基于家庭的艾滋病毒和MCHN教育，支持和转诊CHW。社区卫生工作者辅助技术（CHAT）将在手持平台上开发（即，多功能平板电脑），并将利用现有的低成本设备和开放源码软件。CHAT将为CHW提供持续的综合支持，包括协议培训、强大的手持技术和可访问的媒体增强资源（例如，健康教育录影带及动画），以促进与病人的互动讨论。它将实现电子数据采集，支持使用数据验证和分支逻辑收集高质量的信息，并支持与诊所医疗服务提供者和CHW主管的沟通。为了测试CHAT的影响，我们将进行一项小型社区随机对照试验（C-RCT），以调查CHAT对以下方面的影响：1）CHW护理质量以及有关艾滋病毒、营养、儿童疾病危险体征和儿童发育的知识; 2）儿童照顾者的卫生保健利用，以及儿童保育相关行为（例如，疫苗接种、卫生习惯）; 3）CHAT对儿童健康的初步影响，包括0至59个月大的HIV感染儿童的生长、疾病和发育。参与者将包括60名CHW（30名干预者，30名对照者）和80名儿童-儿童对（40名干预者和40名对照者），他们将接受一次随访， 一年，并定期评估感兴趣的结果。我们还将评估CHAT的可接受性和可行性，在儿童之家进行健康和发展评估，并将发展研究中吸取的经验教训转化为大型C-RCT的设计。 公共卫生相关性：社区卫生工作者（CHW）可以在改善服务不足人群获得护理和治疗的机会和连续性方面发挥关键作用。该项目将制定和评估针对社区卫生工作者的移动健康干预措施的初步影响，社区卫生工作者为南非夸祖鲁纳塔尔省受艾滋病毒影响的家庭提供家庭支持，这些干预措施涉及：1）社区卫生工作者关于艾滋病毒、孕产妇和儿童健康与营养、儿童发育以及护理质量的知识; 2）0-59个月大受艾滋病毒影响的儿童的护理者健康行为和保健利用; 3）干预措施对0-59个月感染艾滋病毒儿童的生长、疾病和发育的初步影响。最终，该项目有可能通过展示移动健康在改善社区卫生工作实践和改善受艾滋病毒影响儿童及其照顾者健康方面的作用，改善在整个非洲社区概念化和提供社区卫生保健和预防服务的方式。

DESCRIPTION (provided by applicant): In South Africa (SA), an estimated 51,300 children between 1 month and 5 years old die every year. -- the majority (57%) due to HIV. Childhood malnutrition, associated with diminished immune function, is a major contributor to these deaths. Key interventions to reduce HIV- and nutrition- related child mortality include well- defined and evidence-based packages of care to improve survival of HIV-infected adult caregivers as well as HIV-exposed children. Community health workers (CHW), if appropriately supported, can play a critical role in improving access to care and supporting delivery of evidence-based HIV and maternal and child health and nutritional (MCHN) interventions. While prior studies have shown the feasibility of CHW-led models for MCHN health promotion and their impact on some maternal-child health outcomes, evaluations of non-HIV focused CHW programs have shown CHW adherence to protocols to decline rapidly after training. Thus, despite the recognized importance of CHW models, there is little research to address the effectiveness of strategies for training CHW or for ensuring quality of care and fidelity to evidence-based protocols. We propose a 3-year study to develop and test an mHealth innovation to support CHW in their delivery of home-based HIV and MCHN education, support, and referral in a high HIV prevalence community in KwaZulu Natal, SA. Community Health Worker Assistive Technologies (CHAT) will be developed on a handheld platform (i.e., a multi-function tablet computer) and will leverage available, low-cost devices and open source software. CHAT will provide CHW with sustained, integrated support including protocol training, powerful handheld technologies and accessible, media enhanced resources (e.g., health education videos and animations) that will promote interactive discussions with clients. It will enable electronic data capture that supports high quality information gathering using data validation and branching logic, and will support communication with clinic-based health providers and CHW supervisors. To test the impact of CHAT, we will conduct a small community randomized controlled trial (C-RCT) to investigate the impact of CHAT on 1) CHW quality of care as well as knowledge about HIV, nutrition, danger signs of childhood illness, and child development; 2) health care utilization of caregivers for children, and child-care-related behaviors (e.g., immunizations, hygiene practices); and 3) the preliminary impact of CHAT on child health including growth, disease, and development for HIV-affected children age 0 to 59 months old. Participants will include 60 CHW (30 intervention, 30 control) and 80 caregiver-child pairs (40 intervention and 40 control) who will be followed for one year and assessed at regular intervals for the outcomes of interest. We will also assess the acceptability and feasibility of CHAT, conducting health and developmental assessments at children's homes, and translate lessons learned in the development study into the design of a large C-RCT. PUBLIC HEALTH RELEVANCE: Community health workers (CHW) can play a critical role in improving access to and continuity of care and treatment for underserved populations. This project will develop and assess the preliminary impact of an mHealth intervention targeting CHW who provide home-based support for HIV-affected households in KwaZulu Natal Province, South Africa on 1) CHW knowledge about HIV, maternal and child health and nutrition, and child development and on quality of care; 2) caregiver health behaviors and health care utilization for HIV- affected children ages 0-59 months old; and 3) the preliminary impact of the intervention on child growth, disease and development of HIV-affected children ages 0-59 months old. Ultimately, the project has the potential to improve the ways in which community-based health care and prevention services are conceptualized and delivered throughout African communities by demonstrating the role of mHealth in improving CHW practice and improving the health of HIV-affected children and their caregivers.