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

描述(申请人提供)：在南非(SA)，估计每年有51,300名1个月至5岁的儿童死亡。--大多数(57%)是由艾滋病毒引起的。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措施，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存活率。如果得到适当的支持，社区卫生工作者可以在改善获得护理的机会和支持提供循证艾滋病毒以及妇幼保健和营养干预方面发挥关键作用。虽然先前的研究表明，CHW领导的模式用于MCHN健康促进的可行性及其对一些母婴健康结果的影响，但对非HIV重点CHW项目的评估表明，CHW对方案的遵守在培训后迅速下降。因此，尽管承认CHW模型的重要性，但很少有研究解决培训CHW或确保护理质量和对循证方案的忠诚度的战略的有效性。我们建议进行一项为期3年的研究，以开发和测试一项mHealth创新，以支持CHW在南萨州夸祖鲁纳塔尔艾滋病毒高流行社区提供基于家庭的艾滋病毒和MCHN教育、支持和转诊。社区卫生工作者辅助技术(CHAT)将在手持平台(即多功能平板电脑)上开发，并将利用现有的低成本设备和开源软件。Chat将为CHW提供持续的综合支持，包括礼仪培训、强大的手持技术和可访问的、媒体增强的资源(例如，健康教育视频和动画)，这些资源将促进与客户的互动讨论。它将实现电子数据捕获，支持使用数据验证和分支逻辑进行高质量的信息收集，并将支持与以诊所为基础的卫生保健提供者和CHW监督员的沟通。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1)CHW护理质量以及有关艾滋病毒、营养、儿童疾病危险征兆和儿童发展的知识的影响；2)儿童照顾者的医疗利用情况，以及与儿童护理相关的行为(如免疫接种、卫生习惯)；以及3)CHAT对0至59个月受艾滋病毒影响儿童的生长、疾病和发展等儿童健康的初步影响。参与者将包括60名CHW(30名干预，30名对照)和80名照顾者-儿童配对(40名干预和40名对照)，他们将被跟踪一次 并定期对感兴趣的结果进行评估。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，并将从发展研究中吸取的经验教训转化为设计一个大型儿童权利中心。

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.