A Clinical Decision Support System for Integrating Tuberculosis and HIV Care in Kenya: A Human-Centered Design Approach

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul G.

doi:10.1371/journal.pone.0103205

Cited by 64 publications

(143 citation statements)

References 33 publications

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“…The 22 articles retained in the review represented 11 different studies: m4Change [25], Decision Support and Integrated Record-Keeping (DESIRE) [26], CommCare [27], mPneumonia [28], Basic Antenatal Care Information System (Bacis) [29], TBTech [30], txt2MEDLINE [31], New Algorithm for Managing Childhood Illness Using Mobile Technology (ALMANACH) [32,33], electronic Integrated Management of Childhood Illness (eIMCI) [34-36], Text Messaging of Malaria Guidelines [37-39], and Quality of Maternal and Prenatal Care (QUALMAT) [40-46]). These studies were conducted in 7 sub-Saharan African countries: Kenya, Nigeria, Ghana, Tanzania, Burkina Faso, Botswana, and South Africa.…”

Section: Resultsmentioning

confidence: 99%

“…Perceived usefulness of mCDSS in light of users’ perception on its effect on their workload, alongside other institutional and resource barriers, could have hindered the transition from early to sustained adoption by health care workers. Although the relatively short duration characterizing many mHealth pilots hinder the ability to evaluate rate and effect of adoption over time, a human-centered, multistakeholder approach to design and implement these technologies has been suggested as a way to mitigate resistance and encourage efficient integration into complex environments such as health systems [27,30,40-46]. Although some of the studies in this review used strategies such as training, supervision, and financial incentives to motivate the adoption and utilization of mCDSS, there were mixed reports about their effectiveness.…”

Section: Discussionmentioning

confidence: 99%

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mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

Adepoju¹,

Albersen²,

Brouwere³

et al. 2017

JMIR Mhealth Uhealth

134

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BackgroundIn a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established.ObjectiveThe aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa.MethodsA scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA.ResultsWe retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training.ConclusionsThe use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

Adepoju¹,

Albersen²,

Brouwere³

et al. 2017

JMIR Mhealth Uhealth

134

View full text Add to dashboard Cite

show abstract

“…New approaches to intervention development such as “human centred design” offer potential approaches which centralize participants’ experiences and perspectives . However, in a recent review of human centred design in global health, few examples went beyond undertaking focus groups and some basic ethnographic research, to meaningfully involve those who the intervention is designed for in the development, piloting and refining of the intervention .…”

Section: Discussionmentioning

confidence: 99%

Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

et al. 2019

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Introduction Adolescent girls and young women aged 15 to 24 years have some of the highest HIV incidence rates globally, with girls two to four times more likely to be living with HIV than their male peers. High levels of intimate partner violence ( IPV ) experienced by this age group is a significant risk factor for HIV acquisition. While behavioural interventions to prevent IPV and HIV in southern Africa have seen some success in reducing self‐reported experiences of IPV , these interventions have largely failed to achieve similar outcomes for young women. Discussion We identify three main reasons for the failure of IPV / HIV interventions for many young women in southern Africa. First, interventions are usually developed without the meaningful involvement of both young women and young men. Youth input into research design is largely focused on user testing or consultation of targeted groups, involving relatively low levels of participation. Second, interventions are focused on addressing individual risk factors rather than broader social and structural contexts of being a young woman. “Risk factor” interventions, rather than supporting women's agency, can pose a major barrier for supporting changes in behaviour among young women because they often fail to dislodge well‐entrenched gender and age‐related inequalities. Third, current intervention models have not adequately accounted for changes in gender norms and relationships across southern Africa. Individuals are getting married later in life (or not at all), new technologies are transforming romantic interactions and opening new opportunities for violence, and discussions about women's rights are both challenging gender inequalities and reinforcing them. Conclusions In order to move beyond the status quo of current approaches, and to support real innovation, IPV / HIV prevention interventions need to be co‐developed with youth as part of a meaningful participatory process of research, intervention design, youth involvement in development and implementation. This process of co‐development needs to be radical and break with the current focus on adapting existing interventions to meet the needs of young people, which are not well understood and often do not directly reflect their priorities. Broader social contexts and compound lenses are needed to avoid narrow approaches and to accommodate evolving norms.

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“…As part of this study, we created a new set of reminders for TB prevention and treatment based on accepted clinical algorithms [13]. These reminders are designed to prompt medical providers to complete TB screening, consider initiating anti-TB treatment or IPT, and monitor adherence to treatment based on clinical data that exist in AMRS.…”

Section: Methodsmentioning

confidence: 99%

Do clinical decision-support reminders for medical providers improve isoniazid preventative therapy prescription rates among HIV-positive adults?: study protocol for a randomized controlled trial

Green

Catalani

Diero

et al. 2015

Trials

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BackgroundThis document describes a research protocol for a study designed to estimate the impact of implementing a reminder system for medical providers on the use of isoniazid preventative therapy (IPT) for adults living with HIV in western Kenya. People living with HIV have a 5% to 10% annual risk of developing active tuberculosis (TB) once infected with TB bacilli, compared to a 5% lifetime risk in HIV-negative people with latent TB infection. Moreover, people living with HIV have a 20-fold higher risk of dying from TB. A growing body of literature suggests that IPT reduces overall TB incidence and is therefore of considerable benefit to patients and the larger community. However, in 2009, of the estimated 33 million people living with HIV, only 1.7 million (5%) were screened for TB, and about 85,000 (0.2%) were offered IPT.Methods/DesignThis study will examine the use of clinical decision-support reminders to improve rates of initiation of preventative treatment in a TB/HIV co-morbid population living in a TB endemic area. This will be a pragmatic, parallel-group, cluster-randomized superiority trial with a 1:1 allocation to treatment ratio. For the trial, 20 public medical facilities that use clinical summary sheets generated from an electronic medical records system will participate as clusters. All HIV-positive adult patients who complete an initial encounter at a study cluster and at least one return encounter during the study period will be included in the study cohort. The primary endpoint will be IPT prescription at 3 months post the initial encounter. We will conduct both individual-level and cluster-level analyses. Due to the nature of the intervention, the trial will not be blinded. This study will contribute to the growing evidence base for the use of electronic health interventions in low-resource settings to promote high-quality clinical care, health system optimization and positive patient outcomes.Trial registration ClinicalTrials.gov NCT01934309, registered 29 August 2013.

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A Clinical Decision Support System for Integrating Tuberculosis and HIV Care in Kenya: A Human-Centered Design Approach

Cited by 64 publications

References 33 publications

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review

Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa

Do clinical decision-support reminders for medical providers improve isoniazid preventative therapy prescription rates among HIV-positive adults?: study protocol for a randomized controlled trial

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