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Access to primary healthcare, including diagnostic testing is limited in Guinea, particularly for low-income residents of rural communities. Here we share findings from an interventional operational research study evaluating the feasibility of deploying a digital tool and rapid diagnostic tests to support community-based testing for priority medical conditions across three rural and peri-urban communities in Guinea. An existing web-based application was modified to include integrated symptom screening for malaria and COVID-19, maximize workflow efficiency and conduct end-to-end data capture on tablet devices. Using the application, community health workers screened participants for symptoms of malaria and COVID-19, with eligible participants tested using rapid diagnostic tests. All participants also underwent blood pressure and blood glucose measurements, while malnutrition screening was offered to pregnant women or children under 5 years. Services were provided to residents through mass consultations and home care visits across the study locations. The intervention reached 5204 people overall, with 3241 people enrolled via the application. 32.4% and 15.8% of participants had elevated blood pressure and blood glucose levels, the majority of whom were previously undiagnosed. Of those tested for malaria, 3.2% (n = 28/876) tested positive. The digital tool was successful in providing end-to-end data capture, with 99% of participants having their rapid diagnostic test results captured in real-time, and all outcomes reported into the Ministry of Health database. Together, the study demonstrates the feasibility of using a web-based digital tool to support community health workers with providing community-based diagnostic services in rural and peri-urban communities in a low-resource setting.
Access to primary healthcare, including diagnostic testing is limited in Guinea, particularly for low-income residents of rural communities. Here we share findings from an interventional operational research study evaluating the feasibility of deploying a digital tool and rapid diagnostic tests to support community-based testing for priority medical conditions across three rural and peri-urban communities in Guinea. An existing web-based application was modified to include integrated symptom screening for malaria and COVID-19, maximize workflow efficiency and conduct end-to-end data capture on tablet devices. Using the application, community health workers screened participants for symptoms of malaria and COVID-19, with eligible participants tested using rapid diagnostic tests. All participants also underwent blood pressure and blood glucose measurements, while malnutrition screening was offered to pregnant women or children under 5 years. Services were provided to residents through mass consultations and home care visits across the study locations. The intervention reached 5204 people overall, with 3241 people enrolled via the application. 32.4% and 15.8% of participants had elevated blood pressure and blood glucose levels, the majority of whom were previously undiagnosed. Of those tested for malaria, 3.2% (n = 28/876) tested positive. The digital tool was successful in providing end-to-end data capture, with 99% of participants having their rapid diagnostic test results captured in real-time, and all outcomes reported into the Ministry of Health database. Together, the study demonstrates the feasibility of using a web-based digital tool to support community health workers with providing community-based diagnostic services in rural and peri-urban communities in a low-resource setting.
Background Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. Conclusions This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855
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