Effectiveness of an mHealth intervention to increase adherence to triage of HPV DNA positive women who have performed self-collection (the ATICA study): A hybrid type I cluster randomised effectiveness-implementation trial

Arrossi, Silvina; Paolino, Melisa; Antelo, Victoria Sánchez; Thouyaret, Laura; Kohler, Racquel E.; Cuberli, Milca; Flores, Liliana; Serra, Verónica; Viswanath, Kasisomayajula; Orellana, Liliana

doi:10.1016/j.lana.2022.100199

Cited by 15 publications

(32 citation statements)

References 30 publications

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“…In our study, the respondents evaluated the ATICA strategy as highly effective in increasing triage of HPV + women and facilitating access to an early diagnosis; this assessment coincides with the results of the cluster-randomized trial [13]. This is a key result, as the perception of effectiveness of the intervention is an in uential factor of the intervention's sustainability [37].…”

Section: Discussionsupporting

confidence: 68%

“…Acceptability of interventions by CHWs is correlated with potential work overburden that those might impose on their daily tasks [29]. Although our study did not interview CHWs, previously reported results showed that 87% of CHWs accepted the incorporation of the ATICA strategy into their daily activities and 91% visited HPV + women who did not respond to the SMS [13]. It is therefore possible to assume that interviewees perception of the intervention as advantageous for CHWs is also shared by CHWs.…”

Section: Discussionmentioning

confidence: 80%

“…In this paper, we present an evaluation of the decision-makers and healthcare providers (HCPs) perceptions of the ATICA strategy. This qualitative analysis allows for a better understanding of key factors for scaling up the ATICA strategy and builds on the effectiveness data from the CTR [13].…”

Section: Introductionmentioning

confidence: 99%

“…The ATICA Study (Application of Communication and Information Technologies to Self-Collection, for its initials in Spanish) is a hybrid type I effectiveness-implementation trial to evaluate the effectiveness of a multi-component mHealth intervention (ATICA strategy) to increase adherence to triage by women with a positive self-collected test [12]. Results of the CRT showed that sending SMS to encourage women with positive self-collected tests to visit a health center for triage combined with an e-mail/SMS to the CHWs to encourage them to visit women without Pap triage after 60 days effectively increased triage [13]. For this reason, scaling-up of the ATICA strategy into routine CC screening programs using self-collected tests could have great impact in CC prevention programs by facilitating the continuity of care for HPV-positive women.…”

Section: Introductionmentioning

confidence: 99%

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Adoption and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): Perceptions of health decision-makers and health-care providers

Straw

Sanchez-Antelo

Kohler

et al. 2022

Preprint

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Background: The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and healthcare providers regarding the intervention adoption and scaling-up. Methods: A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n=10) and health care providers (n= 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results: Both health care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women’s needs, and relative priority. However, some potential barriers were also identified including complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy’s sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there is staff to take the Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-test. Conclusions: Health decision-makers and healthcare providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications for not only to Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Adoption and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): Perceptions of health decision-makers and health-care providers

Straw

Sanchez-Antelo

Kohler

et al. 2022

Preprint

Self Cite

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“…The use of mHealth technologies to send reminders to women could be a feasible tool to reduce the time from screening to triage and improve patient-provider communication. In Jujuy, the ATICA project, 44 an effectiveness-implementation hybrid type-I trial, showed that a multi-component mHealth intervention increased adherence to triage among women with HPV + self-collected tests. This strategy could be scaled up to improve the effectiveness of SC and reduce CC incidence and mortality.…”

Section: Discussionmentioning

confidence: 99%

Assessing the implementation fidelity of HPV self-collection offered by Community Health Workers during home visits (the EMA strategy): a case study in a low-middle resource setting in Argentina

Paolino

Antelo

Cuberli

et al. 2022

Preprint

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BackgroundIn Argentina, HPV self-collection offered by Community Health Workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled-up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity -in relation to the core components proposed by the National Program on Cervical Cancer Prevention- with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. Methods This descriptive study used a multi-methods approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters (HPs), observations, and secondary data from the national screening information system. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. ResultsOur results showed that the core components with highest fidelity were “Training”, Sample Handling, and Transportation. Regarding the Offer of HPV self-collection, we found some adaptations such as locations in which HPs offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the Follow-up and Treatment core component we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of HPs that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers.ConclusionsOut study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in Low-middle income settings.

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Recommendations for Empowering Partners to Conduct Implementation Research in Latin America to Advance Global Health

Pelt

Beidas

Baumann

et al. 2023

Glob Implement Res Appl

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Effectiveness of an mHealth intervention to increase adherence to triage of HPV DNA positive women who have performed self-collection (the ATICA study): A hybrid type I cluster randomised effectiveness-implementation trial

Cited by 15 publications

References 30 publications

Adoption and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): Perceptions of health decision-makers and health-care providers

Adoption and scaling-up of an effective mHealth intervention to increase adherence to triage of HPV-positive women (ATICA study): Perceptions of health decision-makers and health-care providers

Assessing the implementation fidelity of HPV self-collection offered by Community Health Workers during home visits (the EMA strategy): a case study in a low-middle resource setting in Argentina

Recommendations for Empowering Partners to Conduct Implementation Research in Latin America to Advance Global Health

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