Implementation of an electronic fingerprint-linked data collection system: a feasibility and acceptability study among Zambian female sex workers

Abstract

BackgroundPatient identification within and between health services is an operational challenge in many resource-limited settings. When following HIV risk groups for service provision and in the context of vaccine trials, patient misidentification can harm patient care and bias trial outcomes. Electronic fingerprinting has been proposed to identify patients over time and link patient data between health services. The objective of this study was to determine 1) the feasibility of implementing an electronic-fingerprint linked data capture system in Zambia and 2) the acceptability of this system among a key HIV risk group: female sex workers (FSWs).MethodsWorking with Biometrac, a US-based company providing biometric-linked healthcare platforms, an electronic fingerprint-linked data capture system was developed for use by field recruiters among Zambian FSWs. We evaluated the technical feasibility of the system for use in the field in Zambia and conducted a pilot study to determine the acceptability of the system, as well as barriers to uptake, among FSWs.ResultsWe found that implementation of an electronic fingerprint-linked patient tracking and data collection system was feasible in this relatively resource-limited setting (false fingerprint matching rate of 1/1000 and false rejection rate of <1/10,000) and was acceptable among FSWs in a clinic setting (2 % refusals). However, our data indicate that less than half of FSWs are comfortable providing an electronic fingerprint when recruited while they are working. The most common reasons cited for not providing a fingerprint (lack of privacy/confidentiality issues while at work, typically at bars or lodges) could be addressed by recruiting women during less busy hours, in their own homes, in the presence of “Queen Mothers” (FSW organizers), or in the presence of a FSW that has already been fingerprinted.ConclusionsOur findings have major implications for key population research and improved health services provision. However, more work needs to be done to increase the acceptability of the electronic fingerprint-linked data capture system during field recruitment. This study indicated several potential avenues that will be explored to increase acceptability.

Technologies and Social Justice Outcomes in Sex Work Charities

“…[48] Sambasivan et al, for example, have designed a phone broadcasting system for urban sex workers in India [48] in collaboration with a charity and have improved reach and informed sex workers about health issues. Wall et al [55] have taken a healthfocus on sex work in Zambia, where it was found that fingerprint-linked patient tracking and data collection was a feasible option in resource restrained areas (although the sex workers often refused to give their fingerprints due to a perceived lack of privacy).…”

Sustainable support solutions for Community-Based Rehabilitation Workers in refugee camps: Piloting telehealth acceptability and implementation

“…This study incidentally identi ed some speci c diagnoses in which CBR workers feel they require more support, and whether assistance was most needed before, during, or after telehealth sessions, which carries its own implications for the training and support needs of CBR workers [4]. Similar to other studies completed in LMICs, this study also identi ed some cultural barriers and beliefs that might limit progression of technology use in LMIC [17].…”

“…This pilot addressed previously mentioned barriers to sustainability and scalability through qualitative evaluation of technical, operational, infrastructural, cultural and economic feasibility [11]. Similar to other studies implementing technologies that are novel to the adopting community, a training to mitigate complexity of the intervention was planned and executed [11,17]. Implementation science literature highlight the importance of technical consensus when planning for scalability [11].…”

Technologies for Social Justice

“…Cunningham and Kendall [14] raise important legal and regulatory questions surrounding the advertising and exchanging of digitally mediated sexual encounters for this growing online market that incentivises reputation-building as well as screening practices. Furthermore, digital technologies have been designed to support peer-sharing [49], to track health information in developing contexts [67], or to support sharing of safety information [59]. What may be lacking in the current research however, is the development of digital technologies with sex workers directly that take into account their agency and skillsets.…”