mobile telemedicine for community health worker hiv care: a pilot study in nairobi, kenya
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Mobile telemedicine for Community Health Worker HIV Care: A pilot study in Nairobi, Kenya. Jennifer Cohn, MD MPH University of Pennsylvania School of Medicine. Background. Scale up vs HCW shortage Use of CHW for HIV care WHO Task Shifting Report (2007) Evidence of health systems benefit - PowerPoint PPT PresentationTRANSCRIPT
Mobile telemedicine for Community Health Worker
HIV Care: A pilot study in Nairobi,
Kenya
Jennifer Cohn, MD MPHUniversity of Pennsylvania School of Medicine
Background Scale up vs HCW shortage Use of CHW for HIV care
WHO Task Shifting Report (2007)
Evidence of health systems benefit
Evidence of clinical benefit Country guidelines
Challenges Poor clinical support of
CHWs in field Poor linkage of CHIS to
formal HIS
Decroo et al, JAIDS 2010MSF Khayelitsha programme report, 2011
WHO. Task shifting, 2007Celletti et al., AIDS 2010
Background: Kenya HIV
1.6 million HIV 540,000 on ART Changing guidelines
Health workforce shortage Nurses 1.18 per 1000 Doctors 0.14 per 1000
Kenya Community Health Strategy Developed 2006, roll-out
2009 Level 1 of the health system Aid in delivery of Kenya EHP Supports CHWs in a variety of
tasks, links to an RN supervisor
Link CHIS to HIS Interim reviews
The Pilot Study Goals
Support CHW clinical-decision making
Link CHIS to HIS Innovation
Branched logic surveys Easy-to-use interface Real-time upload to server
Aims Assess ability of CHWs to learn
and use mHealth application Assess function and connectivity
of server Assess patient outcomes (earlier
return to clinic, clinician action). Setting
Nairobi, Kenya Mbagathi District Hospital
Subjects 17 CHWs Convenience sampling
The Pilot Study: Methods CHW activities
1st line ART initiation 2nd line ART initiation Defaulters Post-hospitalization Clinician request
Training Standard 4 hour,
didactic and role play 2 Facilitators
Use for 6 weeks
CHW Home Visit
Collect and record patient
information
Transmit information
to clinic
Information to clinician
Patient clinic visit
ACTION!
The Pilot Study: Methods CHW activities
1st line ART initiation 2nd line ART initiation Defaulters Post-hospitalization Clinician request
Training Standard 4 hour,
didactic and role play 2 Facilitators
Use for 6 weeks
CHW Home Visit
Collect and record patient
information
Transmit information
to clinic
Information to clinician
Patient clinic visit
ACTION!
Evaluation Tools Ability to learn and use
technologyRole playTime 0, 3 and 6 weeks
SatisfactionSurvey (Likert scale)Time 0 and 6 weeks
Server functionServer downtimesFailed uploads
Patient outcomesRed flagsChart review
Results: CHW Demographics and Server Function
Server FunctioningDowntime: 1 episode lasting 33 hoursSurvey transmission
78 total16 (20.5%) uploaded >24 hours6 (7.7%) uploaded greater than 48 hours
Results: Role Play
Results: Satisfaction
Results: Red Flags
Results: Chart Review Charts reviewed
28 reviewed 34 not found 28 mismatched name/chart
number Results
20 (71%) red flags (earlier visits)
6 (20%) CHW-instructed earlier visits
Key indicators:Cough >2 weeksAdherence
Discussion Technology
Minimal training requirements Quickly attained and maintained Good connection and server functionality Acceptance and satisfaction
Clinical significance High numbers of red flags CHWs identify critical issues clinicians may not
Limitations and next steps Small sample size, short follow-up period Inability to locate many charts Next steps: Push technology to link to clinicians
Thank YouUniversity of Pennsylvania
Penn CFARGreg Bisson, MD MSCE
Nairobi, KenyaKhou Shong MPHDonata Muthoni Josephine Mwagiru
IT teamDebbie TheobaldAdam Kundishora