The core thesis of this study is to explore the legal and technological feasibility to interoperate two mobile health-based solutions in Kenya: Ushauri-Text for Adherence (T4A), and Mobile Laboratory (mLab), to enhance HIV/AIDS care and treatment. This paper focuses on two aspects namely data interoperability by analysing secondary data abstracted from the mLab and the Ushauri databases from June 2017 to June 2018 and doctrinal analysis of the legal and policy environment to support the interoperability. This paper is a case study of the mLab and the Ushauri systems in terms of the technological stack for interoperability which has some legal implications. It includes a pilot study that employed a multistage sampling method in which thirty-nine health facilities in Siaya, Homa bay, Nyeri, and Muranga were selected. Findings show a satisfactory legal environment to augment the interoperability of the two mHealth systems. It is also evident that the two systems were considerably interoperable in terms of technology, semantics, data, and processes. However, interoperating them could largely be compromised by language semantics leading to a discrepancy of characters and numbering in unique identifiers in data entry. Though data in the systems were for the same individuals, it is critical to note that there was a low level of concordance in patient identification numbers in the same facilities where the same patients were receiving clinical services. Additionally, healthcare workers across the various facilities did not follow the NASCOP (2010) eleven-digit unique identifier system. Standardizing human activities while using systems such as the allocation of patient identifiers and following laid down standards while developing systems are critical ways of ensuring interoperability. This paper highlights the need to achieve full-scale implementation of laid down policies and legal requirements such as the systems’ interoperability certification process to standardise the systems and make them interoperable.
This study examined the perceptions of health service providers on the relationship between utilization of digital health intervention (DHI) for clients’ adherence to appointments and performance of HIV/AIDS projects in Kisumu County using an ex-post facto cross-sectional descriptive survey design. A census approach was used to recruit 191 participants who were at work during the data collection period across eight health facilities where the DHI was being used. Quantitative data was collected electronically using a questionnaire built a 5-point Likert scale and analyzed using SPSS version 26. Descriptive analysis involved generating the means and standard deviations while inferential analysis involved determining correlations and linear regression modelling. Results for both descriptive and inferential statistics are presented using tables. Qualitative data was collected using a key informant interview guide and analyzed thematically. Data were collected in January 2022. Results show a high level of utilization of DHI for clients’ appointments adherence (composite mean =4.28; SD=0.77; CI=95%). Performance of HIV/AIDS projects was scored highly with a composite mean of 4.47 (SD=0.057; CI=95%). A Pearson correlation coefficient of 0.349; p value<0.001, showed a statistically significant positive relationship between the two variables. Utilization of DHI for clients’ appointments adherence could potentially influence performance of HIV/AIDS projects by up to 28% (R2=0.28, p value<0.001). The study concluded that the DHI for clients’ appointments adherence was critical in improving adherence to treatment plans and management of appointments as an electronic diary at the health facilities hence improving performance of HIV/AIDS projects.
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