Implementation of Electronic Adherence Monitors and Associated Interventions for Routine HIV Antiretroviral Therapy in Uganda: Promising Findings

Haberer, Jessica; Baijuka, Robert; Tumuhairwe, John Bosco; Tindimwebwa, Edna; Tinkamanyire, James; Tuhanamagyezi, Ellyk; Musoke, Lawrence; Garrison, Lindsey; DelSignore, Marisa; Musinguzi, Nicholas; Asiimwe, Stephen

doi:10.3389/fdgth.2022.899643

Cited by 6 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to what we found in our study, these studies also identified technology and tools as a prominent barrier to implementation. Patients identified issues with device connectivity 19,31 and with alarms being either inappropriate or obtrusive. 27,35,37 Other qualitative studies also highlight patient-reported issues with device portability during commuting or travel.…”

Section: Discussionmentioning

confidence: 99%

“…Our study's focus on implementation of technologically enabled pillboxes at the time of hospital discharge adds to existing qualitative studies in the ambulatory setting. 19,22,[27][28][29][30][31][32][33][34][35][36] These studies have examined the use of a smart pillbox in a variety of geographic locations (e.g., U.S. academic medical centers, clinics in sub-Saharan Africa, urban clinics in India) for a variety of conditions. Similar to what we found in our study, these studies also identified technology and tools as a prominent barrier to implementation.…”

Section: Discussionmentioning

confidence: 99%

“…Smart pillboxes are technologically enabled pillboxes that have a range of capabilities, including the ability to transmit audible and digital alerts, track patient medication adherence, and generate adherence reports to clinicians. [12][13][14] Several studies to date have touted the success of such interventions in reducing medication discrepancies and, in some cases, improving chronic disease control in the ambulatory setting for a wide range of conditions such as hypertension, 15,16 diabetes, 15,17 human immunodeficiency virus (HIV), 12,[18][19][20][21][22][23][24] tuberculosis (TB), 18,25 multiple myeloma, 26 and post-kidney transplantation. 15 Additionally, and importantly given the novelty of smart pillbox devices, several studies have also explored user perspectives of this technology, the majority of which have focused on patient 19,22,[27][28][29][30][31][32][33][34][35][36] rather than clinician 32,35,37 perspectives.…”

Section: Background and Significancementioning

confidence: 99%

See 2 more Smart Citations

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

Shannon,

Mueller,

Schnipper

2023

ACI open

View full text Add to dashboard Cite

Objectives As part of a study to assess whether a technologically enabled pillbox prescribed to patients at hospital discharge can improve medication safety, we sought to assess participant experiences with the intervention. Methods We conducted a series of semi-structured phone interviews with patients, patient caregivers, and inpatient and outpatient clinicians who participated in the Smart Pillbox Transition Study. We developed an interview guide using the Systems Engineering Initiative for Patient Safety (SEIPS) framework, which included the a priori domains of (1) barriers to implementation, (2) facilitators of the intervention, and (3) general feedback regarding experience with the intervention. Within these domains, we employed SEIPS-informed themes of environment and organization, logistics and tasks, personnel and patients, and technology and tools. Interviews were conducted between May 2018 and January 2019. We used content analysis to interpret findings. Results We interviewed 6 patients, 2 caregivers, and 5 inpatient and 2 outpatient clinicians. Patient-endorsed barriers in the theme of technology and tools included signal issues, inappropriate alarms, and portability. Barriers in the theme of logistics and tasks included coordination with pharmacists in the event of a prescription change. Barriers mentioned by clinicians included patients who were poor fits for the intervention (theme: personnel and patients) and competing demands at discharge (theme: logistics and tasks). Facilitators that were frequently mentioned by patients and caregivers in the theme of technology and tools included useful alarms and ease of use. Clinicians stated that communication with pharmacy and study staff helped facilitate the intervention (theme: personnel and patients). Conclusion We identified several key barriers and facilitators from patients, caregivers, and clinicians to successful implementation of this intervention. Reconciling these sometimes contrasting viewpoints will be crucial if the Smart Pillbox or similar health information technology interventions are to be adopted as tools to improve medication safety during care transitions.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

See 1 more Smart Citation

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

Shannon,

Mueller,

Schnipper

2023

ACI open

View full text Add to dashboard Cite

show abstract

“…Existing studies examined the application of the CFIR in both pre- and post-implementation stages. These studies have demonstrated the strengths of utilizing the CFIR in various types of research, including qualitative [ 54 , 55 , 65 – 67 , 69 , 71 , 73 , 75 , 77 , 79 ], quantitative [ 53 ], mixed methods [ 76 ] and case studies [ 72 ]. Qualitative studies have employed the CFIR as an interview design and guide and collection tool to explore the perspectives and engagement of healthcare system stakeholders concerning implementation readiness [ 54 , 55 , 65 – 67 , 69 , 71 , 73 , 75 , 77 , 79 ].…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research

Li,

Su,

Zhang

et al. 2023

Health Res Policy Sys

View full text Add to dashboard Cite

Background Tuberculosis (TB) has been regarded as ‘a relentless scourge’, increasing morbidity and mortality and burdening vulnerable populations. Poor adherence to TB treatment and ineffective traditional interventions hinders TB control. A novel TB approach called ‘electronic monitors’, equipping medication boxes with daily audio or visual reminders for electronically monitoring medication intake, seems promising in improving adherence and health outcomes and overcoming the weaknesses of traditional interventions. However, no review has systematically examined and synthesized the influencing factors of implementing electronic monitors. Implementation research offers the means to analyse the influencing factors of the implementation and its process, fitting well with the aim of this review. Therefore, the widely recognized Consolidated Framework for Implementation Research (CFIR), which offers a common taxonomy for evaluating intervention implementation, will be adopted to systematically identify barriers and facilitators of the electronic monitors for improving adherence and health outcomes in patients with TB. Methods and analysis The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature research will be conducted in five electronic databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) to identify the barriers and facilitators of implementing electronic monitors in patients with TB. The CFIR will be used as a guide for categorizing and synthesizing the barriers and facilitators. Study screening, data extraction, quality appraisal and data analysis will be conducted by two independent reviewers. The use of additional reviewers will solve any disagreements between the two reviewers. Discussion Given the increased prominence of TB epidemiology and the adherence problem of electronic monitors, there is a solid rationale for synthesizing the existing studies via the CFIR. The findings and conclusion of this review will lay bare the achievements and effectiveness of implementing electronic monitors, as well as the attendant gaps and limitations. Further strategies for facilitating the implementation of electronic monitors will also be explored. This review will be of essential significance for research and practice, supporting future academic research initiatives centred on patients with TB and aiding electronic monitor design in lowering the morbidity and mortality associated with TB disease. Trial registration number: PROSPERO: CRD42023395747.

show abstract

“…In LMIC settings, digital solutions have provided a means to ensure that data could be reliably collected from decentralized testing sites ( 12 , 13 ). While digital solutions have often served a similar function in other disease responses in Uganda in the past ( 12 , 13 ), the national e-Health and data management strategy highlights that these tools have often been fragmented, with limited scale-up outside of individual projects ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Uptake and effectiveness of a mobile application for real-time reporting and quality assurance of decentralized SARS-CoV-2 testing in Uganda

Nansumba,

Nambuya,

Wafula

et al. 2023

Front. Public Health

View full text Add to dashboard Cite

BackgroundEffective management of the COVID-19 pandemic required rapid expansion of diagnosis. The introduction of antigen tests presented an opportunity to decentralize testing, but raised challenges with ensuring accurate and timely reporting of testing data, which is essential to guide the response. Digital solutions can help address this challenge and provide more efficient means of monitoring and quality assurance.MethodsUganda’s existing laboratory investigation form was digitized in the form of an Android-based application, eLIF, which was developed by the Central Public Health Laboratory and implemented in 11 high-volume facilities between December 2021 and May 2022. The app enabled healthcare workers to report testing data via mobile phone or tablet. Uptake of the tool was monitored through a dashboard that enabled real-time visibility into data being transmitted from sites, as well as qualitative insights from site visits and online questionnaires.Results and discussionA total of 15,351 tests were conducted at the 11 health facilities during the study period. Of these, 65% were reported through eLIF, while 12% were reported through preexisting Excel-based tools. However, 23% of tests were only captured in paper registers and not transmitted to the national database, illustrating the need for increased uptake of digital tools to ensure real-time data reporting. While data captured through eLIF were transmitted to the national database within 0–3 days (min, max), data transmitted through Excel were transmitted in within 0–37 days (min, max), and data for paper-based reporting took up to 3 months. The majority of healthcare workers interviewed in an endpoint questionnaire responded that eLIF improved timeliness of patient management, and reduced reporting time. However, some functions of the app were not successfully implemented, such as providing random selections of samples for external quality assurance and enabling seamless linkage of these data. Challenges arose from broader operational complexities, such as staff workload, frequent task-shifting and unexpected changes to facility workflows, which limited adherence to the envisioned study procedures. Ongoing improvements are needed to adjust to these realities, to strengthen the technology and support to healthcare workers using it, to optimize the impact of this digital intervention.

show abstract

Implementation of Electronic Adherence Monitors and Associated Interventions for Routine HIV Antiretroviral Therapy in Uganda: Promising Findings

Cited by 6 publications

References 26 publications

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research

Uptake and effectiveness of a mobile application for real-time reporting and quality assurance of decentralized SARS-CoV-2 testing in Uganda

Contact Info

Product

Resources

About