Process Evaluation of Pragmatic Cluster-Randomized Trials of Digital Adherence Technologies for Tuberculosis Treatment Support: A Mixed-Method Study in Five Countries.

IF 2.8 4区 医学 Q2 INFECTIOUS DISEASES
Norma Madden, Amare W Tadesse, Chung Lam Leung, Bianca Gonçalves Tasca, Jason Alacapa, Natasha Deyanova, Nontobeko Ndlovu, Nontobeko Mokone, Baraka Onjare, Andrew Mganga, Kristian van Kalmthout, Degu Jerene, Katherine Fielding
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Abstract

Digital adherence technologies (DATs) could improve the person-centeredness of tuberculosis (TB) treatment. DATs are found to be acceptable, though evidence of their effectiveness is varied. Our objective was to understand the fidelity of DAT interventions within five cluster-randomized trials. Two DATs (smart pillbox, medication labels) were assessed, with real-time adherence data available to healthcare providers (HCPs) on a digital platform in Ethiopia, the Philippines, South Africa, Tanzania, and Ukraine. A framework assessed four components of implementation: inputs (training, support, mobile access), processes (SMS, home visits, platform usage), outputs (DAT engagement, manual dosing), and outcomes (people with TB (PwTB)-HCP relationship). Fidelity was evaluated by quantitative indicators, and content analysis of qualitative sub-studies supplemented some indicators. Engagement with DATs was high among PwTB. Pillbox users showed high levels of sustained engagement (box opening), with digitally recorded doses ranging from 82% to 91%. Differences were observed in login frequency by HCPs to the adherence platform. In Ethiopia, Tanzania, and Ukraine, there was at least one login to the platform on 71% of weekdays per facility compared with the Philippines and South Africa at 42% and 52%, respectively. Intervention fidelity varied among countries, suggesting a need for future work on optimizing implementation.

结核病治疗支持数字依从性技术的实用聚类随机试验的过程评价:在五个国家的混合方法研究。
数字依从性技术(dat)可以改善以人为本的结核病(TB)治疗。dat是可以接受的,尽管证明其有效性的证据各不相同。我们的目的是在5个集群随机试验中了解DAT干预的保真度。对两种dat(智能药盒、药物标签)进行了评估,并在埃塞俄比亚、菲律宾、南非、坦桑尼亚和乌克兰的数字平台上向医疗保健提供者(hcp)提供了实时依从性数据。一个框架评估了实施的四个组成部分:投入(培训、支持、移动接入)、流程(短信、家访、平台使用)、产出(DAT参与、手动给药)和结果(结核病患者(PwTB)与hcp的关系)。以定量指标评价保真度,定性子研究内容分析补充部分指标。工务局与技术谘询服务的接触程度很高。Pillbox用户表现出高水平的持续参与(打开药盒),数字记录的剂量从82%到91%不等。HCPs登录依从性平台的频率存在差异。在埃塞俄比亚、坦桑尼亚和乌克兰,每个设施在工作日至少有一次登录该平台的比例为71%,而菲律宾和南非的这一比例分别为42%和52%。干预的保真度因国家而异,这表明未来需要在优化实施方面开展工作。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Tropical Medicine and Infectious Disease
Tropical Medicine and Infectious Disease Medicine-Public Health, Environmental and Occupational Health
CiteScore
3.90
自引率
10.30%
发文量
353
审稿时长
11 weeks
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