Abstract
BackgroundLiterature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants.ObjectiveWe aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention.MethodsAs part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories.ResultsProviders emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians.ConclusionsProvider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs.Trial RegistrationClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm)
Highlights
In East Africa, electronic health interventions are increasingly being integrated into health care settings to support a range of HIV-related services and improve patient outcomes
Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals
Perceived Usefulness The perceived usefulness of the HITSystem was a strong theme among intervention respondents, who saw it as providing several benefits over standard early infant diagnosis (EID) care (Figure 1)
Summary
In East Africa, electronic health (eHealth) interventions are increasingly being integrated into health care settings to support a range of HIV-related services and improve patient outcomes. The HITSystem sends short message service (SMS) texts to mothers alerting them when results are available at the hospital and serving as a reminder or cue to action for upcoming retesting services or when any service is missed. These processes are automated and may result in up to 14 provider alerts per infant enrolled (average of 3 to 5) and 3 or more SMS messages to mothers over the course of EID services, depending on infant test results and timeliness of seeking care. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants
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