Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences

Catherine Wexler, Melinda Brown, Emily A Hurley, Martin Ochieng, Kathy Goggin, Brad Gautney, May Maloba, Raphael Lwembe, Samoel Khamadi, Sarah Finocchario-Kessler, Catherine Wexler, Melinda Brown, Emily A Hurley, Martin Ochieng, Kathy Goggin, Brad Gautney, May Maloba, Raphael Lwembe, Samoel Khamadi, Sarah Finocchario-Kessler

Abstract

Background: Literature 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.

Objective: We 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.

Methods: As 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.

Results: Providers 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.

Conclusions: 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. 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 registration: ClinicalTrials.gov NCT02072603; https://ichgcp.net/clinical-trials-registry/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm).

Keywords: HIV/AIDS; Kenya; eHealth; early infant diagnosis (EID); implementation science; mHealth.

Conflict of interest statement

Conflicts of Interest: None declared.

©Catherine Wexler, Melinda Brown, Emily A Hurley, Martin Ochieng, Kathy Goggin, Brad Gautney, May Maloba, Raphael Lwembe, Samoel Khamadi, Sarah Finocchario-Kessler. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 22.08.2018.

Figures

Figure 1
Figure 1
Perceived usefulness of the HIV Infant Tracking System (HITSystem). ART: antiretroviral therapy; EID: early infant diagnosis; LTFU: loss to follow up; PCR: polymerase chain reaction; SMS: short message service; TAT: turnaround time.

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