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Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe

Adult medical male circumcision (MC) is safe: global notifiable adverse event (AE) rates average below 2.0%. With Zimbabwe’s shortage of health care workers (HCWs) compounded by COVID-19 constraints, two-way text-based (2wT) MC follow-up may be advantageous over routinely scheduled in-person reviews...

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Autores principales: Marongwe, Phiona, Wasunna, Beatrice, Gavera, Jacqueline, Murenje, Vernon, Gwenzi, Farai, Hove, Joseph, Mauhy, Christine, Xaba, Sinokuthemba, Mugwanya, Raymond, Makunike-Chikwinya, Batsirai, Munyaradzi, Tinashe, Korir, Michael, Oni, Femi, Khaemba, Antony, Barasa, Mourice, Holec, Marrianne, Sidile-Chitimbire, Vuyelwa, Tshimanga, Mufuta, Holeman, Isaac, Barnhart, Scott, Feldacker, Caryl
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931231/
https://www.ncbi.nlm.nih.gov/pubmed/36812548
http://dx.doi.org/10.1371/journal.pdig.0000066
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author Marongwe, Phiona
Wasunna, Beatrice
Gavera, Jacqueline
Murenje, Vernon
Gwenzi, Farai
Hove, Joseph
Mauhy, Christine
Xaba, Sinokuthemba
Mugwanya, Raymond
Makunike-Chikwinya, Batsirai
Munyaradzi, Tinashe
Korir, Michael
Oni, Femi
Khaemba, Antony
Barasa, Mourice
Holec, Marrianne
Sidile-Chitimbire, Vuyelwa
Tshimanga, Mufuta
Holeman, Isaac
Barnhart, Scott
Feldacker, Caryl
author_facet Marongwe, Phiona
Wasunna, Beatrice
Gavera, Jacqueline
Murenje, Vernon
Gwenzi, Farai
Hove, Joseph
Mauhy, Christine
Xaba, Sinokuthemba
Mugwanya, Raymond
Makunike-Chikwinya, Batsirai
Munyaradzi, Tinashe
Korir, Michael
Oni, Femi
Khaemba, Antony
Barasa, Mourice
Holec, Marrianne
Sidile-Chitimbire, Vuyelwa
Tshimanga, Mufuta
Holeman, Isaac
Barnhart, Scott
Feldacker, Caryl
author_sort Marongwe, Phiona
collection PubMed
description Adult medical male circumcision (MC) is safe: global notifiable adverse event (AE) rates average below 2.0%. With Zimbabwe’s shortage of health care workers (HCWs) compounded by COVID-19 constraints, two-way text-based (2wT) MC follow-up may be advantageous over routinely scheduled in-person reviews. A 2019 randomized control trial (RCT) found 2wT to be safe and efficient for MC follow-up. As few digital health interventions successfully transition from RCT to scale, we detail the 2wT scale-up approach from RCT to routine MC practice comparing MC safety and efficiency outcomes. After the RCT, 2wT transitioned from a site-based (centralized) system to hub-and-spoke model for scale-up where one nurse triaged all 2wT patients, referring patients in need to their local clinic. No post-operative visits were required with 2wT. Routine patients were expected to attend at least one post-operative review. We compare 1) AEs and in-person visits between 2wT men from RCT and routine MC service delivery; and 2) 2wT-based and routine follow-up among adults during the 2wT scale-up period, January to October 2021. During scale-up period, 5084 of 17417 adult MC patients (29%) opted into 2wT. Of the 5084, 0.08% (95% CI: 0.03, 2.0) had an AE and 71.0% (95% CI: 69.7, 72.2) responded to ≥1 daily SMS, a significant decrease from the 1.9% AE rate (95% CI: 0.7, 3.6; p<0.001) and 92.5% response rate (95% CI: 89.0, 94.6; p<0.001) from 2wT RCT men. During scale-up, AE rates did not differ between routine (0.03%; 95% CI: 0.02, 0.08) and 2wT (p = 0.248) groups. Of 5084 2wT men, 630 (12.4%) received telehealth reassurance, wound care reminders, and hygiene advice via 2wT; 64 (19.7%) were referred for care of which 50% had visits. Similar to RCT outcomes, routine 2wT was safe and provided clear efficiency advantages over in-person follow-up. 2wT reduced unnecessary patient-provider contact for COVID-19 infection prevention. Rural network coverage, provider hesitancy, and the slow pace of MC guideline changes slowed 2wT expansion. However, immediate 2wT benefits for MC programs and potential benefits of 2wT-based telehealth for other health contexts outweigh limitations.
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spelling pubmed-99312312023-02-16 Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe Marongwe, Phiona Wasunna, Beatrice Gavera, Jacqueline Murenje, Vernon Gwenzi, Farai Hove, Joseph Mauhy, Christine Xaba, Sinokuthemba Mugwanya, Raymond Makunike-Chikwinya, Batsirai Munyaradzi, Tinashe Korir, Michael Oni, Femi Khaemba, Antony Barasa, Mourice Holec, Marrianne Sidile-Chitimbire, Vuyelwa Tshimanga, Mufuta Holeman, Isaac Barnhart, Scott Feldacker, Caryl PLOS Digit Health Research Article Adult medical male circumcision (MC) is safe: global notifiable adverse event (AE) rates average below 2.0%. With Zimbabwe’s shortage of health care workers (HCWs) compounded by COVID-19 constraints, two-way text-based (2wT) MC follow-up may be advantageous over routinely scheduled in-person reviews. A 2019 randomized control trial (RCT) found 2wT to be safe and efficient for MC follow-up. As few digital health interventions successfully transition from RCT to scale, we detail the 2wT scale-up approach from RCT to routine MC practice comparing MC safety and efficiency outcomes. After the RCT, 2wT transitioned from a site-based (centralized) system to hub-and-spoke model for scale-up where one nurse triaged all 2wT patients, referring patients in need to their local clinic. No post-operative visits were required with 2wT. Routine patients were expected to attend at least one post-operative review. We compare 1) AEs and in-person visits between 2wT men from RCT and routine MC service delivery; and 2) 2wT-based and routine follow-up among adults during the 2wT scale-up period, January to October 2021. During scale-up period, 5084 of 17417 adult MC patients (29%) opted into 2wT. Of the 5084, 0.08% (95% CI: 0.03, 2.0) had an AE and 71.0% (95% CI: 69.7, 72.2) responded to ≥1 daily SMS, a significant decrease from the 1.9% AE rate (95% CI: 0.7, 3.6; p<0.001) and 92.5% response rate (95% CI: 89.0, 94.6; p<0.001) from 2wT RCT men. During scale-up, AE rates did not differ between routine (0.03%; 95% CI: 0.02, 0.08) and 2wT (p = 0.248) groups. Of 5084 2wT men, 630 (12.4%) received telehealth reassurance, wound care reminders, and hygiene advice via 2wT; 64 (19.7%) were referred for care of which 50% had visits. Similar to RCT outcomes, routine 2wT was safe and provided clear efficiency advantages over in-person follow-up. 2wT reduced unnecessary patient-provider contact for COVID-19 infection prevention. Rural network coverage, provider hesitancy, and the slow pace of MC guideline changes slowed 2wT expansion. However, immediate 2wT benefits for MC programs and potential benefits of 2wT-based telehealth for other health contexts outweigh limitations. Public Library of Science 2022-06-15 /pmc/articles/PMC9931231/ /pubmed/36812548 http://dx.doi.org/10.1371/journal.pdig.0000066 Text en © 2022 Marongwe et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Marongwe, Phiona
Wasunna, Beatrice
Gavera, Jacqueline
Murenje, Vernon
Gwenzi, Farai
Hove, Joseph
Mauhy, Christine
Xaba, Sinokuthemba
Mugwanya, Raymond
Makunike-Chikwinya, Batsirai
Munyaradzi, Tinashe
Korir, Michael
Oni, Femi
Khaemba, Antony
Barasa, Mourice
Holec, Marrianne
Sidile-Chitimbire, Vuyelwa
Tshimanga, Mufuta
Holeman, Isaac
Barnhart, Scott
Feldacker, Caryl
Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe
title Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe
title_full Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe
title_fullStr Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe
title_full_unstemmed Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe
title_short Transitioning a digital health innovation from research to routine practice: Two-way texting for male circumcision follow-up in Zimbabwe
title_sort transitioning a digital health innovation from research to routine practice: two-way texting for male circumcision follow-up in zimbabwe
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9931231/
https://www.ncbi.nlm.nih.gov/pubmed/36812548
http://dx.doi.org/10.1371/journal.pdig.0000066
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