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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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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. |
format | Online Article Text |
id | pubmed-9931231 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
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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