eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho

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dc.contributor.authorScherrer, Ramona
dc.contributor.authorTschumi, Nadine
dc.contributor.authorLejone, Thabo I
dc.contributor.authorKopo, Mathebe
dc.contributor.authorMotaboli, Lipontso
dc.contributor.authorMothobi, Buoang
dc.contributor.authorAmstutz, Alain
dc.contributor.authorDeml, Michael J.
dc.contributor.authorLerotholi, Malebanye
dc.contributor.authorLabhardt, Niklaus D
dc.date.accessioned2022-04-12T10:19:02Z
dc.date.available2022-04-12T10:19:02Z
dc.date.issued2022-03-11
dc.date.updated2022-03-14T09:38:09Z
dc.description.abstractBackground Multi-month dispensing (MMD) of antiretroviral therapy (ART) represents one approach of differentiated service delivery (DSD) aiming to improve quality and cost-effectiveness for HIV services in resource-limited settings. However, reduction in clinic visits for people living with HIV (PLWH) should go along with out-of-clinic care tailored to PLWH`s preferences and comorbidities to maintain quality of care. eHealth supported MMD offers a potential solution. Methods Between October 2019 and January 2020 we assessed preferences on an eHealth supported MMD package among adult PLWH attending routine ART care at a rural clinic in Lesotho using a mixed-methods approach. Participants reported their preferences among different refill and eHealth options. They were invited to test automated text messages (SMS) informing about their viral load results, an automated tuberculosis symptoms screening call and telemedical support by an expert nurse. Telemedical service comprised a call-back option if participants required any additional support and adherence counselling for closer follow-up of participants with unsuppressed viral loads. After 6 weeks, participants were followed-up to assess perception of the chosen eHealth support using a qualitative approach. Results Among 112 participants (median age = 43 years; 74% female), 83/112 (75%) preferred MMD for 6–12 months (median = 9 months, IQR = [5, 12]). Neither sex, age, employment, costs and time for travel to clinic, nor the duration of taking ART correlated with the MMD preference. All 17 participants attending routine viral load measurement wished to receive the result via SMS. Fifteen (19.2%) participants requested a telemedical nurse call-back during the study period. All participants with recent unsuppressed viral load (N = 13) requested telemedical adherence counselling for closer follow-up. Among 78 participants followed-up, 76 (97%) would appreciate having the call-back option in future. Seventy-five participants (67%) received and evaluated the automated symptomatic tuberculosis screening call, overall 71 (95%) appreciated it. Conclusions The great majority of PLWH in this study preferred 6–12 months MMD and appreciated the additional eHealth support, including viral load results via SMS, telemedical nurse consultations and automated tuberculosis symptom screening calls. eHealth supported MMD packages appear to be a promising approach for DSD models and should be assessed for clinical endpoints and cost-effectiveness in larger studies.en_US
dc.identifier.apacitationScherrer, R., Tschumi, N., Lejone, T. I., Kopo, M., Motaboli, L., Mothobi, B., ... Labhardt, N. D. (2022). eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho. <i>Pilot and Feasibility Studies</i>, 8(1), 61. http://hdl.handle.net/11427/36345en_ZA
dc.identifier.chicagocitationScherrer, Ramona, Nadine Tschumi, Thabo I Lejone, Mathebe Kopo, Lipontso Motaboli, Buoang Mothobi, Alain Amstutz, Michael J. Deml, Malebanye Lerotholi, and Niklaus D Labhardt "eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho." <i>Pilot and Feasibility Studies</i> 8, 1. (2022): 61. http://hdl.handle.net/11427/36345en_ZA
dc.identifier.citationScherrer, R., Tschumi, N., Lejone, T.I., Kopo, M., Motaboli, L., Mothobi, B., Amstutz, A. & Deml, Michael J. et al. 2022. eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho. <i>Pilot and Feasibility Studies.</i> 8(1):61. http://hdl.handle.net/11427/36345en_ZA
dc.identifier.ris TY - Journal Article AU - Scherrer, Ramona AU - Tschumi, Nadine AU - Lejone, Thabo I AU - Kopo, Mathebe AU - Motaboli, Lipontso AU - Mothobi, Buoang AU - Amstutz, Alain AU - Deml, Michael J. AU - Lerotholi, Malebanye AU - Labhardt, Niklaus D AB - Background Multi-month dispensing (MMD) of antiretroviral therapy (ART) represents one approach of differentiated service delivery (DSD) aiming to improve quality and cost-effectiveness for HIV services in resource-limited settings. However, reduction in clinic visits for people living with HIV (PLWH) should go along with out-of-clinic care tailored to PLWH`s preferences and comorbidities to maintain quality of care. eHealth supported MMD offers a potential solution. Methods Between October 2019 and January 2020 we assessed preferences on an eHealth supported MMD package among adult PLWH attending routine ART care at a rural clinic in Lesotho using a mixed-methods approach. Participants reported their preferences among different refill and eHealth options. They were invited to test automated text messages (SMS) informing about their viral load results, an automated tuberculosis symptoms screening call and telemedical support by an expert nurse. Telemedical service comprised a call-back option if participants required any additional support and adherence counselling for closer follow-up of participants with unsuppressed viral loads. After 6 weeks, participants were followed-up to assess perception of the chosen eHealth support using a qualitative approach. Results Among 112 participants (median age = 43 years; 74% female), 83/112 (75%) preferred MMD for 6–12 months (median = 9 months, IQR = [5, 12]). Neither sex, age, employment, costs and time for travel to clinic, nor the duration of taking ART correlated with the MMD preference. All 17 participants attending routine viral load measurement wished to receive the result via SMS. Fifteen (19.2%) participants requested a telemedical nurse call-back during the study period. All participants with recent unsuppressed viral load (N = 13) requested telemedical adherence counselling for closer follow-up. Among 78 participants followed-up, 76 (97%) would appreciate having the call-back option in future. Seventy-five participants (67%) received and evaluated the automated symptomatic tuberculosis screening call, overall 71 (95%) appreciated it. Conclusions The great majority of PLWH in this study preferred 6–12 months MMD and appreciated the additional eHealth support, including viral load results via SMS, telemedical nurse consultations and automated tuberculosis symptom screening calls. eHealth supported MMD packages appear to be a promising approach for DSD models and should be assessed for clinical endpoints and cost-effectiveness in larger studies. DA - 2022-03-11 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Pilot and Feasibility Studies KW - HIV KW - Differentiated service delivery (DSD) model KW - Antiretroviral therapy (ART) KW - People living with HIV (PLWH) KW - Multi-month dispensing (MMD) KW - Viral load (VL) KW - eHealth KW - Telemedical support LK - https://open.uct.ac.za PY - 2022 T1 - eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho TI - eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho UR - http://hdl.handle.net/11427/36345 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s40814-022-01019-x
dc.identifier.urihttp://hdl.handle.net/11427/36345
dc.identifier.vancouvercitationScherrer R, Tschumi N, Lejone TI, Kopo M, Motaboli L, Mothobi B, et al. eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho. Pilot and Feasibility Studies. 2022;8(1):61. http://hdl.handle.net/11427/36345.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Public Health and Family Medicineen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourcePilot and Feasibility Studiesen_US
dc.source.journalissue1en_US
dc.source.journalvolume8en_US
dc.source.pagination61en_US
dc.source.urihttps://pilotfeasibilitystudies.biomedcentral.com/
dc.subjectHIVen_US
dc.subjectDifferentiated service delivery (DSD) modelen_US
dc.subjectAntiretroviral therapy (ART)en_US
dc.subjectPeople living with HIV (PLWH)en_US
dc.subjectMulti-month dispensing (MMD)en_US
dc.subjectViral load (VL)en_US
dc.subjecteHealthen_US
dc.subjectTelemedical supporten_US
dc.titleeHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesothoen_US
dc.typeJournal Articleen_US
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