Work has been a bit hectic lately (part of the reason for my terrible blogging), but it is hectic in a really good way. One of the big projects I have been working on is really getting off the ground and another one is finally wrapping up. I wrote a while back about our research on HIV care before patients begin antiretroviral therapy and how big an issue (54% of patients are lost!) patient retention is. Along with Isaac and Evan, I've been working on developing an intervention to pilot to try to improve retention and quality of care. We've been visiting health centers, meeting with people in all areas of HIV care, digging for research, and communicating with other CHAI offices to figure out what makes the most sense.
After multiple iterations, the intervention we are going to pilot (in 7 sites - site visits next week!) is one that combines improving data management with introducing reminders and follow-ups. We, along with a team from one of the PEPFAR implementing partners, are going to be working with sites to re-organize patient files and improve systems to make sure that files are not lost and that they are complete -- this is a big issue in treating HIV as a chronic disease because doctors need to know a patient's medical history in order to know how to treat them, and we frequently see patient records piled haphazardly in facilities. The hope is that doing this will cut down the time staff spend digging for records, ensure that test results reach patients, and reduce the huge information loss that happens when patient files go missing. The second piece is introducing text message reminders to remind patients when to come back to the clinic and implementing a system of phone call follow-ups for when patients miss their appointments. Mobile phones are amazingly widespread (74% of patients had them in a recent CHAI study), and from the existing published research and work CHAI has done elsewhere, it seems like this is a way we can really improve attendance and retention. In a recent CHAI pilot, patients were more than 50% more likely to come back when followed up by phone than otherwise.
There's a bit more to it than that, but those are the basics, and I'm really excited about it! The pilot should give us some very interesting information, and the Ministry of Health is interesting in rolling this system out more broadly in the country if the pilot goes well. It's a very cool feeling to be working on something that I was a big part of developing and really believe can be effective. Funding issues, getting sites to actually implement changes, and politics will all be uphill battles, but I think/hope that this can help bring patients back to get the care they so desperately need.
(and let me know if you know of any relevant studies/research - have found a lot of great evidence on the usefulness of each of these elements, but always looking for more).
After multiple iterations, the intervention we are going to pilot (in 7 sites - site visits next week!) is one that combines improving data management with introducing reminders and follow-ups. We, along with a team from one of the PEPFAR implementing partners, are going to be working with sites to re-organize patient files and improve systems to make sure that files are not lost and that they are complete -- this is a big issue in treating HIV as a chronic disease because doctors need to know a patient's medical history in order to know how to treat them, and we frequently see patient records piled haphazardly in facilities. The hope is that doing this will cut down the time staff spend digging for records, ensure that test results reach patients, and reduce the huge information loss that happens when patient files go missing. The second piece is introducing text message reminders to remind patients when to come back to the clinic and implementing a system of phone call follow-ups for when patients miss their appointments. Mobile phones are amazingly widespread (74% of patients had them in a recent CHAI study), and from the existing published research and work CHAI has done elsewhere, it seems like this is a way we can really improve attendance and retention. In a recent CHAI pilot, patients were more than 50% more likely to come back when followed up by phone than otherwise.
There's a bit more to it than that, but those are the basics, and I'm really excited about it! The pilot should give us some very interesting information, and the Ministry of Health is interesting in rolling this system out more broadly in the country if the pilot goes well. It's a very cool feeling to be working on something that I was a big part of developing and really believe can be effective. Funding issues, getting sites to actually implement changes, and politics will all be uphill battles, but I think/hope that this can help bring patients back to get the care they so desperately need.
(and let me know if you know of any relevant studies/research - have found a lot of great evidence on the usefulness of each of these elements, but always looking for more).
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