BACKGROUND: The Wise Mama (WM) study was a randomized trial to assess the effectiveness of real-time electronic drug monitoring (EDM) on antiretroviral therapy (ART) adherence for prevention of mother-to-child transmission of HIV (PMTCT) for newly diagnosed, ART-naive HIV+ pregnant women in Uganda. Intervention mothers received real-time ART reminders via EDM technology and control mothers received standard of care. All infants born to women in the WM study were to receive standard PMTCT care: 6 weeks of nevirapine (NVP) ART prophylaxis following birth and HIV DNA testing at 6 weeks of life. OBJECTIVE: To test whether infants born to intervention mothers would have improved adherence to infant PMTCT guidelines. Methods: Information on delivery, infant NVP prophylaxis, and timing to first infant HIV test were abstracted from medical registers. Descriptive statistics and differences in 1) infant prophylaxis administration, and 2) time to infant HIV testing were generated and analyzed. RESULTS: Of the 121 WM women eligible for WIN, 97 consented and enrolled (80%). There were no differences in receipt of 6-week NVP supply (86.7% of control infants, 82.0% of intervention infants, p=0.53). Infants delivered at non-study health facilities were less likely to receive any NVP prophylaxis. There was no difference in mean days to infant's first HIV test (control 51.9, intervention 51.3, p=0.86). CONCLUSION: There were no significant differences in infant adherence to PMTCT guidelines between intervention and control groups, though all infants could have had improved access to NVP prophylaxis and decreased time to first HIV test. / 2019-02-28T00:00:00Z

Despite advances in recent years, human immunodeficiency virus (HIV) and tuberculosis (TB) are major contributors to global morbidity and mortality. Progress in mitigating the spread and impact of both infectious diseases is being made in many settings, but there is an ongoing gap in hard- to-reach and marginalized populations. Early diagnosis and treatment of infectious diseases is a core component of global efforts to mitigate infectious disease burden. The cost effectiveness of enhanced screening through systematic screening and self-testing (ST) is imperative prior to scaling up these programs given the reality of finite resources within any health care setting. We have undertaken a systematic review to summarize the current economic literature around systematic screening for active TB and ST for HIV. The inputs from the HIVST systematic review were used to create a combined decision tree and Markov model to evaluate the cost utility of HIVST along with digital and community-based programs to support downstream linkage to care.

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Background: International agencies such as the World Health Organisation have highlighted the potential of digital information and communications technologies to strengthen health systems, which are underpinned by the 'building blocks' of information, human resources, finances, commodities, leadership and governance, and service delivery. In high income countries, evidence of the positive impacts of 'eHealth' innovations on the cost-effectiveness of healthcare is growing and many governments are now providing incentives for their adoption. In contrast, the use of eHealth in developing countries has remained low and efforts to introduce these new approaches have experienced high failure rates. There is even scepticism regarding the feasibility of eHealth in low-resource settings, which may be hindered by high costs, indeterminate returns on investment, technical problems and socio-organisational barriers. More research is needed to document both the value of eHealth for strengthening resource-limited health systems and the challenges involved in their implementation and adoption, so that insights from such research may be used to inform future initiatives. While many studies of eHealth for patient care in low- and middle-income countries (LMIC) are taking place, evidence of its role in improving administrative processes such as financial management is lacking, despite the importance of 'good governance' (transparency and accountability) for ensuring strong and resilient health systems. The overall objective of this PhD was to elucidate the enablers, inhibitors and outcomes characterising the implementation and adoption of a modular eHealth system in a group of healthcare facilities in rural Malawi. The system included both clinical and billing modules. The specific objectives were (i) to understand the socio-technical, organisational and change management factors facilitating or hindering the implementation and adoption of the eHealth system, (ii) to assess the quality of data captured by the eHealth system compared with conventional paper-based records, and (iii) to understand how information within the eHealth system was used for service delivery, reporting and financial management. A further aim was to contribute to the corpus of mixed-methods case studies exploring eHealth system implementation processes and outcomes (including data quality) in LMIC. As described in the following chapters, the research also gave rise to unanticipated and serendipitous findings, which led to new lines of enquiry and influenced the theoretical perspectives from which the analysis drew.

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu