Digital health interventions for clinical care and treatment of tuberculosis and HIV: Capacity and readiness assessment of healthcare facilities in Addis Ababa, Ethiopia
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Date
2021-06
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Addis Abeba University
Abstract
Background: Digital Health Interventions (DHIs) such as electronic health (eHealth) and mobile
health (mHealth) are emerging as promising technologies to advance clinical care and treatment.
However, many of these breakthroughs have not reached the people most in need to tackle the
rising burden of diseases such as Tuberculosis (TB) and Human Immunodeficiency Virus (HIV).
People living in low-income countries are at high risk of many health conditions than those living
in other regions while having the least access to such technologies. There is a high level of concern
that low-income countries lack the infrastructure and human resource capacity needed to
effectively adopt, implement, and scale up DHIs. Being one of the top 30 high TB and HIV burden
countries globally, Ethiopia exerts efforts to meet the global targets to End TB by 2035 and End
HIV/AIDS by 2030. DHIs could transform TB and HIV clinical care and treatment services in
Ethiopia. However, the country needs an in-depth assessment of the healthcare system’s capacity
and readiness to absorb and implement DHIs.
Objective: This study aimed to assess the capacity and readiness of healthcare facilities to adopt
and implement DHIs for TB and HIV care and treatment.
Method: This study was a multi-center, facility-based, mixed-method, cross-sectional study. The
study included 14 government healthcare facilities: 10 health centers and four hospitals with high
TB/HIV clients load in Addis Ababa, Ethiopia. The participants were healthcare providers who
provide TB and HIV clinical care and treatment services in the study facilities. With a purposive
sampling method, two healthcare providers have participated from each included site. Using a
questionnaire framed by the Technology Readiness and Acceptance Model, data were collected
from the participants that assessed their experience using digital health technologies and the
potential readiness of their healthcare facilities to implement DHIs. Using a tool framed by the
unified theory of acceptance and use of technology (UTAUT) model, data were collected from
participants who hold a solid prior experience of using DHIs to understand further the level of
acceptability of such digital health technologies. A multiple linear regression model to determine
the relationship between dependent and independent variables. Cronbach’s alpha test was
performed to evaluate the internal consistency and reliability. Using an adapted checklist, the
healthcare facilities were assessed to investigate their infrastructure and human resource capacity
to adopt and implement DHIs.
Result: There were 76 healthcare providers actively engaged in HIV/TB clinical care services in
the selected 14 study sites, of whom 60 met the inclusion criteria and participated in this study.
sixty-two percent of the participants were working in HIV clinics, 37% of them had more than 10
years of working experience, 65% of them held a minimum of BSc degree, 60% were female, and
42% were aged between 31-40 years.
According to the responses, 80% of the healthcare providers had the experience of using DHIs to
facilitate their healthcare delivery. Most of them had internet access and computers in their
facilities. Seventy-five percent of the participants found the technologies advantageous than the
traditional system and the majority preferred to use the DHIs in their healthcare facility. The major
factors that influence healthcare providers’ willingness to use different technologies were
educational level (β= .097, t= 3.784, p= .006), age (β= -.227, t= -1.757, p= .027), work experience
(β= -.366, t= -2.855, p= .016).
Respondents who had experience using digital adherence technology for TB felt that remote
monitoring of medication adherence benefits both patients and providers. Similarly, respondents
who had experience using smart care technology for HIV felt that the technology helps to retrieve
patients’ data easily and simplify their work. The strongest facilitator of their acceptance and the
use of the digital adherence technology were perceptions of positive performance expectancy (i.e.,
perceived usefulness).
According to Cronbach’s alpha test, all factors were greater than 0.7, and such values suggest a
high level of internal consistency and reliability of related items. The majority of respondents
reported the absence of regulatory policy and guidelines as the major gap to adopt and use DHTs
in their facilities. The correlation between technological readiness and organizational cultural
readiness was considered to being significant (r = 0.8).
Thirty-one percent of the healthcare facilities had prior needs assessments made to make their sites
ready for new DHIs. The data showed that 57.1% of facilities had skilled staff on payroll for
maintaining computers and other dysfunctions related to technologies. The average number of
computers in each facility was about 20. most of the healthcare providers used Wi-Fi while 42.9%
of them used both Wi-Fi and broadband internet. Of the 14 facilities, 35.7% had the plan to
establish a functional Local Area Network for interconnectivity to give better services.
Conclusion: The present data confirm that many public healthcare facilities in Addis Ababa have
already begun implementing various DHIs/e-Health systems for TB/HIV services and the level of
acceptability of these technologies by healthcare providers was noticeably good. Thus, there is an
excellent opportunity for DHIs to be integrated into the healthcare system in tertiary health
facilities in Ethiopia with appropriate training and education. However, most of the available
digital health technologies in the facilities were utilized without reliable DHIs/eHealth regulatory
policy in place. Thus, there is a critical need for DHIs/e-Health regulatory policies and some
improvement is needed in DHIs/e-Health strategic planning (core readiness). There should be a
prior need assessment and proper training given to healthcare providers to properly adopt and
implement new DHIs in healthcare facilities.
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Keywords
Digital Health, eHealth, technology, Tuberculosis (TB), Human Immunodeficiency Virus (HIV), Healthcare Providers.