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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Addis Abeba University


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.



Digital Health, eHealth, technology, Tuberculosis (TB), Human Immunodeficiency Virus (HIV), Healthcare Providers.