Abstract:

The World Health Organisation recommends telehealth as an alternative to help reach remote or underserved areas. Telehealth adoption is therefore key to ending the HIV pandemic. Successful implementation and scale-up of telehealth heavily rely on stakeholders’ involvement. This study explored key stakeholders’ perspectives on the implementation and scale-up of telehealth in HIV care in Harare. In-depth interviews were conducted with professionals within the Ministry of Health and Childcare and its partners, between May and August 2023. Fourteen purposively selected stakeholders were interviewed. Thematic approach to analysis with a coding framework guided by Consolidated Framework for Implementation Research was adopted. Key stakeholders perceived telehealth as a potentially effective intervention, which can improve health delivery. Key stakeholders cited the following challenges for implementation and scale-up of telehealth in HIV care: poor internet and mobile network; financial challenges; and unavailability of policies. Key stakeholders suggested the following strategies to the successful implementation and scale-up: multi-sectoral collaboration for reliable and affordable mobile and internet connectivity; policy formulation, donors’ engagement; and recruitment of competent staff. The study findings showed the confidence of key stakeholders in Harare to effectively sustain telehealth in HIV intervention. Despite its promising potential, significant hurdles to telehealth implementation exist and should be addressed to realise the full potential. Further research incorporating telehealth end-users is recommended, to fully understand challenges and hence inform policy.

References:

[1] Thomas, L. T., Lee, C. M. Y., McClelland, K., Nunis, G., Robinson, S., & Norman, R. (2023). Health workforce perceptions on telehealth augmentation opportunities. BMC Health Services Research, 23(1), 182. https://doi.org/10.1186/s12913-023-09174-4.

[2] Oleribe, O. E., Momoh, J., Uzochukwu, B. S., Mbofana, F., Adebiyi, A., Barbera, T., Williams, R., & Taylor Robinson, S. D. (2019). Identifying Key Challenges Facing Healthcare Systems in Africa and Potential Solutions. International Journal of General Medicine, Volume 12, 395–403. https://doi.org/10.2147/IJGM.S223882.

[3] Nchasi, G., Okonji, O. C., Jena, R., Ahmad, S., Soomro, U., Kolawole, B. O., Nawaz, F. A., Essar, M. Y., & Aborode, A. T. (2022). Challenges faced by African healthcare workers during the third wave of the pandemic. Health Science Reports, 5(6), e893. https://doi.org/10.1002/hsr2.893.

[4] World Health Organisation. (n.d.). Global strategy on digital health 2020-2025. World Health Organization. Retrieved 3 April 2023, from https://apps.who.int/iris/bitstream/handle/10665/344249/9789240020924-eng.pdf.

[5] Breton, M., Sullivan, E. E., Deville-Stoetzel, N., McKinstry, D., DePuccio, M., Sriharan, A., Deslauriers, V., Dong, A., & McAlearney, A. S. (2021). Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Family Practice, 22(1), 192. https://doi.org/10.1186/s12875-021-01543-4.

[6] Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if Telehealth Can Reduce Health System Costs: Scoping Review. Journal of Medical Internet Research, 22(10), e17298. https://doi.org/10.2196/17298.

[7] Eze, N. D., Mateus, C., & Cravo Oliveira Hashiguchi, T. (2020). Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLOS ONE, 15(8), e0237585. https://doi.org/10.1371/journal.pone.0237585.

[8] Salgado, S., Felzien, G., & Brumbeloe, J. (2021). Georgia Leverages Telehealth to Expand HIV Care Management in Underserved Areas. American Journal of Preventive Medicine, 61(5 Suppl 1), S55–S59. https://doi.org/10.1016/j.amepre.2021.07.001.

[9] Phan, J. M., Kim, S., Linh, Đ. T. T., Cosimi, L. A., & Pollack, T. M. (2022). Telehealth Interventions for HIV in Low- and Middle-Income Countries. Current HIV/AIDS Reports, 19(6), 600–609. https://doi.org/10.1007/s11904-022-00630-0.

[10] Pollack, T. M., Nhung, V. T. T., Vinh, D. T. N., Hao, D. T., Trang, L. T. T., Duc, P. A., Kinh, N. V., Dung, N. T. H., Dung, D. L., Ninh, N. T., Huyen, H. T. T., Huy, V. X., Hai, D. M., Khanh, T. H., Hien, N. T. T., Khuong, P. T. A., Trong, N. T., Lam, N. V., Phinh, V. N., … Cosimi, L. (2020). Building HIV healthcare worker capacity through telehealth in Vietnam. BMJ Global Health, 5(4), e002166. https://doi.org/10.1136/bmjgh-2019-002166.

[11] Speyer, R., Denman, D., Wilkes-Gillan, S., Chen, Y., Bogaardt, H., Kim, J., Heckathorn, D., & Cordier, R. (2018). Effects of telehealth by allied health professionals and nurses in rural and remote areas: A systematic review and meta-analysis. Journal of Rehabilitation Medicine, 50(3), 225–235. https://doi.org/10.2340/16501977-2297.

[12] Huang, Z., Tao, H., Meng, Q., & Jing, L. (2015). MANAGEMENT OF ENDOCRINE DISEASE: Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. European Journal of Endocrinology, 172(3), R93–R101. https://doi.org/10.1530/EJE-14-0441.

[13] Nair, U., Armfield, N. R., Chatfield, M. D., & Edirippulige, S. (2018). The effectiveness of telemedicine interventions to address maternal depression: A systematic review and meta-analysis. Journal of Telemedicine and Telecare, 24(10), 639–650. https://doi.org/10.1177/1357633X18794332.

[14] Udsen, F. W., Hejlesen, O., & Ehlers, L. H. (2014). A systematic review of the cost and cost-effectiveness of telehealth for patients suffering from chronic obstructive pulmonary disease. Journal of Telemedicine and Telecare, 20(4), 212–220. https://doi.org/10.1177/1357633X14533896.

[15] Hui CY., Walton R., McKinstry B., Jackson T., Parker R., & Pinnock H. (2017). The use of mobile applications to support self-management for people with asthma: a systematic review of controlled studies to identify features associated with clinical effectiveness and adherence. Journal of the American Medical Informatics Association, 24(3), 619–632. 10.1093/jamia/ocw143.

[16] 16. Liptrott, S., Bee, P., & Lovell, K. (2018). Acceptability of telephone support as perceived by patients with cancer: A systematic review. European Journal of Cancer Care, 27(1), e12643. https://doi.org/10.1111/ecc.12643

[17] 17. Liddy, C., Drosinis, P., & Keely, E. (2016). Electronic consultation systems: Worldwide prevalence and their impact on patient care—a systematic review. Family Practice, 33(3), 274–285. https://doi.org/10.1093/fampra/cmw024.

[18] Labisi, T., Regan, N., Davis, P., & Fadul, N. (2022). HIV Care Meets Telehealth: A Review of Successes, Disparities, and Unresolved Challenges. Current HIV/AIDS Reports. https://doi.org/10.1007/s11904-022-00623-z.

[19] Centre for Disease Control and Prevention. (2018). Telehealth for HIV Prevention and Care Services. Centre for Disease Control and Disease. https://www.cdc.gov/hiv/effective-interventions/treat/telehealth/index.html.

[20] Esmaeili, E. D., Azizi, H., Dastgiri, S., & Kalankesh, L. R. (2023). Does telehealth affect the adherence to ART among patients with HIV? A systematic review and meta-analysis. BMC Infectious Diseases, 23(1), 169. https://doi.org/10.1186/s12879-023-08119-w.

[21] Dandachi, D., Freytag, J., Giordano, T. P., & Dang, B. N. (2020). It is Time to Include Telehealth in Our Measure of Patient Retention in HIV Care. AIDS and Behavior, 24(9), 2463–2465. https://doi.org/10.1007/s10461-020-02880-8.

[22] Mgbako, O., Miller, E. H., Santoro, A. F., Remien, R. H., Shalev, N., Olender, S., Gordon, P., & Sobieszczyk, M. E. (2020). COVID-19, Telemedicine, and Patient Empowerment in HIV Care and Research. AIDS and Behavior, 24(7), 1990–1993. https://doi.org/10.1007/s10461-020-02926-x.

[23] International Center for AIDS Care and Treatment Program. (2020). Zimbabwe population-based HIV impact assessment. https://phia.icap.columbia.edu/zimbabwe2020-final-report/.

[24] Aniteye, P., & Mayhew, S.H. (2013). Shaping legal abortion provision in Ghana: Using policy theory to understand provider-related obstacles to policy implementation. Health Research and Policy Systems, 11(23). https://doi.org/10.1186/1478-4505-11-23.

[25] Bennett, S., Mahmood, S.S., Edward, A., Tetui, M. & Ekirapa-Kiracho, E. (2017). Strengthening scaling up through learning from implementation: Comparing experiences from Afghanistan, Bangladesh and Uganda. Health Research and Policy Systems, 15(108). https://doi.org/10.1186/s12961-017-0270-0.

[26] Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042.

[27] Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research: Exploring its conceptualization and operationalization. Quality & Quantity, 52(4), 1893–1907. https://doi.org/10.1007/s11135-017-0574-8.

[28] Iliffe, S., Wilcock, J., Drennan, V., Goodman, C., Griffin, M., Knapp, M., Lowery, D., Manthorpe, J., Rait, G., & Warner, J. (2015). Changing practice in dementia care in the community: Developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM). Programme Grants for Applied Research, 3(3), 1–596. https://doi.org/10.3310/pgfar03030.

[29] Chang, C.-P., Lee, T.-T., & Mills, M. E. (2013). Telecare for the elderly—Community nurses’ experiences in Taiwan. Computers, Informatics, Nursing: CIN, 31(1), 29–35. https://doi.org/10.1097/NXN.0b013e318266ca94.

[30] Adeloye, D., Adigun, T., Misra, S., & Omoregbe, N. (2017). Assessing the Coverage of E-Health Services in Sub-Saharan Africa: A Systematic Review and Analysis. Methods of Information in Medicine, 56(03), 189–199. https://doi.org/10.3414/ME16-05-0012.

[31] Aranda-Jan, C. B., Mohutsiwa-Dibe, N., & Loukanova, S. (2014). Systematic review on what works, what does not work and why of implementation of mobile health (mHealth) projects in Africa. BMC Public Health, 14, 188. https://doi.org/10.1186/1471-2458-14-188.

[32]  Kruse, C., Betancourt, J., Ortiz, S., Valdes Luna, S. M., Bamrah, I. K., & Segovia, N. (2019). Barriers to the Use of Mobile Health in Improving Health Outcomes in Developing Countries: Systematic Review. Journal of Medical Internet Research, 21(10), e13263. https://doi.org/10.2196/13263.

[33] Yelverton, V., Qiao, S., Weissman, S., Olatosi, B., & Li, X. (2021). Telehealth for HIV Care Services in South Carolina: Utilization, Barriers, and Promotion Strategies During the COVID-19 Pandemic. AIDS and Behavior, 25(12), 3909–3921. https://doi.org/10.1007/s10461-021-03349-y.

[34] Mulawa, M. I., Rosengren, A. L., Amico, K. R., Hightow-Weidman, L. B., & Muessig, K. E. (2021). mHealth to reduce HIV-related stigma among youth in the United States: A scoping review. MHealth, 7, 35. https://doi.org/10.21037/mhealth-20-68.

[35] Asah, F. N., Kaasbøll, J. J., & Anthun, K. S. (2022). Obstacles of eHealth Capacity Building and Innovation Promotion Initiative in African Countries. In B. Blobel, B. Yang, & M. Giacomini (Eds.), Studies in Health Technology and Informatics. IOS Press. https://doi.org/10.3233/SHTI220961.

[36] Queirós, A., Faria, D., & Almeida, F. (2017). Strengths and limitations of qualitative and quantitative research methods. European Journal of Education Studies. 3(9).a.