Achieving a high degree of digital health technology utilization for HIV case management and making data-informed decisions in the community settings of Ethiopia (Preprint)

BACKGROUND Digital health technologies have untapped potential to transform community health systems, and they are underutilized for chronic HIV care and electronic data management in low- and middle-income countries. OBJECTIVE To describe the design, development, and use of a mobile health application in the community HIV prevention, care and treatment programs that have been implemented in the community settings of Ethiopia since July 2018. METHODS Local software developers applied user-centered methods to build the Unified Data System (UDS) - an innovative digital health solution aimed at standardizing case management and routine data collection procedures. Developers involved end-users, i.e., frontline community health workers (CHWs) and program managers, in the design and development process. They reviewed project documents together with implementation leads. They also conducted field visits to understand user activities and to assess their needs. Developers and program staff conducted field testing, and they made design changes iteratively to incorporate user feedback. Data were collected and stored centrally in the CommCare HQ webservice backed by a local analytics server. UDS was linked to Power BI for advanced data analytics and visualization on a dashboard. Developers provided end-users with training and routine technical assistance for high levels of usage. RESULTS Local implementing partners (LIPs) deployed 950 CHWs to use the UDS for HIV service delivery and client-level data collection offline. Over 1,766 mobile accounts were opened for CHWs of which 1,628 (92.2%; 95%CI: 90.8%, 93.4%) submitted data. An additional 368 (93.9%; 95%CI: 91.0%, 96.0%) web accounts were used by managers to access the dashboard. More than 31 LIPs, three technical assistance partners and stakeholders utilized the UDS dashboard largely for planning, monitoring activities, reviewing performance, checking data quality, and making data-informed decisions. Over 102 performance review meetings were held virtually or in-person to facilitate learnings, and to share experiences amongst LIPs towards achieving their annual targets. Hence, the number of days to access client-level data by LIPs reduced from one month to just a day, and reporting on activity performance shortened from five days to half-a-day. Data completeness was nearly 100% and data validation tests demonstrated no invalid data elements or errors. CONCLUSIONS There was a high degree of digital health technology utilization by frontline CHWs and LIPs for standardized HIV care, high-quality data collection and making data-informed decisions. Lessons learned from UDS implementation could be adapted not only to support community HIV programming but also to strengthen national community health systems. CLINICALTRIAL n/a