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Table 1 Implementation research to increase resources

From: Implementation science in resource-poor countries and communities

Health systems function

Delivery innovation

Delivery control

Outcomes

Study design

Population

Country

Reference

Creating higher-skilled human resources for health through tele-education

 Training on neonatal resuscitation

Tele-education

Conventional classroom teaching

• Knowledge scores

• Skills scores

RCT

Staff nurses

India

Jain et al. Journal of Perinatology 2010 [112]

 Training on retinopathy of prematurity diagnosis

Tele-education

Standard onsite training

• Sensitivity of retinopathy of prematurity diagnosis

• Specificity of retinopathy of prematurity diagnosis

RCT

Ophthalmology residents

Mexico

Patel et al. Ophthalmology 2017 [113]

 Education on nursing, public health, child and adolescent health, mental health

Tele-education

No control

• Tele-education participation

• User satisfaction

Process evaluation

Primary care staff

Brazil

Joshi et al. Journal of Telemedicine and Telecare 2011 [114]

Creating higher-skilled human resources for health through telemedicine

 Endocrine surgery

Telemedicine (tele-education and surgical treatment planning, teleconsultation, telepathology, teleradiology, and telesurgical conferences)

Standard of care at the time of the study

• Endocrine surgery rate

UBA

General surgeons

India

Pradeep et al. World Journal of Surgery 2007 [115]

 Dermatological diagnosis

Internet-based teledermatology system

Face-to-face examination

• Agreement between the two diagnostic approaches

Validation study

Junior doctors

Brazil

Chao et al. Telemedicine Journal and Ehealth 2003 [116]

 Intensive care

Tele-intensive care unit

Standard of care at the time of the study

• Number of ICU patients per month

UBA

Nurses

Syria

Moughrabieh et al. Annals of the American Thoracic Society 2016 [117]

Freeing up human resources through task-shifting to lower-skilled health workers

 HIV treatment initiation and management

Nurses

Standard of care at the time of the study (doctors)

• Mortality

• Viral suppression

RCT

Adult HIV patients in primary care

South Africa

Fairall et al. Lancet 2012 [118]

 Depression and anxiety screening, diagnosis and treatment

Lay village health workers together with primary care doctors, supported by an electronic decision support system

Standard of care at the time of the study (trained mental health professionals)

• Coverage with mental health treatment

• Depression score

• Anxiety score

UBA

Members of rural scheduled tribe communities

India

Maulik et al. Journal of Global Health 2017 [119]

 Hypertension treatment

Community health nurses delivering the WHO Package of Essential NCD Interventions (WHO PEN)

Standard of care at the time of the study

• Blood pressure

RCT

Patients visiting community health centers

Ghana

Ogedegbe et al. Implementation Science 2014 [120]

 HIV and HIV risk screening and linkage to care for children

Community health workers

Standard of care at the time of the study

• Identification of HIV-infected and HIV-exposed children

• Linkage to care

UBA

Children born to mothers living with HIV

Malawi

Ahmed et al. Journal of the International AIDS Society 2015 [121]

HIV treatment

Lay health workers

Standard of care at the time of the study (doctors and nurses)

• Viral suppression

RCT

Adult HIV patients in primary care

Tanzania

Geldsetzer et al. BMC Health Services Research 2017 [122]

 Antenatal and postnatal counseling

Lay nurse aides using job aids

Professional nurses using job aids

• Coverage with correct antenatal and postnatal messages

• Pregnant women with correct antenatal knowledge

NRC

Women in antenatal care

Benin

Jennings et al. Implementation Science 2011 [123]

 HIV treatment initiation

Community health workers providing home-based HIV treatment initiation

Standard of care at time of the study (only facility-based initiation of HIV treatment)

• HIV treatment initiation

RCT

General population

Malawi

Macpherson et al. JAMA 2014 [124]

Freeing up human resources through task-shifting to clients

 HIV testing

HIV self-testing

Standard of care at the time of the study (facility HIV testing)

• HIV testing rates

RCT

Female sex workers

Uganda, Zambia

Ortblad et al. PLOS Medicine 2017 [125], Chanda et al. PLOS Medicine 2017 [126]

 HIV testing

Unsupervised HIV self-testing

Provider-supervised HIV self-testing

• Sensitivity

RCT

Fisherfolk

Uganda

Asiimwe et al. AIDS & Behavior 2014 [127]

 Cervical cancer screening

Vaginal self-collection of specimens

Cervical specimens collection by clinician

• Sensitivity

• Specificity

Validation study

Adult women

India, Nicaragua, Uganda

Jeronimo et al. International Journal of Gynecological Cancer 2014 [128]

Freeing up human resources through new models of care

 HIV treatment

Community-based adherence clubs

Standard of care at the time of the study

• Loss to follow-up

• Viral suppression

NRC

Adult HIV patients in primary care

South Africa

Grimsrud et al. JAIDS 2016 [62]

 Buruli ulcer detection and treatment

Buruli ulcus community of practice composed of hospital staff, former patients, CHWs, and traditional healers

Standard of care at the time of the study

• Buruli ulcus detection rate

• Buruli ulcus treatment adherence

UBA

General population

Cameroon

Awah et al. PLOS Neglected Tropical Diseases 2018 [129]

 Family healthcare services

Community-based family health program

Standard of care at the time of the study

• Mortality rates

• Causes of death

• Adult employment

• School enrollment

UBA

Children (aged 10–17) and adults

Brazil

Rocha et al. Health Economics 2010 [130]

Freeing up human resources through technological innovations

 Encouragement to remain in postpartum care

Text messages

Standard of care at the time of the study

• Maternal postpartum visit attendance

• Early infant HIV testing

RCT

Pregnant women enrolled in public sector PMTCT program

Kenya

Odeny et al. AIDS 2014 [131]

 Hypertension treatment

Automated self-management calls plus home blood pressure monitoring

Standard of care at the time of the study

• Systolic blood pressure

RCT

Adult patients with hypertension in primary care

Honduras and Mexico

Piette et al. Telemedicine Journal and Ehealth 2012 [132]

 Encouragement to adhere to hypertension treatment

Text messages

Standard of care at the time of the study

• Systolic blood pressure

RCT

Adult patients with hypertension in primary care

South Africa

Bobrow et al. Circulation 2016 [133]

 Encouragement to adhere to HIV treatment

Text messages

Standard of care at the time of the study

• Adherence

• Viral suppression

RCT

Adult patients with hypertension in primary care

Kenya

Lester et al. Lancet 2010 [134]

 Neurocognitive impairment screening

NeuroScreen mobile app administered by a lay health worker

Neuropsychological test battery administered by research psychometrist

• Sensitivity

• Specificity

Validation study

Adult HIV patients in primary care

South Africa

Robbins et al. Journal of Medical Internet Research Mhealth Uhealth 2018 [77]

Increasing laboratory capacity through technological innovations

 Viral load monitoring

Point-of-care viral load test using capillary blood

Laboratory viral load test using venous blood

• Sensitivity

• Specificity

Validation study

Adult HIV patients in primary care

Mozambique

Jani et al. Journal of Clinical Microbiology 2016 [135]

 CD4 testing

Point-of-care CD4 test using capillary blood

Laboratory CD4 test using venous blood

• Sensitivity

• Specificity

Validation study

Adult HIV patients in primary care

Zimbabwe

Mtapuri-Zinyowera et al. Journal of Acquired Immune Deficiency Syndromes 2010 [136]

 CD4 testing

Point-of-care CD4 test using capillary blood

Laboratory CD4 test using venous blood

• Loss to follow-up

UBA

Adult HIV patients in primary care

Mozambique

Jani et al. Lancet 2011 [137]

 Tuberculosis diagnosis

Point-of-care TB test performed by nurses in primary care clinics

Laboratory TB test

• Sensitivity

• Specificity

• Same-day diagnosis

• Same-day treatment initiation

• Loss to follow-up

cRCT

Adult primary care patients

South Africa, Tanzania, Zambia, Zimbabwe

Theron et al. Lancet 2014 [138]

 Breast cancer screening

Point-of-care breast imaging device

Standard of care (clinical breast examination)

• Sensitivity

• Specificity

• Positive predictive value

• Negative predictive value

Validation study

Healthy women visiting a hospital

India

Somashekar et al. Indian Journal of Gynecologic Oncology 2016 [139]

Increasing the availability of medicines through supply chain innovations

 Nevirapine (NVP) prophylaxis for HIV-exposed infants

Pratt Pouch delivery system

No control

• Administration of NVP to infants

• Infant dried blood spot NVP concentration

Process evaluation

HIV-exposed infants and their mothers

Tanzania

Dahinten et al. Pediatric Infectious Diseases 2016 [140]

 Access to artemisinin-based combination therapy (ACT) antimalarials

Private-sector Accredited Drug Dispensing Outlet (ADDO)

Public sector distribution

• Uptake of ACT

• Availability of ACT

UBA

Adults and children

Tanzania

Rutta et al. Health Research Policy and Systems 2011 [141]

 Access to oral rehydration salts (ORS) and zinc for children

Private-sector distribution channels (Coca Cola)

Public sector distribution

• Availability of ORS and zinc at rural retail outlets

• Distance traveled by caregivers to obtain ORS and zinc

• Use of ORS and zinc in infants

CBA

Community retailers, children and their caregivers

Zambia

Berry et al. Endline report: Colalife Operational Trial Zambia 2014 [142]

 Vaccine supply chain

Public-private partnership for vaccine supply

Government-managed supply

• Vaccine stock

• Immunization coverage

UBA

Regional zone stores, primary healthcare facilities

Nigeria

Molemodile et al. Global Public Health 2017 [143]

 Supply of health workers, essential medicines and equipment to remote villages

Systematic motorcycle fleet management for health care supplies (supply of high-quality motorcycles, driver training, preventive maintenance, fuel, on demand repair)

Standard of care motorcycle fleet management for health care supplies

• Trips to rural villages per health worker per week

• Patient visits per health worker per week

• Measles immunization per health worker per week

• Child growth assessment per health worker per week

CBA

Village health workers

Zambia

Mehta et al. American Journal of Public Health 2015 [144]

  1. RCT randomized controlled trial, UBA uncontrolled before-after study, CBA controlled before-after study, NRC non-randomized controlled study, WSuV within-subject validation study, PMTCT prevention of mother-to-child transmission of HIV program