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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