Healthcare Technology Insights for June 1st-June15th, 2021
Here are the most-read articles from our Digital Health Blogs and Curated Newsletters over the past 2 weeks. Insights by
Case-Initiated COVID-19 Contact Tracing Using Anonymous Notifications
We discuss the concept of a participatory digital contact notification approach to assist tracing of contacts who are exposed to confirmed cases of coronavirus disease (COVID-19);
The core functionality of our concept is to provide a usable, labor-saving tool for contact tracing by confirmed cases themselves
the approach is simple and affordable for countries with limited access to health care resources and advanced technology.
The proposed tool serves as a supplemental contract tracing approach to counteract the shortage of health care staff while providing privacy protection for both cases and contacts.
- This tool can be deployed on the internet or as a plugin for a smartphone app.
- Confirmed cases with COVID-19 can use this tool to provide contact information (either email addresses or mobile phone numbers) of close contacts.
- The system will then automatically send a message to the contacts informing them of their contact status, what this status means, the actions that should follow (eg, self-quarantine, respiratory hygiene/cough etiquette), and advice for receiving early care if they develop symptoms.
- The name of the sender of the notification message by email or mobile phone can be anonymous or not.
- The message received by the contact contains no disease information but contains a security code for the contact to log on the platform to retrieve the information.
The successful application of this tool relies heavily on public social responsibility and credibility, and it remains to be seen if the public would adopt such a tool and what mechanisms are required to prevent misuse.
This is a simple tool that does not require complicated computer techniques despite strict user privacy protection design with respect to countries and regions. Additionally, this tool can help avoid coercive surveillance, facilitate the allocation of health resources, and prioritize clinical service for patients with COVID-19. Information obtained from the platform can also increase our understanding of the epidemiology of COVID-19.
read this concept paper at https://mhealth.jmir.org/2020/6/e20369
our insight:
The success of this approach relies heavily on public social responsibility and credibility. Using awareness campaigns, especially using community influencers will be needed. It remains to be seen if the public would adopt such a tool and what mechanisms are required to prevent misuse.
Acceptability of App-Based Contact Tracing for COVID-19
The COVID-19 pandemic is the greatest public health crisis of the last 100 years. Countries have responded with various levels of lockdown to save lives and stop health systems from being overwhelmed. At the same time, lockdowns entail large socioeconomic costs.
One exit strategy under consideration is a mobile phone app that traces the close contacts of those infected with COVID-19.
Recent research has demonstrated the theoretical effectiveness of this solution in different disease settings. However, concerns have been raised about such apps because of the potential privacy implications. This could limit the acceptability of app-based contact tracing in the general population. As the effectiveness of this approach increases strongly with app uptake, it is crucial to understand public support for this intervention.
Objective: The objective of this study is to investigate the user acceptability of a contact-tracing app in five countries hit by the pandemic.
Methods: We conducted a largescale, multicountry study (N=5995) to measure public support for the digital contact tracing of COVID-19 infections.
We ran anonymous online surveys in France, Germany, Italy, the United Kingdom, and the United States and measured intentions to use a contact-tracing app across different installation regimes (voluntary installation vs automatic installation by mobile phone providers) and studied how these intentions vary across individuals and countries.
Results: We found strong support for the app under both regimes, in all countries, across all subgroups of the population, and irrespective of regional-level COVID-19 mortality rates.
We investigated the main factors that may hinder or facilitate uptake and found that concerns about cybersecurity and privacy, together with a lack of trust in the government, are the main barriers to adoption.
Conclusions:
Epidemiological evidence shows that app-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app and that it can still reduce the number of infections if uptake is moderate. Our findings show that the willingness to install the app is very high. The available evidence suggests that app-based contact tracing may be a viable approach to control the diffusion of COVID-19.
read the study at https://mhealth.jmir.org/2020/8/e19857
Nrip's insight:
A lot of research and anecdotal evidence shows that mHealth/Mobile App-based contact tracing can suppress the spread of COVID-19 if a high enough proportion of the population uses the app.
that it can still reduce the number of infections if uptake is moderate is interesting to note.
Mathematical model predicts the effect of bacterial mutations on antibiotic success
Antibiotic resistance is a significant public health challenge, caused by changes in bacterial cells that allow them to survive drugs that are designed to kill them. Resistance often occurs through new mutations in bacteria that arise during the treatment of an infection. Understanding how this resistance emerges and spreads through bacterial populations is important to preventing treatment failure.
Scientists have developed a mathematical model that predicts how the number and effects of bacterial mutations leading to drug resistance will influence the success of antibiotic treatments.
Their model, described in the journal eLife, provides new insights on the emergence of drug resistance in clinical settings and hints at how to design novel treatment strategies that help avoid this resistance occurring.
“Mathematical models are a crucial tool for exploring the outcome of drug treatment and assessing the risk of the evolution of antibiotic resistance,” explains first author Claudia Igler, Postdoctoral Researcher at ETH Zurich, Switzerland. “These models usually consider a single mutation, which leads to full drug resistance, but multiple mutations that increase antibiotic resistance in bacteria can occur. So there are some mutations that lead to a high level of resistance individually, and some that provide a small level of resistance individually but can accumulate to provide high-level resistance.”
“Our work provides a crucial step in understanding the emergence of antibiotic resistance in clinically relevant treatment settings,” says senior author Roland Regoes, Group Leader at ETH Zurich. “Together, our findings highlight the importance of measuring the level of antibiotic resistance granted by single mutations to help inform effective antimicrobial treatment strategies.”
read the study paper at https://elifesciences.org/articles/64116
read the original unedited article at https://phys.org/news/2021-05-mathematical-effect-bacterial-mutations-antibiotic.html
nrip’s insight:
Mathematical models are a crucial tool for exploring outcomes.
That they can be outcomes of drug treatment , and the further and deeper study into assessing the risk of the evolution of antibiotic resistance is fascinating. This is an excellent paper.
Acceptability of a Mobile Phone Support Tool for Promoting Adherence to Antiretroviral Therapy Among Young Adults
Adherence to treatment is critical for successful treatment outcomes.
Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment.
The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support.
Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial.
Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites is used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach.
Results: The CFLU mHealth tool was perceived as an acceptable intervention;
young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips.
Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues.
HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth-friendly.
Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important.
Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings.
Nrip’s insight:
Adherence techniques are critical for the success of personal health treatment plans as well as public health programs.
Over the past few weeks, I have been brainstorming the efficacy of various medication adherence techniques with a few different healthcare consultants; and concluded that with available techniques we keep looping back to self adherence assessment using mobile tools as the apt choice in today's times.
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