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Community Health WorkersNCT04106921

Universal Coverage Mode RCT

A study testing Universal Health Coverage Mode in people with Community Health Workers, run by Ari Johnson, MD at 1 site in Mali.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Community Health Workers that work in collaboration with the NGO Muso Health and the Malian government in both a peri-urban and a rural site in Mali, provide care proactively to the population they form part of. Read more about this study

Who is it for?
Any ageHealthy volunteers can take part
Conditions the study is for
Community Health Workers
What is being tested?
Universal Health Coverage Mode
Could I receive a placebo?
No, everyone receives an active treatment
How many people
199 participants
Where
1 siteMali
Study dates
1 Feb 2019to 26 Jul 2019
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Any age
  • All sexes
  • Healthy volunteers accepted
  • Child, Adult, Older adult

Who may be able to join

  • Community Health Workers serving the Tori (n=27) and Yirimadio (n=172) catchment areas conducting proactive home visits will be eligible to participate in the study

Who cannot join

  • CHWs involved in pilot-testing UHC Mode prior to the trial will be excluded from the trial.

Trial locations and contacts

1 site in 1 country.

Mali1 site
  • Muso

    Bamako

Other trials in Mali

About this study

Official title: Evaluation of a Mobile Application Tool for Increasing Community Health Worker Home Visit Coverage: A Randomized Controlled Study

Community Health Workers that work in collaboration with the NGO Muso Health and the Malian government in both a peri-urban and a rural site in Mali, provide care proactively to the population they form part of.

To work, they use a smartphone application that was developed as a job aid to support task management, panel management and clinical decision support functions. For this study, a tool called "Universal Health Coverage Mode" was designed to be integrated into the CHW application to help Community Health Workers visit every household at least twice per month.

We hypothesize that Community Health Workers (CHWs) assigned to use Universal Health Coverage (UHC) Mode, a mobile application tool, will achieve higher coverage of homes visited (defined as being visited at least two times in a month) than those without this tool.

Read the detailed description

Community Health Workers participating in the study will be providing care through the Proactive Community Case Management intervention, described in detail elsewhere. Through this package of services, CHWs are required to conduct at least two hours of home visits per day, six days per week, to achieve a goal of at least two home visits per household per month. All CHWs receive monthly individual supervision via a 360 Supervision protocol, described in detail elsewhere, as well as group supervisions weekly (at the Yirimadio site) or twice-monthly (at the Tori site). At the Tori site, households served by each CHW were previously registered via a population census which is updated every year by an independent team of surveyors. Within the Yirimadio site, all households have been registered by the CHW herself to achieve a ratio of approximately 1000 patients per CHW.

CHWs at both sites and both arms of the study will also receive monthly performance feedback via a CHW Performance Dashboard, described elsewhere, which provides personalized feedback on the quantity, speed, and coverage of care. CHW supervisors will be able to see their supervisees' performance data and provide feedback via the monthly supervisions. CHWs at both sites will receive feedback for community care management indicators, but only Yirimadio's CHW supervisors will observe CHWs performance on proactive household visits.

All CHWs at both sites use a CHW App, a free and open source smartphone application developed by Medic Mobile with Muso. The CHW App is a job aid that supports task management, panel management, and clinical decision support functions, while providing a mechanism for data collection and submission. Previously, CHWs had to manage 14 different types of paper forms that their core workflow entails, and the data was entered by hand for each of these forms to carry out monitoring and evaluation tasks. Now, there is no need for photocopying, carrying and stocking all 14 forms, and data is automatically sent to a central database once the smartphones are synchronized. Also, for CHW tracking their patients and the tasks they performed meant a huge organizational challenge. The app was modeled to tackle this problem using a human centered design, allowing the CHWs to easily search for and access their patients registries and histories.

For the control arm, all households within the CHW's household list in the app will have the same appearance. There will be no visual differentiation between households on the list to indicate the frequency of home visits.

In the intervention arm, the CHW's household list will appear differently within the app in the following ways:

The CHW will be able to filter and order households by the date of the most recent home visit, to identify households that have been visited least frequently.

A color-coded visual icon will display the number of home visits in the past month for each household.Red color for 0 home visits for a household in the past month (default at the start of every month).Orange color for 1 home visit for a household in the past month.Blue color for 2 or more visits for a household in the past month.

A red exclamation mark will be displayed for every household that has not reached 2 visits in the past month (default at the start of every month).

Text displayed below each household showing the date of last visit will turn red if more than 30 days have passed since last visit. When more than 60 days have passed since the most recent visit, the text displayed below each household showing the date of last visit will be changed to "date of last visit is unknown" in red.

The family profile will also contain the date of last visit, and the visits they have received in that month.

Being tested
Universal Health Coverage Mode
Keywords
community health workers, primary health care, mobile applications

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Universal Health Coverage ModeOther

    In the intervention arm, the CHW's household list will appear differently within the app in the following ways:

    The CHW will be able to filter and order households by the date of the most recent home visit.

    A color-coded visual icon will display the number of home visits in the past month for each household.

    A red exclamation mark will be displayed for every household that has not reached 2 visits in the past month (default at the start of every month).

    Text displayed below each household showing the date of last visit will turn red if more than 30 days have passed since last visit. When more than 60 days have passed since the most recent visit, the text displayed below each household showing the date of last visit will be changed to "date of last visit is unknown" in red.

    The family profile will also contain the date of last visit, and the visits they have received in that month

Study groups in NCT04106921
Study groupRoleWhat they receive
Universal Health Coverage ModeExperimentalThe NGOs Muso and Medic Mobile have partnered to develop Universal Health Coverage Mode, a smartphone app tool that provides visual cues to help CHWs track the quantity of household visits they have conducted at each household in a given month.
Receives: Other: Universal Health Coverage Mode
Work as usualNo interventionFor the control arm, all households within the CHW's household list in the app will have the same appearance. There will be no visual differentiation between households on the list to indicate the frequency of home visits.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Primary outcome

    The probability of a household receiving two or more visits per "workflow" month (a month being from the 26th of one month to the 25th of the next month).

    Measured: 4 months

Secondary outcomes (3)
  1. Secondary outcome 1

    Number of days between household visits for each household served by CHWs

    Measured: 4 months

  2. Secondary outcome 2

    Number of visits per household per "workflow"month

    Measured: 4 months

  3. Secondary outcome 3

    Percentage of sick individuals in a household visited within 24 hours (among households with a sick person).

    Measured: 4 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Sep 2019
  2. Study start1 Feb 2019
  3. Primary completion26 Jul 2019
  4. Study completion26 Jul 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Model description
Difference in differences parallel randomized controlled trial.
Masking
None (open label)
Enrolment
199 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04106921
Sponsor's protocol ID
0219-0619
Status last verified
Sep 2019
First submitted
25 Sep 2019
Last updated
27 Sep 2019
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • GBD 2015 SDG Collaborators. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1813-1850. doi: 10.1016/S0140-6736(16)31467-2. Epub 2016 Sep 21.

    PubMed 27665228
  • Rasanathan K, Muniz M, Bakshi S, Kumar M, Solano A, Kariuki W, George A, Sylla M, Nefdt R, Young M, Diaz T. Community case management of childhood illness in sub-Saharan Africa - findings from a cross-sectional survey on policy and implementation. J Glob Health. 2014 Dec;4(2):020401. doi: 10.7189/jogh.04.020401.

    PubMed 25520791
  • Young M, Wolfheim C, Marsh DR, Hammamy D. World Health Organization/United Nations Children's Fund joint statement on integrated community case management: an equity-focused strategy to improve access to essential treatment services for children. Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):6-10. doi: 10.4269/ajtmh.2012.12-0221.

    PubMed 23136272
  • Black RE, Taylor CE, Arole S, Bang A, Bhutta ZA, Chowdhury AMR, Kirkwood BR, Kureshy N, Lanata CF, Phillips JF, Taylor M, Victora CG, Zhu Z, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel. J Glob Health. 2017 Jun;7(1):010908. doi: 10.7189/jogh.07.010908.

    PubMed 28685046
  • Freeman PA, Schleiff M, Sacks E, Rassekh BM, Gupta S, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 4. child health findings. J Glob Health. 2017 Jun;7(1):010904. doi: 10.7189/jogh.07.010904.

    PubMed 28685042
  • Jennings MC, Pradhan S, Schleiff M, Sacks E, Freeman PA, Gupta S, Rassekh BM, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 2. maternal health findings. J Glob Health. 2017 Jun;7(1):010902. doi: 10.7189/jogh.07.010902.

    PubMed 28685040
  • Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399-421. doi: 10.1146/annurev-publhealth-032013-182354. Epub 2014 Jan 2.

    PubMed 24387091
  • Sacks E, Freeman PA, Sakyi K, Jennings MC, Rassekh BM, Gupta S, Perry HB. Comprehensive review of the evidence regarding the effectiveness of community-based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings. J Glob Health. 2017 Jun;7(1):010903. doi: 10.7189/jogh.07.010903.

    PubMed 28685041
  • Munos M, Guiella G, Roberton T, Maiga A, Tiendrebeogo A, Tam Y, Bryce J, Baya B. Independent Evaluation of the Rapid Scale-Up Program to Reduce Under-Five Mortality in Burkina Faso. Am J Trop Med Hyg. 2016 Mar;94(3):584-595. doi: 10.4269/ajtmh.15-0585. Epub 2016 Jan 19.

    PubMed 26787147
  • Amouzou A, Kanyuka M, Hazel E, Heidkamp R, Marsh A, Mleme T, Munthali S, Park L, Banda B, Moulton LH, Black RE, Hill K, Perin J, Victora CG, Bryce J. Independent Evaluation of the Integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design. Am J Trop Med Hyg. 2016 Jun 1;94(6):1434-1435. doi: 10.4269/ajtmh.16-0110b. No abstract available.

    PubMed 27252480
  • Amouzou A, Hazel E, Shaw B, Miller NP, Tafesse M, Mekonnen Y, Moulton LH, Bryce J, Black RE. Effects of the integrated Community Case Management of Childhood Illness Strategy on Child Mortality in Ethiopia: A Cluster Randomized Trial. Am J Trop Med Hyg. 2016 Mar;94(3):596-604. doi: 10.4269/ajtmh.15-0586. Epub 2016 Jan 19.

    PubMed 26787148
  • Hazel E, Bryce J, The Iip-Jhu iCCM Evaluation Working Group. On Bathwater, Babies, and Designing Programs for Impact: Evaluations of the Integrated Community Case Management Strategy in Burkina Faso, Ethiopia, and Malawi. Am J Trop Med Hyg. 2016 Mar;94(3):568-570. doi: 10.4269/ajtmh.94-3intro1. No abstract available.

    PubMed 26936991
  • Johnson A, Goss A, Beckerman J, Castro A. Hidden costs: the direct and indirect impact of user fees on access to malaria treatment and primary care in Mali. Soc Sci Med. 2012 Nov;75(10):1786-92. doi: 10.1016/j.socscimed.2012.07.015. Epub 2012 Aug 1.

    PubMed 22883255
  • Johnson AD, Thiero O, Whidden C, Poudiougou B, Diakite D, Traore F, Samake S, Kone D, Cisse I, Kayentao K. Proactive community case management and child survival in periurban Mali. BMJ Glob Health. 2018 Mar 12;3(2):e000634. doi: 10.1136/bmjgh-2017-000634. eCollection 2018.

    PubMed 29607100
  • Linn AM, Ndiaye Y, Hennessee I, Gaye S, Linn P, Nordstrom K, McLaughlin M. Reduction in symptomatic malaria prevalence through proactive community treatment in rural Senegal. Trop Med Int Health. 2015 Nov;20(11):1438-1446. doi: 10.1111/tmi.12564. Epub 2015 Aug 7.

    PubMed 26171642

Questions about this trial

What is this clinical trial studying?

A study testing Universal Health Coverage Mode in people with Community Health Workers, run by Ari Johnson, MD at 1 site in Mali.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 27 Sep 2019. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Mali. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Primary outcome (time frame: 4 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04106921, which also lists 18 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Sep 2019.

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