With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.
The African continent has immense depth of culture, warmth and a very special heartbeat
1 that makes it an unmatched home to approximately 973 million people . However, despite
its tremendous potential and resources, the continent carries a heavy disease morbidity
and mortality burden mostly impacted by Human Immune deficiency virus (HIV),
Tuberculosis (TB) and Malaria.
Globally, there are an estimated 33 million people living with HIV and 2 million people died
due to Acquired Immune Deficiency Syndrome (AIDS) in 2007. Africa bears a
disproportionate share of the global burden of HIV. Sub-Saharan Africa is home to 67% of all
people living with HIV and Southern Africa alone accounts for 35% of HIV infections and
38% of AIDS deaths in 2007. An estimated 370,000 children younger than 15 years were
infected with HIV in 2007, and almost 90% live in sub-Saharan Africa. Nearly 12 million
2 children under age 18 have lost one or both parents to HIV within the region .
WHO estimates that 9.27 million new cases of TB occurred in 2007. Among the 15 countries
with the highest TB incidence rates, 13 are in Africa, a phenomenon linked to high rates of
HIV co-infection. In 2007, as in previous years, the African Region accounted for 79% of HIV-
3 positive TB cases .
Of the estimated 247 million episodes of malaria in 2006, 86% were in the African region.
Eighty percent (80%) of the cases recorded in Africa were in 13 countries, and over half were
in Nigeria, Democratic Republic of the Congo, Ethiopia, United Republic of Tanzania and
Kenya. Of the estimated 881 000 malaria deaths globally in 2006, 91% were in Africa and
4 85% were children under 5 years of age .
Monitoring and evaluation (M&E) are critical to measuring and reporting on the success of National TB (Tuberculosis) Programs (NTPs) and the TB CARE I/II projects. While governments and donors are placing greater emphasis on results, at the country level,
greater attention is being paid to the use of data for improving patient care and enhancing program management. In order to ensure that adequate capacity exists to meet the increasingly stringent M&E requirements, this course was designed to build the capacity of M&E Officers of NTPs and technical partners.
Knowledge of lay beliefs on existence, cause, mode of TB transmission, and the association of TB/HIV
relationship are key entry point to initiate effective prevention and control of TB in communities.
Misconceptions of this result to fear and stigma that can sustain TB transmission. The main objective of this
study was to determine the study community beliefs of TB, its relationship with HIV/AIDS and to quantify
prevention practices. A cross- sectional survey of community members was done in Athi-river and Central
Divisions of Machakos County. A pre-tested self administered questionnaire and researcher assisted interviews
was used to collect data. The data was analyzed by use of statistical package for social sciences (SPSS) version
16. Pearson Chi-Square analysis was used to determine the relationships between variables. Level of significance
was fixed at 0.05 (p=0.05). The results of this study reveal a majority (90.6%) of the community is aware of the
existence of TB and that 90.1% believe it can be transmitted p<0.05 respectively. Misconceptions and lay
beliefs on the cause and mode of TB disease transmission was prevalent with (90.8%) blaming these on
unrelated factors such as smoking, poor hygiene, HIV/AIDS, hereditary and sharing eating utensils respectively.
The community practices were discriminatory as they separated eating utensils of TB patients or isolated them as
a way of preventing the disease spread which causes fear. A slight majority of the community (46.5%) believes
TB is related to HIV/AIDS, a disease of stigma citing similarity of symptoms .The rest obseveve there is no
relationship and said the symptoms and modes of transmission are different. The Ministry of health needs to
urgently bridge this gap by disseminating health education on TB and TB/ HIV/AIDS relationships in the
communities to demystify fear that result from misconceptions