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  • Will an innovative connected AideSmart! app-based multiplex, point-of-care screening strategy for HIV and related coinfections affect timely quality antenatal screening of rural Indian women? Results from a cross-sectional study in India

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Epidemiology
Original article
Will an innovative connected AideSmart! app-based multiplex, point-of-care screening strategy for HIV and related coinfections affect timely quality antenatal screening of rural Indian women? Results from a cross-sectional study in India
  1. Nitika Pant Pai1,2,
  2. Jana Daher2,
  3. HR Prashanth3,
  4. Achal Shetty3,
  5. Rani Diana Sahni4,
  6. Rajesh Kannangai5,
  7. Priya Abraham5,
  8. Rita Isaac3
  1. 1 Department of Medicine, McGill University, Montreal, Quebec, Canada
  2. 2 Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Canada
  3. 3 Rural Unit for Health and Social Affairs (RUHSA), Christian Medical College, Vellore, Tamil Nadu, India
  4. 4 Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
  5. 5 Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
  1. Correspondence to Dr Nitika Pant Pai, Department of Medicine, McGill University, Montreal, QC H4A 3S5, Canada; nitika.pai{at}mcgill.ca

Abstract

Objectives In rural pregnant Indian women, multiple missed antenatal screening opportunities due to inadequate public health facility-based screening result in undiagnosed HIV and sexually transmitted bloodborne infections (STBBIs) and conditions (anaemia). Untreated infections complicate pregnancy management, precipitate adverse outcomes and risk mother-to-child transmission. Additionally, a shortage of trained doctors, rural women’s preference for home delivery and health illiteracy affect health service delivery. To address these issues, we developed AideSmart!, an innovative, app-based, cloud-connected, rapid screening strategy that offers multiplex screening for STBBIs and anaemia at the point of care. It offers connectivity, integration, expedited communications and linkages to clinical care throughout pregnancy.

Methods In a cross-sectional study, we evaluated the AideSmart! strategy for feasibility, acceptability, preference and impact. We trained 15 healthcare professionals (HCPs) to offer the AideSmart! strategy to 510 pregnant women presenting for care to outreach rural service units of Christian Medical College, Vellore, India.

Results With the AideSmart! screening strategy, we recorded an acceptability of 100% (510/510), feasibility (completion rate) of 91.6% (466/510) and preference of 73%. We detected 239 infections/conditions (239/510, 46.8%) at the point-of-care, of which 168 (168/239; 70%) were lab confirmed, staged and treated rapidly. Of the 168 confirmed infections/conditions, 127 were anaemia, 11 Trichomonas and 30 hepatitis B virus (HBV) (25 resolved naturally, 5 active infections). Four infants (4/5; 80%) were prophylaxed for HBV and were declared disease-free at 9 months. Recruited participants were young; mean age was 24 years (range: 17–40) and 74% (376/510) were in their second trimester. Furthermore, 95% of the participants were retained throughout their pregnancy.

Conclusion The AideSmart! strategy was deemed feasible to operationalise by HCPs. It was accepted and preferred by participants, resulting in timely screening and treatment of HIV/STIs and anaemia, preventing mother-to-child transmission. The strategy could be reverse-innovated to any context to maximise its health impact.

  • multiplex, point-of-care, innovative, HIV
  • STBBI, antenatal care, cross-sectional study

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: http://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/sextrans-2017-053491

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    Footnotes

    • JD, HP and AS contributed equally.

    • Handling editor Jackie A Cassell

    • Contributors NPP: idea and concept, development of App, oversight and execution, write-up of first draft, critique of draft, data analyses, data interpretation. JD: development of app, study execution, write-up of the first draft, data analyses and data interpretation, critique of drafts. PHR, AS: study execution, study co-ordination, data interpretation, critique. RDS, RK, PA: study execution, write-up, critique, oversight of study conduct, data interpretation. RI: oversight and execution, write-up of first draft, critique of draft, data analyses, data interpretation.

    • Funding This study was funded by Fonds de Recherche du Québec - Santé (Research-Scholar Junior 2 Award), Grand Challenges Canada (Grant Number: 0376-01).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was formally approved by two Institutional Review Boards: (1) McGill University Health Centre, Montreal (approval# 14–184-BMB) and (2) Christian Medical College, Vellore.

    • Provenance and peer review Not commissioned; externally peer reviewed.