In this study, the investigators shall evaluate the use unmanned air vehicles (medical drones) to deliver ART to adult patients eligible/enrolled in community DSD models in Bufumira Islands, Kalangala district. The geography of the islands is ideal for this project because of the flat landscape and water coverage. The investigators hypothesize that the use of drones would be acceptable to patients and stakeholders, reduce facility drug stock outs, increase retention in care by 10% in intervention (at 12 months) compared to the control health centres and be cost neutral (to the patients and health sector perspectives). The investigators will also undertake evaluation of an efficient sample delivery system using medical drones especially for expansive rural areas like Moyo and Adjumani.
Stage one will be a cross-sectional observational study with baseline data collection on ART accessibility, adherence, challenges as well as perceptions and attitudes towards possible medical drones. Stage two will be a non-randomized observational pilot of medical drones at 3 landing sites in Kalangala District, comparing to 3 landing sites without drones, and at five health facilities in Moyo and Adjumani districts. The investigators shall use qualitative and quantitative methods and a process evaluation to assess the feasibility of using drones for ART delivery and determine the impact on patient outcomes. The COVID pandemic has taken hold in Uganda since this protocol was first approved in June 2020, and having received approval from the Ministry of Health, the investigators will extend this pilot to Moyo and Adjumani Districts. The investigators shall use qualitative and quantitative methods and a process evaluation to assess the feasibility of using drones for COVID sample delivery and determine the impact on result turnaround times. Stage two includes a sub-study on validity and quality of transport of biological samples including HIV, STI, TB and COVID diagnostic and monitoring samples.
Study Type
OBSERVATIONAL
Enrollment
1,450
Use of an Unmanned ariel vehicle for medical delivery (drugs and samples)
Infectious Diseases Institute
Kampala, Uganda
RECRUITINGAcceptability for ART delivery as reported using qualitative methods with key stakeholders including health care workers, district officials, people living with HIV
To assess acceptability of medical drone use for ART in Kalangala as compared to boat delivery through qualitative assessment including focus group discussions and in depth interviews with key stakeholders including district officials, health care workers, people living with HIV
Time frame: 24 months
Feasibility of medical drones for ART delivery to peer support workers using number of successful flights delivering ART
To undertake a process evaluation for feasibility of medical drones for ART and sample transport
Time frame: 24 months
Retention in care as determined by attendance for ART refils at health facility or peer support group meetings in Bufumira health centre (with drone delivery) as compared to Mazinga health centre (with boat only)
To gather information on retention in care in PLHIV receiving ART by medical drone at 6 and 12 months in patients accessing ART compared with other ART service delivery models in Bufumira Sub County and Mazinga sub county, Kalangala District
Time frame: 12 months
Cost of ART transport by boat as compared to drone based on actual costs of fuel and staff time
To compare the cost of drone delivery compared to other ART service delivery models (e.g. individual care at health centre, outreach from health centre to landing sites, community drug distribution by boat, community drug distribution by drone) in Bufumira Sub County, Kalangala District.
Time frame: 24 months
Acceptability for use of medical drone to move COVID samples as reported using qualitative methods
To assess acceptability of medical drone use for COVID samples as compared to ground delivery through qualitative assessment including focus group discussions and in depth interviews with key stakeholders including district officials, health care workers, people who have been tested for COVID-19
Time frame: 24 months
Turnaround times of COVID samples from arrival in receiving laboratory to results returned to receiving laboratory delivered by medical drone as compared to by land transport
To compare turnaround times for samples delivered by drones as compared to delivered by land transport (standard of care) in Moyo and Adjumani districts
Time frame: 24 months
Cost of samples transport by medical drone as compared to by land using cost of fuel and staff time
To compare the cost of drone delivery compared to other sample delivery models bike or car in Moyo and Adjumani districts.
Time frame: 24 months
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