Digital Health Screening in Persons with HIV in Uganda to Increase Alcohol Reporting (Preprint)

Abstract

Alcohol brief interventions are effective for reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often under-reported. Self-administered digital health screeners may improve reporting.

Our first aim was to develop a brief touch-screen tablet based health screener to be administered in an HIV clinic waiting room, to increase reporting of unhealthy alcohol use for persons with HIV in Uganda. Our second aim was to pilot test the health screener developed in Aim 1 to examine acceptability, ease of use, comfort with reporting, and to discuss how the results of such screening might be used.

We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener assessed behaviors regarding general health, HIV care, mental health, as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions (FGD) with clinicians and patients of the Mbarara ISS Clinic with HIV who consume alcohol to obtain input on the need for, content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener and conducted individual semi-structured in-depth interviews (IDIs) with 20 prior alcohol study participants, including those who previously under-reported use and those with low literacy.

Forty-five people (five clinicians and forty Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% were male, 43% had low literacy, and all had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing staff burden, and mitigating patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language, found the screener easy to use, although many required help.

We found a self-administered digital health screener to be appealing to patients and clinicians, and usable in a busy HIV clinic setting, albeit there were concerns about confidentiality and training. Such a screener may be useful to improve reporting of unhealthy alcohol use for referral to interventions.

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