title: A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.
abstract: 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.
authors.affiliation: Innovative Support to Emergency, Disease, & Disaster (InSTEDD), Sunnyvale, California, United States of America; School of Public Health, University of California, Berkeley, California, United States of America.
authors.forename: Caricia
authors.initials: C
authors.lastname: Catalani
authors.affiliation: Kijani Consulting, Chapel Hill, North Carolina, United States of America; Duke University, Chapel Hill, North Carolina, United States of America.
authors.forename: Eric
authors.initials: E
authors.lastname: Green
authors.affiliation: Academic Model for the Prevention and Treatment of HIV (AMPATH), Eldoret, Kenya.
authors.forename: Philip
authors.initials: P
authors.lastname: Owiti
authors.affiliation: Duke University, Chapel Hill, North Carolina, United States of America.
authors.forename: Aggrey
authors.initials: A
authors.lastname: Keny
authors.affiliation: Academic Model for the Prevention and Treatment of HIV (AMPATH), Eldoret, Kenya.
authors.forename: Lameck
authors.initials: L
authors.lastname: Diero
authors.affiliation: Regenstrief Institute, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Ada
authors.initials: A
authors.lastname: Yeung
authors.affiliation: Innovative Support to Emergency, Disease, & Disaster (InSTEDD), Sunnyvale, California, United States of America; School of Medicine, Stanford University, Palo Alto, California, United States of America.
authors.forename: Dennis
authors.initials: D
authors.lastname: Israelski
authors.affiliation: Academic Model for the Prevention and Treatment of HIV (AMPATH), Eldoret, Kenya; Regenstrief Institute, Indiana University, Indianapolis, Indiana, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Biondich
mesh_terms: D020000:Decision Support Systems, Clinical; D003695:Delivery of Health Care; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D014944:World Health Organization