Puttkammer Nancy, Dunbar Elizabeth, Germanovych Myroslava, Rosol Mariia, Golden Matthew, Hubashova Anna, Fedorchenko Vladyslav, Hetman Larisa, Legkostup Liudmyla, Flowers Jan, Nesterova Olena
Digital Initiatives Group at I-TECH, Department of Global Health, University of Washington, Seattle, WA, United States.
Department of Human Centered Design and Engineering, College of Engineering, University of Washington, Seattle, WA, United States.
JMIR Form Res. 2025 Jan 30;9:e66132. doi: 10.2196/66132.
Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)-Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking.
The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability.
This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study's formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients.
The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine's wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload.
It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing.
辅助性伴侣服务（APS；有时也称为索引检测）目前正在许多国家作为一种高收益的艾滋病毒检测策略进行推广。然而，伴侣引出率低常常阻碍了APS的成功。计算机辅助自我访谈（CASI）增强版研究旨在开发并测试一种移动健康（mHealth）工具，以提高新诊断出艾滋病毒的人群对性伴侣和共用针具伴侣的引出率。CASI增强版为客户提供有关APS方法的信息，并使用标准化的、自我引导式问卷，以无歧视性的语言让客户列出将从艾滋病毒检测中受益的伴侣。该工具还使医护人员（HCW）能够查看汇总数据，以方便追踪伴侣。
CASI增强版研究的形成性研究阶段旨在收集客户和医护人员对CASI增强版工具设计的意见，以确保其可接受性、可行性和可用性。
本研究收集意见以确定功能的优先级，并在战时乌克兰的公共卫生诊所对接受艾滋病毒服务的医护人员和客户测试CASI增强版的可用性。CASI增强版研究的形成性阶段于2023年5月至2024年7月进行，采用了基于同理心、迭代和创意构思原则的以人为本的设计（HCD）方法。该研究包括3个步骤：形成性HCD，包括对男男性行为者和注射吸毒者等客户进行深入的个人访谈，以及与切尔尼戈夫和第聂伯罗的农村和城市艾滋病毒诊所的医护人员进行基于互联网的设计研讨会；软件平台评估和启发式评估，包括根据CASI增强版的要求评估开源mHealth平台、原型开发以及基于可用性启发式对REDCap（研究电子数据采集）原型进行测试；以及可用性预演，包括与医护人员和客户进行模拟案例。
CASI增强版研究的形成性阶段包括对10名客户进行深入的个人访谈以及与22名医护人员进行3次研讨会。本研究展示了如何将简化的HCD方法应用于战时背景，从而收集到关于功能优先级和工具设计的丰富意见。CASI增强版的设计反映出既具有文化敏感性又符合乌克兰战时背景限制的特点。优先级功能包括有关艾滋病毒索引检测益处的信息；一份无歧视性的、自我引导式的报告伴侣问卷；客户故事；以及与文本搭配的明亮图像。基于隐私泄露风险、国家患者隐私法规和医护人员工作量，客户与医护人员之间的双向短信文本消息被认为不切实际。
在战时的乌克兰进行HCD研究是可行的。CASI增强版mHealth工具对医护人员和客户来说都是可接受的。本研究的下一步是对基于REDCap的CASI增强版工具对列出的伴侣数量和伴侣完成艾滋病毒检测率的影响进行随机临床试验。
