Stakeholder engagement to drive iterative software development of the ARTAccess web-based application for community pharmacy dispensing of anti- retroviral therapy

Abstract

Introduction: Significant advances in combination anti-retroviral therapy (ART) have been instrumental in improving the quality of lives and life expectancy for people living with HIV (PLHIV). However, in the absence of a cure, sustained investment and innovation is required to improve adherence and quality of life for PLHIV. We developed ARTAccess, a web-based application that links patient information on ART and viral load to an algorithm that guides a private community pharmacist on ART refills without the need for an additional nurse in the pharmacy. We present the development process of the ARTAccess application and perceptions about its use by end users.

Methods: Between October–December 2018, we conducted a qualitative observational study to document the processes of the ART-Access™ application development. Using theoretical frameworks of participatory action research and human-centred design, we undertook structured and unstructured observations of the application development review meetings. We observed and had interactions in 12 stakeholder meetings. Three observers attended each development meeting and independently drafted a reflective narration of the transcript and separately conducted their own analyses. ARTAccess was launched in January 2019 and in March 2019, three in-depth interviews were conducted with the nurse dispensers running the refill program at the three pharmacies where ARTAccess was piloted.

Results: The ARTAccess application development meetings generated emerging themes. Introduction of a mHealth application for efficiency introduced job insecurity fears of health workers which needed to be addressed, to allow for increased engagement by health worker stakeholders. Stakeholder meetings provided important perceived gaps and needs for improvement at each stage of the ARTAccess application development. The user-centred design process led to five application versions; three more than the two originally planned; the feedback on the ARTAccess application became more positive as later versions were presented to stakeholders.

Conclusions: The study provides evidence that participatory action research in a human-centred design approach enhanced the application development process of a new technology for health. In resource limited settings, where digital technologies may be used to support overstretched health systems, health workers need re-assurance that digital tools being developed will not threaten their employment.

Key words: ARTAccess, application, pharmacy refill, perceptions, mhealth, Uganda, qualitative research