Applying the ADAPT guidance to implement a telemedicine and medication delivery service in a malaria‐endemic setting: A prospective cohort study

作者：Katelyn E. Flaherty, Mohammed‐Najeeb Mahama, Molly B. Klarman, Nana Anyimadua Anane-Binfoh, Mayur Patel, Nathaniel J. Smith, Maxwell Osei‐Ampofo, Michael Mathelier, Eric J. Nelson, Ahmed Zakariah, Taiba Jibril Afaa, Torben K. Becker · 发表于：Tropical Medicine & International Health · 年份：2025 · DOI：10.1111/tmi.14081 · 被引用次数：2 · 研究领域：Malaria Research and Control、Global Maternal and Child Health、Mosquito-borne diseases and control

BACKGROUND: The ADAPT guidance proposes a process model for adapting evidence-informed interventions to novel contexts. Herein, we leveraged this guidance to adapt a paediatric nighttime telemedicine and medication delivery service from Haiti, a setting with low malaria prevalence, to Ghana, where malaria is a leading cause of paediatric mortality. METHODS: Core components of the intervention were defined and conserved. Discretionary components were identified and considered for adaptation. The service was defined by a workflow involving a call from a guardian of a sick child, a telemedicine assessment, referral of severe cases, and medication delivery/in-person assessments for non-severe cases. Key adaptations related to partner organisation (private to public/government), clinician type (nurse to emergency medical technician), user fees (sliding scale to none), and point-of-care testing (none to malaria rapid diagnostic testing). The adapted model was implemented in Jamestown and Usshertown, Ghana, on 16 November 2022 as part of a 12-month study to evaluate implementation outcomes and the role of the telemedicine assessment. Empiric thresholds for safety and feasibility were set a priori and served as benchmarks for this study and points of iteration for future studies. RESULTS: In the first year of implementation, 517 cases were enrolled; 492 were included in the analysis, 96% of which were reached at 10-day follow-up. Safety and feasibility thresholds were met. 98% of feb...