Testing modality associated with fast-track ART initiation in Botswana.

OBJECTIVES: The aim of this study was to identify community testing modalities associated with fast-track ART initiation in Botswana. METHODS: We conducted a retrospective cohort study that included all Botswana citizens 15 years or older who were newly identified as HIV-positive from 1 May 2017 to 31 January 2019, in Mahalapye and Southern districts. We used Poisson regression with robust error variance and generalised linear mixed models to control for cluster effects to model risk of ART initiation within 7 and 30 days of HIV diagnosis, testing modality factors. RESULTS: A total of 1436 individuals were newly identified HIV-positive, with men accounting for 60% across all testing modalities. 22% of all HIV-positive individuals were initiated on ART within 7 days. Clients diagnosed through index testing were more likely to be started on ART within 7 days (adjusted risk ratio [aRR] = 1.38, 95% CI 1.37-1.38) and 30 days (aRR = 1.17, 95% CI 1.09-1.26) than those diagnosed through mobile/outreach testing. CONCLUSIONS: Community HIV testing can complement facility-based testing by reaching individuals who may be less likely to seek HIV services at a facility, such as men. Monitoring ART initiation by testing modalities is critical to identify the optimal ones and to guide continuous programme improvement.

Bring-your-own-device in medical schools and healthcare facilities: A review of the literature.

BACKGROUND: Enabling personal mobile device use through a bring-your-own device (BYOD) policy can potentially save significant costs for medical schools and healthcare facilities, as they would not always have to acquire facility-owned devices. The BYOD policy is also perceived as a driver for balancing user needs for convenience with institutional needs for security. However, there seems to be a paucity in the literature on BYOD policy development, policy evaluation, and evaluation of mobile device implementation projects. OBJECTIVE: This review explored the literature to identify BYOD policy components (issues, interventions, and guidelines) that could potentially inform BYOD policy development and implementation in medical schools and healthcare facilities. METHODS: A literature search on PubMed, Web of Science, and Ebscohost (Academic Search Premier, ERIC, CINAHL, and MEDLINE) was conducted using the following search terms and their synonyms: healthcare facilities, mobile devices, BYOD, privacy and confidentiality, and health records. We developed a review matrix to capture the main aspects of each article and coded the matrix for emerging themes. The database and hand search yielded 1 594 articles, 14 of which were deemed as meeting the inclusion criteria. RESULTS: Several themes emerging from the analysis include: device management, data security, medical applications, information technology, education and/or curriculum, policy, and guidelines. The guidelines theme seems to provide a direction for BYOD policy development and implementation while the policy theme seems to be the comprehensive solution that synergizes BYOD implementation. CONCLUSION: Rather than an approach of 'chasing' issues with interventions, a more feasible approach towards achieving a safe mobile device use environment is through the development of comprehensive BYOD policies that would balance users' need for convenience with organizational security and patient privacy. The paucity in peer-reviewed literature calls for robust research that uses socio-technical approaches to development and evaluation of BYOD policies in medical schools and healthcare facilities.