RT Journal Article
SR Electronic
T1 A User-Centered Approach to Achieving High Degree of Digital Health Technology Utilization for Community HIV Case Management and Data Collection in Ethiopia
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
DO 10.9745/GHSP-D-24-00353
A1 Mekuria, Legese A.
A1 Likasa, Getaneh
A1 Sintayehu, Temesgan
A1 Mekonen, Leul
A1 Tekeste, Asayehegn
A1 Seid, Endris
A1 Asefa, Wondwossen
A1 Negash, Afework
A1 Shewarega, Abiy
A1 Tilaye, Mesfin
A1 Eyassu, Gizachew
A1 Belete, Kidist
A1 Nur, Mohamed
A1 Neri, Steven
A1 Hayes, Adrienne
A1 Liddell, Emily
A1 Mookherji, Sangeeta
A1 Tsegaye, Dawit A.
YR 2026
UL http://www.ghspjournal.org/content/early/2026/06/16/GHSP-D-24-00353.abstract
AB Key FindingsA user-centered mobile health application, co-designed with frontline community health workers and local partners, was successfully deployed across community HIV programs in Ethiopia, supporting standardized case management and client-level data collection.High degrees of utilization and data quality were achieved: over 92% of the mobile accounts were used by frontline workers and 94% of the web accounts by implementation managers, with close to 100% data completeness scores for key indicators and no invalid data elements detected.The number of days to access client-level data by local partners was reduced from 1 month to 1 day, and the time to report on activity performance from 5 days to half a day.Iterative field testing, training, and routine technical assistance facilitated acceptability and sustained use despite a longer-than-expected implementation timeline.Key ImplicationsThe digital health initiative showed the feasibility of designing, developing, and using digital tools for electronic case management and high-quality data collection in community settings of a low-income country in Africa.Developers should involve end-users in the design and development process, incorporate user feedback, and provide training and routine technical assistance to achieve high levels of usage.Continued investment in training, technical support, local capacity development, and iterative updates is needed to sustain digital health technology utilization and to scale similar solutions in comparable low- and middle-income country contexts.Digital health technologies have untapped potential to transform community health systems, and they are underutilized for chronic HIV care and electronic data management in low- and middle-income countries. We describe the design, development, and use of a mobile health application in community-based HIV prevention, care, and treatment programs implemented in Ethiopia since 2017. Initially, these programs utilized aggregate data collection methods, which were fragmented, non-uniform, and largely paper-based, posing challenges to data quality and data use. Local software developers applied user-centered methods to build a Unified Data System (UDS), an innovative digital health solution aimed at standardizing case management and routine data collection procedures. Developers involved end-users, including frontline community health workers (CHWs) and program managers, in the design and development process. They also conducted field visits to understand and assess user activities and needs. Developers and program staff conducted field testing, and they made design changes iteratively to incorporate user feedback. Local implementing partners deployed 950 CHWs to use the UDS for HIV service delivery and client-level data collection offline. Data were stored centrally in the CommCare HQ web service backed by a local analytics server. The UDS was linked to Power BI for advanced data analytics and visualization. Data validation tests were performed prior to indicator computation and reporting to the next level. 1,766 mobile accounts were opened for CHWs, of which 1,628 (92.2%; 95% confidence interval [CI]=90.8%, 93.4%) have submitted data. An additional 368 of 392 web accounts (93.9%; 95% CI=91.0%, 96.0%) have been used by program managers and monitoring and evaluation experts to access the dashboard. The UDS has eliminated the tedious, manual, paper-based work associated with data (dis)aggregation and reporting by frontline CHWs and local implementing partners. Hence, the number of days to access client-level data by the local partners was reduced from 1 month to just 1 day, and the time to report on activity performance was shortened from 5 days to a half-day. Data completeness was nearly 100% and data validation tests demonstrated no invalid data elements or errors. Generally, there was a high degree of digital health technology utilization by frontline CHWs and local implementing partners for standardized HIV care, high-quality data collection, and making data-informed decisions. Lessons learned from the UDS implementation could be adapted not only to support community HIV programming but also to strengthen national electronic community health information systems.