Digital health helps build trust and retain services for people living with HIV in Cambodia - ISS-G20 Laboratorium Repository

During the COVID-19 pandemic, innovative community engagement approaches have been used to address disruptions to essential health care services, which have increasingly been delivered online. Putting services online risks deepening the digital divide, where people who are already marginalized or lack access to information and communications technology are increasingly left behind. Online health care can not only be inaccessible to some, but can also feel impersonal for health care workers and patients.

To respond to these challenges, the World Health Organization (WHO) in Cambodia collaborated with the Ministry of Health’s National Centre for HIV/AIDS, Dermatology and Sexually Transmitted Diseases and the University of Health Sciences to see if online services could be enhanced. The aim was to help build trust and maintain relationships between people living with HIV/AIDS and health care providers during the pandemic, to ultimately ensure that patients continue to receive timely and quality health care.

“The relationships between people living with HIV/AIDS and their health care providers are very well established and very close. COVID-19 made maintaining these relationships difficult, especially during lockdowns and other necessary strict measures,” WHO Representative Dr Li Ailan said. “Digital solutions can be an excellent part of the solution, but we also need to ensure equality of access, especially for vulnerable populations.”

Community engagement approaches were used to build trust using digital interventions to ensure that people living with HIV/AIDS, health providers and other stakeholders were collectively involved, from the earliest stages, in its design, implementation and evaluation of the project.

In the project, patients and health care providers used apps to access online health services. Getting all participants used to voice and text messaging on Telegram, Facebook Messenger and WhatsApp was only one challenge that needed to be surmounted.

Even more crucial was training the providers, who included doctors, nurses, pharmacists, data clerks, counsellors and community workers, in how to build trust. The aim was not just to deliver care efficiently, but also to build trust by delivering services with the same compassion and kindness as if the patient were in front of them. This was especially important given that people living with HIV/AIDS are often discriminated against and live with stigma. The training was more reflective than prescriptive. It created opportunities for providers to share their challenges, solutions and lessons learned.

An evaluation of the 2021 project found significantly fewer patients lost contact with health workers and dropped out of their anti-retroviral treatment programme than earlier in the pandemic and compared with patients who did not take part in it.

Both patients and providers said that connecting via digital platforms enabled faster and easier communication.

One patient said, “Before COVID-19, I could come to meet providers at the clinic, but during COVID-19, travels in some regions are restricted, so traveling to the clinic is difficult. Sometimes we are at the clinic, but we are not allowed to talk for long or be too close to each other. But now we have Messenger or Telegram, we can talk all the time, even if I am in the middle of the rice field.”

Some patients were more comfortable and open on apps than in person, said another patient.

“Some patients are less shy and more expressive in our group chat, but in person, they are shy and do not want to talk much with us or the providers. With the digital health project, we can get more information from the group chat. That helps keep us informed of matters such as COVID-19 vaccines and other things to keep us healthy.”

Director of the National Center for HIV/AIDS, Dr Vichea Ouk, said, “We found that digital health [interventions] could help maintain and sustain the communication, interaction and connection between patients and health care providers while respecting strict COVID-19 prevention measures such as lockdowns and physical distancing.”

Cambodia’s University of Health Sciences’ Dr Kennarey Seang said “We would like to see digital health continued and scaled up to reach more clients and health care providers,”  adding that enhancing health care workers’ “soft skills” made the difference.

“The most important lesson I learned was that the success of the digital health intervention does not depend only on providing access to Facebook Messenger or giving out personal digital devices like tablets and internet access to people. It also depends on other factors such as building trust, allowing an opening up, listening and paying attention to a patient.”

The project, which was supported by funding including from the Japanese electronics company JVC and the Republic of Korea, illustrates many of the elements of guidance published by WHO in the Western Pacific Region on implementing telemedicine during COVID-19.

Dr Li, WHO Representative to Cambodia, said, “The pandemic has accelerated a lot of innovation in health. Telemedicine will never replace all in-person consultations and relationships, but when it is thoughtfully paired with prioritizing trust building among historically marginalized groups, it can be positive. This project showed that not only access to digital tools can help communities access services, but that meaningfully engaging communities – virtual or otherwise— is key.”

“We are delighted with how care providers were willing to shift the way they work and that patients were open to new technology. We are sure the experience in Cambodia will be valuable for others considering expanding digital health to serve people better during the pandemic and beyond.”

The initiative aligns with WHO’s community engagement approach, which involves developing and maintaining relationships that enable stakeholders to collectively address health-related issues and promote well-being to achieve positive and sustainable health outcomes. Despite service disruptions, like we saw with COVID-19 restrictions, when health providers and patients are supported to meaningfully connect, listen and work together towards a common purpose, connections can thrive and health systems resilience can be strengthened,” said Dr Li.

Watch a video on the project.

Entire content available on: https://www.who.int/cambodia/news/feature-stories/detail/digital-health-helps-build-trust-and-retain-services-for-people-living-with-hiv-in-cambodia