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Digital adaptation kit for HIV: operational requirements for implementing WHO recommendations and standards within digital systems

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Digital health – defined broadly as the systematic application of information and communications technologies, computer science and data to support informed decision-making by individuals, the health workforce and health systems, to strengthen resilience to disease and improve health and wellness (1) – is increasingly an essential enabler for health service delivery and accountability. Ministries of health have recognized the value of digital health as articulated in World Health Assembly resolution 71.7 (2) and the Global strategy on digital health (3). Likewise, donors have advocated the rational use of digital tools as part of efforts to expand the coverage and quality of services, as well as to promote data use and monitoring (4-6).
Despite the investments in and abundance of digital systems, however, there is often limited transparency in the health data and logic of these digital tools or in the relationship with evidence-based clinical or public health recommendations. This limited transparency not only undermines the credibility of such systems but also impedes opportunities for interoperability, which undermines the potential for improving continuity of care.

Evidence-based recommendations, such as those in WHO guidelines, establish standards of care and offer a reference point for informing the content of digital systems that countries adopt. However, guidelines are often available only in a narrative format that requires a resource-intensive process to be elaborated into the specifications needed for digital systems.
This translation of guidelines for digital systems often involves subjective interpretation by implementers and software developers, which can lead to inconsistencies or inability to verify the content of these systems. In addition, where digital systems exist, the documentation of the underlying data and content may be unavailable or proprietary, requiring governments to start from scratch and expend additional resources each time they intend to deploy such a system. This lack of documentation of the health content can lead to dependence on one vendor and haphazard deployments that are unscalable or difficult to replicate across different settings.

To ensure that countries can effectively benefit from digital health investments, “digital adaptation kits” (DAKs) are designed to facilitate the accurate reflection of WHO’s clinical, public health and data use guidelines in the digital systems that countries are adopting. DAKs are operational, software-neutral, standardized documentations that distil clinical, public health and data use guidance into a format that can be transparently incorporated into digital systems. Although digital implementations comprise multiple factors – including (i) health domain data and content, (ii) digital intervention or functionality and (iii) digital application or communication channel for delivering the digital intervention – DAKs focus primarily on ensuring the validity of the health content (Fig. 1) (1, 7). Accordingly, DAKs provide the generic content required in digital systems, independently of a specific software application and with the intention that countries can customize them to meet local needs.

For this particular DAK, the requirements are based on systems that provide the functionalities of digital tracking and decision support (Box 1) and include components such as personas, workflows, core data elements, decision-support algorithms, scheduling logic and reporting indicators.
Operational outputs, such as spreadsheets of the data dictionary and the detailed decision-support algorithms, are included as practical resources that implementers can use as starting points when developing digital systems.
Furthermore, data components within the DAK are mapped to standardsbased terminology, such as the International Classification of Diseases (ICD), to facilitate interoperability.