Supporting hearing health for vulnerable populations affected and infected by HIV/AIDS using mobile technologies

Abstract

Access to ear and hearing care is a challenge in low-to-middle income countries (LMICs) where the burden of hearing loss is greatest. This study investigated a community-based programme for detection and diagnosis of hearing loss, using smartphone hearing screening operated by community care workers (CCWs) in vulnerable populations affected and infected by the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS). This study also surveyed the knowledge and experiences of CCWs providing the service. The study comprised two phases. In phase one, fifteen CCWs were trained to perform hearing screening during home visits using a validated smartphone application (hearScreen™) with calibrated headphones. Diagnostic follow-up assessments included evaluation using the smartphone test (hearTest™), otoscopy and tympanometry. Phase two included a survey on CCW’s knowledge on hearing health and experiences of the hearing screening programme. 276 adults (mean age 30.4 years; range 19 – 70 years; SD 9.1) and 235 children (mean age 8.7 years; range 2 – 18 years; SD 4.1) were tested over an eight-week period. Overall referral rates for adults and children were 5.0% and 4.2% respectively. 75.0% of referred participants returned for follow-up diagnostic assessments, 33.3% of whom were diagnosed with hearing difficulties and referred for further intervention services. All CCWs agreed that community members needed hearing health services and only 6.6% did not want to provide hearing testing as part of their services. Results of this study indicated that simple smartphone-based hearing screening allows minimally trained CCWs to decentralize hearing services to vulnerable communities in a timely, affordable, and reliable manner, thereby reducing the demands placed on limited ear and hearing health professionals.