{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T19:14:42Z","timestamp":1782674082989,"version":"3.54.5"},"reference-count":28,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The ADAPT guidance proposes a process model for adapting evidence\u2010informed interventions to novel contexts. Herein, we leveraged this guidance to adapt a paediatric nighttime telemedicine and medication delivery service from Haiti, a setting with low malaria prevalence, to Ghana, where malaria is a leading cause of paediatric mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Core components of the intervention were defined and conserved. Discretionary components were identified and considered for adaptation. The service was defined by a workflow involving a call from a guardian of a sick child, a telemedicine assessment, referral of severe cases, and medication delivery\/in\u2010person assessments for non\u2010severe cases. Key adaptations related to partner organisation (private to public\/government), clinician type (nurse to emergency medical technician), user fees (sliding scale to none), and point\u2010of\u2010care testing (none to malaria rapid diagnostic testing). The adapted model was implemented in Jamestown and Usshertown, Ghana, on 16 November 2022 as part of a 12\u2010month study to evaluate implementation outcomes and the role of the telemedicine assessment. Empiric thresholds for safety and feasibility were set a priori and served as benchmarks for this study and points of iteration for future studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the first year of implementation, 517 cases were enrolled; 492 were included in the analysis, 96% of which were reached at 10\u2010day follow\u2010up. Safety and feasibility thresholds were met.\u00a098% of febrile cases received rapid diagnostic testing for malaria; 4% tested positive. At 10\u2009days, 97% of cases were improving\/well, and no severe adverse events were reported. The median lengths of the telemedicine assessment, time to delivery, and in\u2010person assessments were 9, 49, and 43\u2009min, respectively. 99% of participants expressed interest in using the service again. There was fair congruence between paired telemedicine and in\u2010person assessments for vital sign assessments and mild\/moderate triage decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A nighttime paediatric telemedicine and medication delivery service adapted and implemented per the ADAPT Guidance met a priori\u2010defined safety and feasibility metrics in the malaria\u2010endemic country of Ghana. The role of telemedicine in assessing vital signs and informing mild versus moderate triage decisions may be limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>This study was registered on <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">Clinicaltrials.gov<\/jats:ext-link> on 8\/17\/2022 (NCT05506683).<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.14081","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T08:56:28Z","timestamp":1737017788000},"page":"181-192","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Applying the <scp>ADAPT<\/scp> guidance to implement a telemedicine and medication delivery service in a malaria\u2010endemic setting: A prospective cohort study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9874-2912","authenticated-orcid":false,"given":"Katelyn E.","family":"Flaherty","sequence":"first","affiliation":[{"name":"Department of Environmental and Global Health College of Public Health and Health Professions, University of Florida  Gainesville Florida USA"},{"name":"Section of Global Health, Department of Emergency Medicine College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed\u2010Najeeb","family":"Mahama","sequence":"additional","affiliation":[{"name":"Ghana National Ambulance Service  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly B.","family":"Klarman","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health College of Public Health and Health Professions, University of Florida  Gainesville Florida USA"},{"name":"Department of Pediatrics College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nana A.","family":"Anane\u2010Binfoh","sequence":"additional","affiliation":[{"name":"Department of Child Health Korle Bu Teaching Hospital  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayur D.","family":"Patel","sequence":"additional","affiliation":[{"name":"Section of Global Health, Department of Emergency Medicine College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathanael J.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4274-5890","authenticated-orcid":false,"given":"Maxwell","family":"Osei\u2010Ampofo","sequence":"additional","affiliation":[{"name":"Department of Medicine Kwame Nkrumah University of Science and Technology  Kumasi Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8119-5821","authenticated-orcid":false,"given":"Michael","family":"Mathelier","sequence":"additional","affiliation":[{"name":"Section of Global Health, Department of Emergency Medicine College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health College of Public Health and Health Professions, University of Florida  Gainesville Florida USA"},{"name":"Department of Pediatrics College of Medicine, University of Florida  Gainesville Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0680-0909","authenticated-orcid":false,"given":"Ahmed N.","family":"Zakariah","sequence":"additional","affiliation":[{"name":"Ghana National Ambulance Service  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiba J.","family":"Afaa","sequence":"additional","affiliation":[{"name":"Department of Child Health Korle Bu Teaching Hospital  Accra Ghana"},{"name":"Department of Child Health Medical School, College of Health Sciences, University of Ghana  Accra Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5287-8056","authenticated-orcid":false,"given":"Torben K.","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Environmental and Global Health College of Public Health and Health Professions, University of Florida  Gainesville Florida USA"},{"name":"Section of Global Health, Department of Emergency Medicine College of Medicine, University of Florida  Gainesville Florida USA"},{"name":"Center for African Studies, Colleges of Liberal Arts &amp; 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