ABSTRACT
Objective: Digital health interventions (DHIs) have the potential to improve access and quality of care in low-middle-income countries. The aim of this study was to assess the acceptability, usability and aesthetics of a DHI by frontline workers in peri-urban community settings in Karachi, Pakistan. Methods: A mixed-methods study was carried out in peri-urban field sites in Karachi, Pakistan, where maternal and childcare services are provided through front-line care providers using a DHI. These workers include community health workers, midwives, and physicians who were using the DHI for at least six months. For quantitative data, a questionnaire regarding the module design and interface, technical difficulty, and appropriate utilisation was assessed using a 5-point Likert scale. For qualitative data, focus group discussions (FGDs) based on experiences regarding operability, design, its effect on work efficiency and the provision of beneficial health services were conducted. Results: There were 93 respondents for the quantitative questionnaire who reported high satisfaction (>85%) with the DHI in many themes including content quality, aesthetics and ease of use. Participants were least satisfied with service quality (45% satisfaction only) due to issues related to data sync and network connections in these areas. During the FGDs, the workers stated that the DHI helped them with accessing previous data and providing quality health care services to the community. Conclusion: Although frontline workers reported a few technical difficulties while using the DHI, the majority reported that it was acceptable, had user-friendly features and was beneficial in their work processes.
ABSTRACT
While surgical resection has remained the mainstay of treatment in early-stage renal cell carcinoma (RCC), therapeutic options in the advanced setting have remarkably expanded over the last 20 years. Tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptor (VEGF-TKIs) and anti-programmed cell death 1 (PD-1)/anti-programmed death-ligand 1 (PD-L1)-based immune checkpoint inhibitors (ICIs) have become globally accepted options in the upfront metastatic setting, with different ICI-based combination strategies improving overall survival compared to single-agent Sunitinib. Although some patients benefit from long-term responses, most eventually develop disease progression. Ongoing efforts to better understand the biology of RCC and the different mechanisms of acquired resistance have led to the identification of promising therapeutic targets. Belzutifan, a novel agent targeting the angiogenic pathway involving hypoxia-inducible factors (HIFs), has already been approved for the treatment of early-stage tumors associated with VHL disease and represents a very promising therapy in advanced RCC. Other putative targets include epigenetic regulation enzymes, as well as several metabolites such as adenosine, glutaminase and tryptophan, which are critical players in cancer cell metabolism and in the tumor microenvironment. Different methods of immune regulation are also being investigated, including CAR-T cell therapy and modulation of the gut microbiome, in addition to novel agents targeting the interleukin-2 (IL-2) pathway. This review aims to highlight the emergent novel therapies for RCC and their respective completed and ongoing clinical trials.
