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Young Africa Live recently hosted a World AIDS Day tribute wall where users posted messages of love and support for those they know who have died from, or are living with AIDS. Young Africa Live recently hosted a World AIDS Day tribute wall where users posted messages of love and support for those they know who have died from, or are living with AIDS. Praekelt Foundation

mHealth Creates Connections for HIV Programs

Mobile phone technology is paving the way for innovative new methods to support patients, empower doctors and engage the public in the fight against HIV and AIDS.

Mobile phones are changing the way that HIV/AIDS is being tackled in the developing world. According the Joint United Nations Programme on HIV/AIDS, by 2011 the number of people in low- and middle-income countries receiving treatment for HIV reached an estimated 6.6 million, while the goal is to reach 15 million people by 2015. mHealth, or mobile health, is an emerging field in healthcare that promises to make these efforts broader and more efficient. Mobile technology is allowing for novel approaches to tracking drugs and supplies, training healthcare workers, supporting patients and educating the public. For the individual, mHealth offers new support systems to make HIV/AIDS treatment more effective and less stigmatizing; for the global community it could be indispensable in meeting ambitious treatment and prevention goals.

Strictly speaking, mHealth is any healthcare activity that is supported by mobile technology. Diagnostic applications, like blood sugar monitoring; training applications, like distance learning courses; or public outreach applications, like awareness campaigns, are just some of the ways mHealth is already breaking new ground. mHealth opens new opportunities for innovation in health data collection, supply chain management, patient monitoring and treatment, as well. The real potential of mHealth lies in the ability to enhance communication between doctors, patients, policy-makers and the public. The following are examples of mHealth projects that have targeted these various audiences in the fight against HIV and AIDS.

The Public

Young Africa Live is a mobile phone platform available in South Africa, Tanzania and Kenya that boasts over 450,000 active users. The project melds education and entertainment in order to spark interest and discussion on HIV/AIDS related issues among young Africans. Information related to HIV testing and prevention is intertwined with pop culture in order to generate dialogue on love, sex and relationships through blogs, group forums, live chats and surveys.

Followers of Young Africa Live can access the platform instantly for free, directly from their mobile phone. The mobile phone offers convenience, privacy and safety for users, allowing them to share and discuss candidly on sensitive issues like sex and HIV. A recent survey by Young Africa Live elicited nearly 140,000 responses to questions regarding views on homosexuality, domestic abuse and sexually transmitted infections. This type of honest discussion helps to inform participants and reduce the stigma surrounding HIV, but may only have been possible with mobile technology.

Ghana’s Text Me! Flash Me! Helpline leveraged the anonymity and popularity of mobile phones to target most-at-risk populations with information and counseling on HIV and AIDS. The service, supported in part by USAID, provided information on sexually transmitted infections, HIV/AIDS medications, where to get tested and where to find condoms. For instance, by texting “PROTECT” to the helpline, a user would receive a text message telling them where to buy condoms. Alternatively, the user can “Flash” the helpline, or call quickly and hang up, to receive a return call from a counselor free of charge.

Mobile phone based information campaigns are effective at reaching both wide and targeted audiences. Young Africa Live reports over 36 million page views since its creation. The Text Me! Flash Me! project led to a 39% increase in referrals to  HIV counseling and treatment centers in the months following the campaign. Mobile technology has the advantage of being able to tap directly into social trends allowing outreach efforts like those highlighted here to appeal to very broad or very focused groups.

Practitioners

mLearning, like mHealth, uses mobile technology to enhance education and training. A study conducted in Peru by the Institute of Tropical Medicine created a mobile phone-based HIV/AIDS training curriculum for healthcare workers serving low-income communities. The curriculum approached the learning process along many fronts, through formal learning modules, interactive quizzes, social media based discussions boards, and a forum of experts to answer specific questions. Since computers are not always available to healthcare workers, especially those already working under tight resources, mobile phones present an opportunity to expand the impact of distance learning resources. Participants in the study indicated that the ability to access training information without a computer was valuable, as was the ability to do training on their own schedule.

The African Medical and Research Foundation (AMREF) hosts an on-line repository for information on antiretroviral therapy (ART), which can be accessed via mobile phone. AMREF’s ART Knowledge Hub provides nurses with the latest research, practices and procedures for ART. Users can also post questions, problems and difficult cases related to ART on a forum to receive advice from experts. As a part of the initiative, AMREF gave mobile phones and unlimited internet access to nurses in remote areas to access the ART hub. By supporting healthcare workers in isolated settings with up-to-date information and expertise, this sort of initiative not only improves patient care, but also gives the healthcare workers more confidence.

Administrators

Mobile technology is also being implemented to give real-time information on drug distribution to central program administrators. One such project, being developed by the New York University School of Medicine and Microsoft Research, uses mobile phones to track anti-retroviral drugs through the supply chain and even to track drugs usage by patients. In a project supported by the GSMA Development Fund and PEPFAR, called Phones for Health, healthcare workers can submit a wide range of data on patients, medical supplies and lab tests to central databases via mobile phones. This provides real-time information to government and program administrators on the success of healthcare initiatives, the outbreak of diseases and the stock of drugs and medical supplies over a broad area.

One such application, Rwanda’s TRACnet, has been in use since 2004. TRACnet was implemented (also with PEPFAR support) to help track the distribution of ART drugs to over 160 rural and urban health clinics. Drug stocks, test results and other critical program information are entered into a central database from each of the facilities. These data are then used to administer the ART program and ensure that drug supply shortages do not occur. As many of the clinics do not have access to the internet, the system was design to support data input from both computers and mobile devices via text messaging. The value of mobile-based data entry is evidenced by the fact that 85% of TRACnet users input data through their phones. The system now covers all ART patients in Rwanda, a feat that, without mobile technology, would have been otherwise impossible.

Patients

mHealth is creating new opportunities for patient-centered approaches to healthcare. The Colecta PALM pilot project, led by the University of Washington, gave mobile devices to ART patients in Peru. The project featured a virtual risk-assessment questionnaire where users choose a virtual guide whose photo accompanies each question. The use of a virtual guide, along with audio and other images, made the experience more personal and interesting to users.

Other patient-focused initiatives include automatic text messages reminding ART patients to take their medications and go to doctors’ appointments. One such project, txtalert (another product of the Praekelt Foundation), is simply an open source code that any organization can use to send automatic messages. While txtalert and other projects like it have been geared toward ART patients, the technology can be used for any application where information needs to be automatically sent to individuals or groups. Simple, flexible systems such as these may form the basis for new innovations in the future.

mHealth also helps patients connect to other patients. Project Zumbido is a mHealth pilot project undertaken in 2007 to help improve patient compliance with HIV/AIDS medical treatment. The project allowed participants in both rural and urban settings to share their daily progress with one another via text messaging; together, participants averaged 80,000 messages per month. The result was a virtual support network for the participants, where individuals shared their problems, their routines, sent messages of encouragement and helped each other to take their daily treatment.

mHealth Resources

mHealth is a recognition of the transformative potential that mobile telecommunications technologies hold for healthcare. mHealth initiatives are often a synthesis of traditional initiatives and the power of mobile technology to target, individualize and socialize the activities and outcomes of that initiative. The information presented in a HIV/AIDs public outreach campaign or distance learning course will be similar whether disseminated through a mobile platform or through traditional means. The difference is that a mobile initiative will support that core information with user interaction through social media, special forums, up-to-date data and direct consultation. Such initiatives benefit from mobile dissemination by offering an experience more closely tailored to the individual, and by connecting users with one another to overcome challenges.

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