Supportive mHealth: Using mobile systems in prevention of mother to child transmission & HIV support services

Dr Peter Benjaminpeter@cell-life.orgSkype ID: peterbenjamin@PeterB_CellLife

www.cell-life.org.za

What will be covered?

• Introduction to Cell-Life• mHealth to support Prevention of

mother-to-child HIV transmission• Other mHealth for HIV applications• mHealth next steps: beyond the hype

What will be covered?

• Introduction to Cell-Life• mHealth to support Prevention of

mother-to-child HIV transmission• Other mHealth for HIV applications• mHealth next steps: beyond the hype

What is Cell-Life is?

• Not-for-profit making tech & services accessible to improve health & meet social challenges

• Started 2010, UCT & CPUT

• Cape Town, SA

• 10 African countries (mainly SA)

• 25 staff (mainly techies)

• Open Source

What do we do?• Applying eHealth (especially mHealth):

1. Social & behaviour change communications

2. Primary health system strengthening

• We are one of the few mHealth organisations active in • Technical development• Proof-of-concept pilots at sites• Larger health system implementations• Developing business models• Research• Policy

What will be covered?

• Introduction to Cell-Life• mHealth to support Prevention of

mother-to-child HIV transmission• Other mHealth for HIV applications• mHealth next steps: beyond the hype

• Initial Randomised Controlled Study• Rahima Moosa Mother & Child Hospital, Jo’burg• RCT 320 mothers (½ test, ½ control), informed

consent• SMS info & reminders (30 messages over 10 weeks)• Msgs help women deal with status, ‘psycho-social’

support• “Text messaging improved infant follow-up rates in this

urban South African context”, small effect• Great difficulty in collecting & verifying all data

mHealth and PMTCT

• Scaling up, 2012 – 2013• Funding: UN Innovation Working Group (Norad)• Partners larger orgs (RTC) & DOH districts

mHealth and PMTCT (Cont)

•Expecting mothers•Advice on PMTCT, pregnancy care, preparing for labour, breastfeeding and baby care

•Mothers about to give birth (birth week) or baby < 3 months•Advice on PMTCT, breastfeeding, keeping healthy, signs of illness, baby care

SMS Themeses

 

Introductory message LifestyleOpt out information MedicationClinic attendance NutritionBaby clinic & advice PostnatalBirth Pregnancy preventionBonding STIBreastfeeding TBHygiene TestingInfant illness Vaccines

Hello. PMTCT means preventing a mother from infecting her baby with HIV. The treatment is free at the clinic. HIV+ mothers can have HIV-negative babies. SMSBaby

Please eat well. So fruit, vegetables, cereals & whole grains (like brown bread & oats), meat & eggs. Don't want to eat? Try many small meals. SMSBaby

You can help stop your baby getting HIV by going to all clinic checkups, having the right medicines, & feeding breastmilk ONLY for the first 6 months. SMSBaby

Good day good Mom. Your baby will love the sound of your voice. He will show you by his smiles and wriggling. Talk and sing to him every day. SMSBaby

• Hawthorne Effect• Little staff time for new procedure: opt-in• Pilots often have people who can ‘help out’• Just for HIV+ or all pregnant women?• HIV explicit? (Now 40% use HIV words)• Data flows to make information useful to

management• Health economic study (Cost to Qualy)

Issues scale & integrating with health system

What will be covered?

• Introduction to Cell-Life• mHealth to support Prevention of

mother-to-child transmission of HIV• Other mHealth for HIV applications• mHealth next steps: beyond the hype

Mobile Data Collection

• Dept of Health cellphone rollout• 12,000 phones• Data collection for all 4,332 health facilities• First application: monitoring of HCT & ARV• Project awarded to Cell-Life and HISP• Initial rollout in 950 facilities June 2012 • Full rollout from Sept - Nov 2012

• Infrastructure for clinical mHealth

Clinical data collection in SA public sector

Messaging for prevention & testing

Soul City, SANAC, Brothers for Life, Just tested (+ve & -ve)

Mass information for positive living

TAC Adherence Clubs, Siyayinqoba

Linking patients & clinics ECHO, Kidz +ve, DTHF, RHRU / WRHI

Counselling National AIDS Helpline

Building capacity of HIV-related organisations

CARIS, HIVAN, TAC ... – over 100 organisations

Maternal health Mobile Alliance for Maternal Action (MAMA), PMTCT

Communicate applications

What will be covered?

• Introduction to Cell-Life• mHealth to support Prevention of

mother-to-child transmission of HIV• Other mHealth for HIV applications• mHealth next steps: beyond the

hype

• Every trial shows people like messaging• Most well-designed studies show small impact • Great potential – but more hype than reality• Growth sector (feeding frenzy)• MAJOR issue of going to scale

• Cost of SMS / limitations of USSD• Integrate to weak Health Info Systems• Take data security & privacy seriously

mHealth issues

• SA DoH & private interest for NHI • ICT4 Health Stakeholders Forum

• Need national integrated systems: • Data collection system, MAMA messaging

• Enabling regulation • “Ecosystem model”• Sustainability beyond pilots & donors:

2 - 3 years to embed what works

Next steps in mHealth in SA

NkosiSiyabonga

Ke a lebogaDankie

Thank you

Dr Peter Benjaminpeter@cell-life.orgSkype ID: peterbenjamin@PeterB_CellLife`