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mHealth: anything in the pipeline?Francois Venter
Wits Reproductive Health & HIV Institute
Thanks John Black, Lynsey Stewart, Jesse Coleman, Eugene Sickle, NHLS, DoH
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Jaundiced view…
• Tech ‘solutions’ have wasted time and money
• Telemedicine - ?any successful models
• eRecords – huge investment, little return– Weakness of the designer
– Each province trying its own system
– Disease-specific systems
– Usually made for reporting, not for clinical management
– Not linked to labs or pharmacy
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What’s the single most useful tech currently for health care workers?
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Oh, and….
• Online links to NHLS results
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So, cell phones….
• End of 2017: 85% of South Africans will have smartphones
• Does beg the question: does providing wireless at health facilities become a priority?
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So, some example programmes
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The MDR-TB Partnership
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Goal
• “Improvement in identifying and curing drug-
susceptible TB and early detection and
effective treatment of all MDR-TB cases
(reduce time from suspicion to starting
standard second-line treatment – five working
days)” NATIONAL STRATEGIC PLAN ON HIV, STIs AND TB: 2012-2016
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To be used by clinicians at the Primary
Health Care clinics in order to
ENROLL potential MDR-TB patients.
[Will also contain a Training Library in
the future.]
To be used by Linkage Officers in
order to receive MDR-TB results from
the NHLS and CONTACT the patient
to LINK them with an MDR-TB unit
[Will also contain a Training Library in
the future.]
To be used by clinicians at MDR-
TB unit in order to REGISTER
MDR-TB patients and confirm that
they have been linked to care.
[Will also include a Training Library
and Clinical Decision Support
modules in the future.]
The Applications
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CLOUD PROCESSES
System Monitors
Back ups NHLS
ENCRYPTED
DATABASEServices
Web Interface
PHC App
L.O. app
MDR-TB Clinic App
Patient
SMS Gateway
processes
Structure
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Dashboard
2378emocha enrollees
1032MDR-TB positive
34new enrollees THIS WEEK
0
25
50
75
100
125
September August July June May April
100
200
300
400
DaysWeek
sMonths YearsProvinces Districts Project Managers
VIEW
:
BY
:
Key
Province 1
Province 2
Province 3
Province 4
Province 5
Province 6
Province 7
Province 8
Province 9
New EnrolleesArea Graph
Enrollment LINKAGE Care
MDR-TB PositiveStacked Graph
DASHBOARD - USER GROUP A
Provides an overview of Enrollment, Linkage, and Care
for the entire project across the country.
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Dashboard
300
400
DaysWeek
sMonths YearsProvinces Districts Project Managers
VIEW
:
BY
:
Key
Province 1
Province 2
Province 3
District 1
District 2
District 3
District 4
District 5
District 6
Province 4
Province 5
Province 6
Province 7
Province 8
Province 9
Enrollment LINKAGE Care
InitiationsStacked Graph
6 days, 3 hrsmean time lapsed from enrollment to initiation
2340successful initiations in the PAST 3 MONTHS
0 3.25 6.5 9.75 13 16.25
Mean Number of Days Lapsed Bar graph
From ENROLLMENT to INITIATION
DASHBOARD - USER GROUP A
Provides an overview of Enrollment, Linkage, and Care
for the entire project across the country.
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Web Dashboard
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Patients Enrolled
15
242
546
722
636
536
595
697
Mar Apr May Jun Jul Aug Sep
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Enrollees per facility
16
0
50
100
150
200
250
300
350
400
Murchison Kwa Mbunde Gamalakhe
5036
156
240
80
226
314
106
302
272
103
261
234
64
238222
103
270
390
72
235
Mar Apr May Jun Jul Aug Sep
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Benefits
• The system directly interfaces with NHLS, results in very rapid turn around time
• Rapid linkage to care (less than 5 working days from results to treatment initiation)
• Easily to trace contacts if the cell phone and address is given
• Reduce initial loss to follow-up
• Very easy for districts to see which patients have been linked to care
• List of schedule appointments at the initiation site.
17
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miLINC
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• Finalist, best health application
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Vodacom mHealth SMS (2011-2014)
• CD4 count lab results (2 CoJ clinics)
– 5 967 patients signed up
– SMS with CD4 count lab result
• Adherence support and appointment reminders (3 CoJ clinics)
– 5 067 / 6 484 patients signed up
– Preliminary results show patients receiving first 6 months of SMSs were 2.8 times more likely to attend on time!
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B-Wise.mobi
• YoungAfricaLive– Youth-oriented health mobisite (Kenya, Tanzania and
South Africa)
• B-Wise.mobi– Re-branded by NDoH as B-Wise.mobi– Articles/Stories, Polls/Surveys, Live chats – 27 000 users (unique visitors and registered users)
• 18 500 desktop• 7 500 mobile phones• 500 tablets
– New features: Clinic finder, ‘Your Words’, Age-tagging
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B-Wise.mobi
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MAMA South Africa
• MAMA SMS (6 CoJ clinics)– 12 500 women signed up– SMS user research study
• 650+ interviews done• MAMA users averaged at least 1 more ANC visit (~3 visits vs ~4.)• MAMA users more likely to attend 4+ ANC visits & all EPI visits.
• AskMAMA.mobi and MXit– Maternal and child health mobisite– 870 000 unique visitors and registered users (AskMAMA.mobi)– 105 000 unique visitors and registered users (MXit)
• MAMA USSD– 35 000 women signed up
• MAMA SMS and USSD are now MomConnect across all provinces!– Mobisite platform currently being converted to MomConnect
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AskMAMA.mobi and MomConnect
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New: Smart Linkage to Care (Smart LtC) App• Background
– Research shows smartphone applications (apps) improve adherence through engagement
• Perera et al. (New Zealand, 2014) found decreased viral load at 3 months (p=0.023) in patients (n=28)
– High smartphone use in SA
• Ownership = 35-50% smartphone
• New sales = 85% smartphone
• Observation of high smartphone (70-80%) use in Hillbrow CHC
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Smart LtC App: Key Features
• Password-protected (username, password and PIN)
• Lab results, health information and appointment reminders
• HIV, TB, STI, healthy living information content and links
• English and isiZulu
• Consuming minimal network data
• Non-descript app icon and name
• For lab results Simple notification
• Call-back number for technical problems
• App usage monitored, including during clinic visits
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Registration and Log-in
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CD4 and Viral Load Results
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Content
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Programmatic and Social Services
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FAQs
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But…
• Enrolment has been slow
• Less owners of smartphones than we thought
• Battling to get young men
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Other mHealth Projects @ Wits RHI
• PrEP Demonstration Project (SMS)– Appointment reminders
– Customised support messaging (seven key areas)
• RCT based on Vodacom project (SMS)– CD4 count lab results
– Appointment reminders
– Customised adherence messaging
• ShaReMo (mobisite)– Registration
– Clinical trial information
• Adolescents (SMS & mobisite)– Appointment reminders
– Customised support messaging
– Bulk messaging
– CD4 count lab results
– Referrals
• CHOICES (SMS)– Appointment reminders
– Bulk messaging
– Logic messaging (i.e. Birthdays, over 18 years)
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Support Messages (SMS)
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Big idea
• Drug stock outs model…
• AIDS helpline?
• Could we link the country to a specialist referral network?
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