mHealth: anything in the pipeline?Francois Venter

Wits Reproductive Health & HIV Institute

Thanks John Black, Lynsey Stewart, Jesse Coleman, Eugene Sickle, NHLS, DoH

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

What’s the single most useful tech currently for health care workers?

Oh, and….

• Online links to NHLS results

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?

So, some example programmes

The MDR-TB Partnership

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

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

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

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.

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.

Web Dashboard

Patients Enrolled

15

242

546

722

636

536

595

697

Mar Apr May Jun Jul Aug Sep

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

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

miLINC

• Finalist, best health application

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!

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

B-Wise.mobi

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

AskMAMA.mobi and MomConnect

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

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

Registration and Log-in

CD4 and Viral Load Results

Content

Programmatic and Social Services

FAQs

But…

• Enrolment has been slow

• Less owners of smartphones than we thought

• Battling to get young men

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)

Support Messages (SMS)

Big idea

• Drug stock outs model…

• AIDS helpline?

• Could we link the country to a specialist referral network?