Closing the HIV/AIDS gap with Digital Health Interventions; Commemorating World AIDS Day 2019.

The 2019 World AIDS Day is being commemorated under the theme ‘Know Your Status’. In this regard and in the fight against HIV/AIDS scourge, Uganda has made significant and steady progress. Current performance against the UNAIDS 2020 90:90:90 target shows  84% of HIV positive people are aware of their positive status, 87% receive antiretroviral medicines and 88% of those have achieved viral load suppression status [1]. A number of interventions have been attributed to these gains, however, we would like to highlight the contributions of Digital Health particularly Tele-health approaches implemented by The Medical Concierge Group (TMCG) in the areas of HIV/AIDS prevention, care and treatment in Uganda.

TMCG is a digital health company headquartered in Kampala-Uganda with a track record of 6 years in implementing HIV/AIDS related public health projects in collaborations with local and international partners. As the digital health partner in consortium-delivered projects, TMCG’sr role is to implement cross cutting interventions in HIV prevention, care and treatment leveraging on digital technologies

In HIV/AIDS prevention, these include; mobile messaging dissemination for behavioral change communication. This involved developing health content on HIV/AIDS prevention topics and making it available to beneficiaries via mobile SMS. During the implementation of the HIV/AIDS Initiative at Workplaces Activity (HIWA) project from October 2016 to October 2019, we reached a total of 49,371 target beneficiaries i.e. police officers, hoteliers, private security guards and wildlife personnel with prevention awareness messages via mobile SMS platforms.

Image 1: IEC material showing how to access health content on mobile phone

In addition, Tele-health supports other biomedical HIV/AIDS prevention programs like Voluntary Medical Male Circumcision (VMMC) and Pre-Exposure Prophylaxis (PrEP). This is done through availing a 24/7 call center services manned by qualified doctors to offer remote support to VMMC and PrEP beneficiaries on inquiries ranging from adverse events, post-operative follow up in addition to supporting honoring of health facility appointment through sending mobile SMS reminders.

Image 2: Tele-Health doctor on call.

In the Regional Health Integration to Enhance Services (RHITES-North, Lango) project currently implemented in 9 districts of Lira, Otuke, Alebtong, Apac, Dokolo, Kwania, Oyam, Amolator and Kole. TMCG is the digital health partner in collaboration with  John Snow Inc, CUAM doctors for Africa, AMREF and Another Option. TMCG has supported 339 clients on PrEP and 2,401 VMMC beneficiaries with aforementioned support services.

The timeliness and convenience tele-health services  offer support beneficiaries to have their inquiries handled remotely without the need to physically visit a health facility. For instance this example of an SMS inquiry from a 27-year-old female PrEP beneficiary from Dokolo district.

“I am HIV negative but my husband is HIV positive and taking antiretroviral therapy. I started taking PrEP medicine at Dokolo HCIV this month. When shall I stop taking this medicine?”

In HIV/AIDS care and treatment, TMCG implements Tele-health activities among HIV positive clients that aim at improving retention rates through sending facility appointment SMS reminders. During the HIWA project lifetime; TMCG supported 1,740 beneficiaries on antiretroviral treatment (ART) from 8 police health facilities including; Nsambya, Jinja, Mbale, Masaka, Rukungiri, Naguru, Gulu, Arua and Mbarara police health centers. The project achieved an 89% retention rates during 2018 which was a great improvement from the 45% at inception during 2016.

In addition, SMS reminders for routine viral load schedules and monthly voice call follow up of unsuppressed HIV positive clients to augment facility-based intensive adherence counselling sessions are interventions implemented among unsuppressed clients. This tele-health approach to supporting unsuppressed HIV positive clients has contributed to the return-into-care campaigns of the RHITES-N Lango project where previously lost-to-follow-up clients are re-contacted and brought back into care.  

In the Elimination of Mother-to-Child transmission of HIV (EMTCT) campaign tele-health supports  access to HIV prevention information targeting adolescent girls and young women as a means of preventing new infections. In addition, TMCG improves access to family planning messaging and leverage on voice and SMS platform for referral and linkage of women seeking contraceptive services. For the HIV positive pregnant women, providing stage-based mobile messages for a successful pregnancy and safe delivery is an additional component to Tele-health support of EMTCT. Data analysis of a cohort from January to December 2017 of 242 EMTCT mothers on Tele-Health support under the HIWA project revealed 97% (236 mothers) reported to have delivered in the hands of a skilled healthcare worker with 100%reporting to have received Nevirapine syrup for their infants.

Image 3: Tele-Health support of EMTCT Cascade

TMCG recently launched Rocket Health, a consumer focussed service that makes it possible for one to order an HIV self-testing kit on an online eShop  and it gets delivered to one’s location of convenience. Placing an order can be done online via the eShop (rockethealth.shop), a toll free phone call to 0800 100 700 or over WhatsApp chat to +256 790 512 074.

Image 4: Making an order of the HIV self-testing kit via Rocket Health eShop

TMCG’s  findings have been presented at both national and international conferences such as the 19th and 20th International Conference on AIDS and STIs in Africa (ICASA)with accolades such as the Young Achievers Award at the 2018 Joint Annual Scientific Conference,

In conclusion, simple effective telecommunication platforms like mobile phone SMS and inbound/outbound voice calls have been shown to be easily adaptable and effective. They solve  common challenges in delivery of HIV/AIDS related activities by increasing of contact time improving patient follow up systems beyond the health facility and better audience segmentation for key messages. With a forecast of increasing phone ownership, internet penetration and lower costs , the HIV/AIDS gap in Uganda would inevitably close towards an HIV/AIDS free country.

Reference

  1. UNAIDS AIDSInfo. (Accessed November 2019). http://aidsinfo.unaids.org/
  2. Uganda Communication Commission. Communication Sector Performance Report Quarter ending December 2018. https://www.ucc.co.ug/wp-content/uploads/2017/09/UCC-Sector-Report-December-2018_260719.pdf

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