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Project Masiluleke: Comprehensive HIV Care With Mobiles

Posted by MohiniBhavsar on Nov 24, 2010

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Project Masiluleke: Comprehensive HIV Care With Mobiles data sheet 4697 Views

Over 5 million people in South Africa are living with HIV and the country has the highest burden of TB-HIV co-infection. TB treatment completion and cure rates fall below 50% in almost half of the districts. Project Masiluleke, Zulu for to give wise counsel or lend a helping hand, stepped up to the challenge and is using mobiles to provide end-to-end care through awareness, testing, and ensuring treatment compliance.

Monopolizing on the 90% of South Africans who own mobile phones, the iTEACH team -- with collaborators from Pop!Tech, The Praekelt Foundation, and Frog Design -- brought HIV awareness to the masses and improved treatment compliance through the use of text messaging. Social stigma towards those carrying the disease results in low rates of HIV testing, and an overburdened public health system discourages people from utilizing available services at local clinics.

Basic Information
Website URL: 
http://www.iteachsouthafrica.o...
Organization involved in the project?: 
iTeach South Africa
Project goals: 

iTEACH identified four links in a chain of care essential for HIV and TB treatment success: [1] Effective awareness, [2] Scale-up of early HIV testing, [3] Early anti-retro viral treatment (ART) initiation, and [4] Support for ART and TB treatment adherence. In October 2007, Project ‘Masiluleke’ (Zulu for ‘to give wise counsel’ or ‘lend a helping hand’) or ‘Project M’, was launched to address these challenges with a chain of interventions designed for replication and scale. Project M is a collaborative effort, lead by the iTEACH NGO, along with a diverse set of partners (The Praekelt Foundation, Frog Design, Pop!Tech, MTN and Vodacom, LifeLine Southern Africa, Ghetto Ruff Records and the National Geographic Society).

Brief description of the project: 

Briefly, each of the three components of Project M addressed a specific barrier for people seeking care and for health care workers managing care.

1. TxtAlert: Reminders for HIV clinic appointments were sent to patients’ mobile phones as text messages. Showing up to your HIV clinic appointment largely correlates with anti-retro viral treatment (ART) adherence. In June 2007, TxtAlert, an SMS-based automated ART clinic appointment reminder system was piloted in partnership with Right to Care at the Themba Lethu Clinic, the largest privately funded ART treatment site in South Africa. TxtAlert is a web service that is linked to the electronic medical record system.

Clinic appointment reminders are sent to patients who are receiving ARVs, both two weeks and one day before their scheduled appointments. Text messages are also sent one day after the appointment to either thank the patient for coming or to alert them of a missed appointment and encourage rescheduling.

2. SocialTxt: A mass mobile messaging campaign was launched to raise HIV awareness, and directed people to the National AIDS Helpline. In October 2007, a mass text message HIV awareness campaign was launched with the so-called SocialTxt technology developed by the Praekelt Foundation.

One million text messages were sent everyday to mobile phone users throughout South Africa that contained key information about HIV and TB and directed mobile phone users to a free National AIDS Helpline.

The campaign resulted in an impressive 300% increase in calls to the helpline, from 1000 calls a day to 3000-4000 calls a day. Since the project launch, over 685 million PCM messages were sent to the helpline. Upon receiving the PCM message, staff at the helpline, who are HIV patients themselves, offer counseling and direct callers to HIV and TB testing centers.

3. HIV Self-Test Kit: Currently in development is a home-based HIV test kit that has the option of calling the National AIDS Hotline for guidance and assistance. The hope is that this kit will enable South Africans to perform an HIV test, in the privacy of their own homes, with the option of calling a counselor at the National AIDS Helpline via cell phone.

Target audience: 

Project M is being piloted in KwaZulu-Natal (KZN), which is the South African province with the highest HIV burden and poorest TB treatment outcomes. The project will be managed from Edendale Hospital, which is located in one of the hardest hit districts in KZN (Umgungundlovu) where 60% of pregnant women test HIV+ and 200 new cases of TB are registered every month. Edendale serves an exclusively Zulu population of 1 million persons, where unemployment is estimated at 60% and most are living in abject poverty.

Edendale was selected specifically because it is replete with challenges faced by large government hospitals at the epicenter of the HIV and TB crisis. Success in this setting would suggest that replication and scale-up in similar underserved communities is feasible.

Detailed Information
Mobile Tools Used: 
TxtAlert
Length of Project (in months) : 
3
Status: 
Ongoing
What worked well? : 

1. TxtAlert: HIV/AIDS Clinic Apppointment Reminders

  • 80-90% opt-in rate was observed at the clinics.
  • Patients started to rely on TxtAlert reminders so much so they were less likely to switch their mobile phone number.
  • Patients started to interact with TxtAlert system via "Please Call Me" messages to reschedule their appointments in advance.
  • Patients currently on ARVs at the pilot site assisted in encouraging patients to opt-in for the SMS alerts.

2. SocialTxt: Mass mobile campaign to raise HIV awareness and direct people to the National AIDS Helpline

  • iTEACH offered relevant clinical and cultural expertise for the content of the SocialTxt SMS messages.
  • The project increased the number of calls by 300% to the National AIDS Helpline.
  • It leveraged the massive uptake of "Please Call Me" messages in South Africa for a large public health messaging campaign at no cost to people.

3. HIV Self-Test Kit, with option of calling via mobile phone to the Helpline

  • Focus group discussions revealed people prefer telephone interactions to seek counseling and HIV testing support, as opposed to in-person consultations.
  • Mobile phones address the issue of perceived stigmatization at clinics, which deters people from getting tested.

 

What did not work? What were the challenges?: 

1. TxtAlert: HIV/AIDS Clinic Apppointment Reminders

  • The process of collecting and registering numbers of patients was tedious, though outcomes show it was well worth it. This process took about 3 months.
  • There is a need to confirm at each appointment that the patient's number is the same as that listed on their system. Many people switch between 2-3 SIM cards.

2. SocialTxt: Mass mobile campaign to raise HIV awareness and direct people to the National AIDS Helpline

  • There are challenges in securing mobile operator support, though this changed once a profitable business case was demonstrated.
  • Counselers at the helpline need more training to deal with the increased volume in calls and to ensure the quality of service is not compromised.
  • The service needs to have increased coverage during evenings and weekend.
  • Counselers need better knowledge of local resources to make effective referrals.
  • A toll-free line is needed so mobile phone users can call without charge. The Helpline is toll-free only if calls are made via landlines.

 



 




  
Family Planning through the Mobile Phone, No Doctor Necessary!


Posted by MohiniBhavsar on Oct 02, 2010





 

        
      
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Family Planning through the Mobile Phone, No Doctor Necessary! data sheet 4854 Views

	
The Institute for Reproductive Health (IRH) at Georgetown University, has pioneered a new way to inform women of their fertility status using mobiles.  IRH conducted proof of concept testing in India for an SMS-based delivery of the Standard Days Method (SDM) as an information based, low-cost and non-hormonal method of family planning.


SDM is a scientifically tested fertility awareness-based method that is recommended by WHO as a modern, natural family planning method. From the first day of menses, in a 26-32 day cycle, a woman’s most likely fertile days are from days 8 to 19. Avoiding intercourse during these days of the cycle has been tested to show up to 95% effectiveness against pregnancy.


Because of the high use of traditional methods for family planning, and the ubiquity of mobile phones, IRH thought of developing an innovative mobile platform for reproductive health called CycleTel™. Currently in pilot phase, women can subscribe to the service via SMS on the first day of the menses, after which, a text message is sent to her mobile indicating her fertility status as per the 8-19 day fertile window.
Basic Information

      
Website URL: 

    

            

                    http://www.irh.org        

        





      
Organization involved in the project?: 

    

            

                    Institute for Reproductive Health, Georgetown University        

        





      
Project goals: 

    

            

                    
To offer the Standard Day Method, a non-hormonal, periodic abstinence,  information-based method of family planning, through the mobile phone as an SMS service. The aim of the project was to transform an existing fertility awareness tool, called the CycleBeads®, to a mobile phone version.

        

        





      
Brief description of the project: 

    

            

                    
Because of the high use of traditional methods for family planning, and  the ubiquity of mobile phones, IRH thought of developing an innovative  mobile platform for reproductive health called CycleTel™. Currently in pilot phase, women can subscribe to the  service via SMS on the first day of the menses, after which, a text  message is sent to her mobile indicating her fertility status as per the  8-19 day fertile window.

        

        





      
Target audience: 

    

            

                    
Women in developing countries, who are interested in using a traditional method of family planning that is non-hormonal, periodic abstinence and information-based. Or women seeking to try other birth control methods than the pill, IUD or condom. Or, women currently using the CycleBeads® tool for family planning, but would like switch to a mobile phone-based tool.


Due to literacy barriers observed in the proof of concept testing, the target audience may shift focus to middle and high income women, who have higher educational background.

        

        








Detailed Information

      
Mobile Tools Used: 

    

            

                    FrontlineSMS        

        





      
Length of Project (in months) : 

    

            

                    2        

        





      
Status: 

    

            

                    Ongoing        

        





      
What worked well? : 

    

            

                    
    

  • While the SMS alerts were targetted to women, many male partners showed interest in also receiving the information to their phones. 
    • 

  • Messages sent in "Hinglish" were best understood.
    • 

  • Men and women, who participated in Cycletel pilot test, were willing to  pay for the service. In the focus group discussions, women suggested  20-25 rupees, men suggested 15 rupees and couples suggested 30-35 rupees  as reasonable monthly price for CycleTel. 
    • 

  • Prior to the pilot test, a large investment was made to involve potential users of the service to give input in the design of the service and composing of text message alerts.
    • 


        

        





      
What did not work? What were the challenges?: 

    

            

                    
    

  • A text message for the helpline number was sent later during the trial, and users preferred it to be sent earlier. 
    • 

  • Women preferred responding to yes or no questions rather than entering key words like “red”, “date” or “agree”. 
    • 

  • Women preferred that messages were limited to 1 SMS, instead of being broken into 2 SMSs. 
    • 

  • Greetings, like “great”, “thank you”, confused participants and  women did not know whether to answer or not. Often they thought they had  to respond to every message they received.
    • 

  • After the pilot testing, there were several non-users. IRH learned that often their womens’ mobiles were switched off. 
    • 

  • There was incompatibility between the major mobile network  operators Vodafone, Reliance and Airtel that impeded their use of the  CycleTel service.
    • 

  • Though initially, SMS messaging was thought to be a common practice, IRH  learned quickly that many women who own a mobile phone were not in fact  in the habit of actually writing and sending SMSs. Instead, women more  commonly were accustomed to forwarding SMS. 
    • 

        

        





      
Links to any evaluations/reports/research: 

    

            

                    http://mobileactive.org/resear...        

        












 




  
Factors Influencing Citizen Adoption of SMS-Based e-Government Services


Posted by MohiniBhavsar on Sep 02, 2010





 

        
      
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Factors Influencing Citizen Adoption of SMS-Based e-Government Services data sheet 2598 Views

	

      
Author: 

    

            

                    Susanto, T, D and Goodwin, R.        

        





      
Publication Date: 

    

            

                    Jan 2010        

        





      
Publication Type: 

    

            

                    Journal article        

        





      
Abstract: 

    

            

                    
This paper identifies the factors that determine citizens’ acceptance of SMS-based e-government services. It reports on a web-based survey, paper-based questionnaires, and phone-call interviews that collected 159 responses from 25 countries. The results indicate that there are fifteen perceptions toward using SMS-based e-government services that may influence citizens to use or to reject the services:


    

  • perceived ease of use
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  • perceived efficiency in time and distance
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  • perceived value for money; perceived usefulness
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  • perceived responsiveness; perceived convenience
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  • perceived relevance, quality and reliability of the information
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  • trust in the SMS technology
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  • perceived risk to user privacy
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  • perceived reliability of the mobile network and the SMS-based system
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  • trust in government and perceived quality of public services
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  • perceived risk to money
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  • perceived availability of device and infrastructure
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  • perceived compatibility; and 
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  • perceived self-efficacy in using SMS.
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Whether or not a citizen adopts an SMS-based e-government service is influenced by these perceptions. To increase the acceptance of SMS-based e-government services, the systems should address all of these belief factors. An intensive advertising campaign for the services in all mass media channels is critically important to make citizens aware of and to provide detailed knowledge about the services. The advertising campaign should involve people who influence individuals’ decision making. These people include friends, family, teachers, experts, public figures, and government officials. This study found that Notification services are the most frequently used followed by Pull SMS, Listen, and Transaction SMS services. Notification services could be an appropriate starting point for governments who want to establish SMS-based e-government services.