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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 4726 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.