MobileActive.org

A new technology has crept onto the African scene that has enabled a step change in the way that the poor can access and share information. This concept paper outlines why we believe that Instant Messaging (IM) through services such as Mxit and JamiiX can make a significant difference, not only to the provision and impact of information services, but more importantly to the ongoing coaching and mentoring of individuals and communities. This technology offers benefits in terms of lower cost and greater ease of use, whereby users can enter into a “conversation” with a service provider. It is this ability to establish a relationship through the multiple exchange of texts that distinguishes the system from SMS based information services, and it is relationships that hold the key to translating information into practice and thus lasting transformation.

In November 2009, the USAID | DELIVER PROJECT office in Zambia, with technical assistance from the home office, conducted the End-Use Verification activity to assess the performance of the logistics management and supply chain systems for selected essential drugs, malaria and family planning commodities.

The survey was used in conjunction with the ongoing Essential Drugs Logistics System Pilot in Zambia, and overall objective was to assess how the logistics systems managed selected commodities at public health institutions, as well as provide a snapshot of how malaria was being diagnosed and treated at lower level facilities. This report presents the findings of the assessment as well as the short- and long-term recommendations to successfully implement the End-Use process, as well as the use of EpiSurveyor for regular data collection purposes.

In the context of the rapid growth of mobile phone penetration in developing countries, mobile telephony is currently considered to be particularly important for development. Yet, until recently, very little systematic evidence was available that shed light on the developmental impacts of mobile telecommunication. The Information and Communication Technology for Development (ICT4D) program of the International Development Research Centre (IDRC), Canada, has played a critical role in filling some of the research gaps through its partnerships with several key actors in this area.

The objective of this paper is to evaluate the case of mobile phones as a tool in solving development problems drawing from the evidence of IDRC supported projects. IDRC has supported around 20 projects that cut across several themes such as livelihoods, poverty reduction, health, education, the environment and disasters. The projects will be analyzed by theme in order to provide a thematic overview as well as a comparative analysis of the development role of mobile phones. In exploring the evidence from completed projects as well as the foci of new projects, the paper summarizes and critically assesses the key findings and suggests possible avenues for future research.

Growth in mobile phone penetration has created new opportunities to reach and improve care to underserved, at-risk populations including those with tuberculosis (TB) or HIV/AIDS.

This paper summarizes a proof-of-concept pilot designed to provide remote Mobile Direct Observation of Treatment (MDOT) for TB patients. The MDOT model combines Clinic with Community DOT through the use of mobile phone video capture and transmission, alleviating the travel burden for patients and health professionals.

Three healthcare professionals along with 13 patients and their treatment supporters were recruited from the Mbagathi District Hospital in Nairobi, Kenya. Treatment supporters were asked to take daily videos of the patient swallowing their medications. Patients submitted the videos for review by the health professionals and were asked to view motivational and educational TB text (SMS) and video health messages. Surveys were conducted at intake, 15 days, and 30 days. Data were collected in 2008 and analyzed in 2009

All three health professionals and 11 patients completed the trial. All agreed that MDOT was a viable option, and eight patients preferred MDOT to clinic DOT or DOT through visiting Community Health Workers.

MDOT is technically feasible. Both patients and health professionals appear empowered by the ability to communicate with each other and appear receptive to remote MDOT and health messaging over mobile. Further research should be conducted to evaluate whether MDOT (1) improves medication adherence, (2) is cost effective, and (3) can be used to improve treatment compliance for other diseases such as AIDS.

Mobile phones are currently used by millions of people around the world. In Africa, mobile phone ownership and use has dispersed at a surprisingly rapid rate across the continent. Recently, there have been multiple and diverse efforts to exploit mobile technologies for purposes of health communication, including collection of health data and provision of health information. Using mobile phones to provide family planning information, however, is a new area that has received almost no attention from health workers.

Recognizing this as a gap and an opportunity, the Mobile for Reproductive Health (m4RH) project was born. The m4RH project is conceptualized as an automated, text-based system that is compatible with any and every mobile phone to maximize reach and access to family planning information via mobile phone. Since this is a new project and mobile phones are a novel method of delivering family planning information, formative research to obtain feedback on the project was carried out in countries where the m4RH project will be piloted in 2010.

We present an innovative approach to healthcare worker (HCW) training using mobile phones as a personal learning environment. Twenty physicians used individual Smartphones (Nokia N95 and iPhone), each equipped with a portable solar charger. Doctors worked in urban and peri-urban HIV/AIDS clinics in Peru, where almost 70% of the nation's HIV patients in need are on treatment. A set of 3D learning scenarios simulating interactive clinical cases was developed and adapted to the Smartphones for a continuing medical education program lasting 3 months. A mobile educational platform supporting learning events tracked participant learning progress. A discussion forum accessible via mobile connected participants to a group of HIV specialists available for back-up of the medical information. Learning outcomes were verified through mobile quizzes using multiple choice questions at the end of each module.

In December 2009, a mid-term evaluation was conducted, targeting both technical feasibility and user satisfaction. It also highlighted user perception of the program and the technical challenges encountered using mobile devices for lifelong learning.

With a response rate of 90% (18/20 questionnaires returned), the overall satisfaction of using mobile tools was generally greater for the iPhone. Access to Skype and Facebook, screen/keyboard size, and image quality were cited as more troublesome for the Nokia N95 compared to the iPhone.

Training, supervision and clinical mentoring of health workers are the cornerstone of the scaling up process of HIV/AIDS care in resource-limited settings (RLSs). Educational modules on mobile phones can give flexibility to HCWs for accessing learning content anywhere. However lack of softwares interoperability and the high investment cost for the Smartphones' purchase could represent a limitation to the wide spread use of such kind mLearning programs in RLSs.

[Adapted from Abstract]

This paper presents a year long study protocol for a trial, to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India (Chennai and Bangalore).

Researchers plan to enroll 600 treatment naïve patients for first-line treatment as per the national antiretroviral treatment guidelines at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders.

Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier.
Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out.

A step-by-step outline of designing a 24-month long trial to determine effectiveness of phone reminders for anti-retroviral adherence.

Background: The objectives are to compare the effectiveness of cell phone-supported SMS messaging to standard care on adherence, quality of life, retention, and mortality in a population receiving antiretroviral therapy (ART) in Nairobi, Kenya.

Methods and Design: A multi-site randomized controlled open-label trial. A central randomization centre provided opaque envelopes to allocate treatments. Patients initiating ART at three comprehensive care clinics in Kenya will be randomized to receive either a structured weekly SMS (’short message system’ or text message) slogan (the intervention) or current standard of care support mechanisms alone (the control). Our hypothesis is that using a structured mobile phone protocol to keep in touch with patients will improve adherence to ART and other patient outcomes. Participants are evaluated at baseline, and then at six and twelve months after initiating ART. The care providers keep a weekly study log of all phone based communications with study participants. Primary outcomes are self-reported adherence to ART and suppression of HIV viral load at twelve months scheduled follow-up. Secondary outcomes are improvements in health, quality of life, social and economic factors, and retention on ART. Primary analysis is by ‘intention-to-treat’. Sensitivity analysis will be used to assess per-protocol effects. Analysis of covariates will be undertaken to determine factors that contribute or deter from expected and determined outcomes.

Discussion: This study protocol tests whether a novel structured mobile phone intervention can positively contribute to ART management in a resource-limited setting.

Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations. 

We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.

The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.

This guide provides an inexpensive way to create an SMS communications network to enable healthcare field workers as they serve communities and their patients. The steps are purposefully simple – the system is easy to set up, use and maintain.

Answers to Frequently Asked Questions:

1. Who might benefit from a text-based communications network?
2. What are the benefits for my hospital, clinic or organization and the people it serves?
3. What technology do I need?
4. Do I need an internet connection?
5. How expensive is an SMS network?
6. How do I distribute communication credit?
7. How much staff training is required?
8. How much time does it take, per day, to manage the SMS network?
9. How do I conduct SMS training?
10. What is the best power source for the cell phones?
11. Do the CHWs communicate with each other?
12. Where can I find more information on FrontlineSMS?

This paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple barcoding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per
patient even though their case loads have risen threefold. It has helped integrate the local-level
primary health service provision of HAART with the kind of centralised data capture and analysis
that could potentially support a national HAART rollout.