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Programme Mwana 2 Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and Underserved Areas. Mobile health technology has the power and potential to make PMTCT more efficient and effective. The Problem

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slide1
Programme Mwana2Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and Underserved Areas
mobile health technology has the power and potential to make pmtct more efficient and effective
Mobile health technology has the power and potential to make PMTCT more efficient and effective
  • The Problem
  • Overburdened health system and difficult to reach areas
  • The Innovation
  • Strengthen entire PMTCT system using mobile technology

How Programme Mwana improves this

    • Now: Decrease turnaround time for PCR test results, increase number of results, enable real-time problem-solving
    • Future: Track women and children to ensure that all individuals living with HIV are tested, enrolled in care, and treated
slide3
There are huge challenges implementing programs and tracking progress in line with the Global Plan and MDGs
  • The Global Plan seeks to eliminate vertical transmission by 2015
    • Reduce new HIV infections among children by 90% & AIDS-related maternal deaths by 50%
  • However, we have no way to accurately identify the number of children currently infected
  • Using current methods, we will not know if we have reached the MDGs until the date has passed
    • Current monitoring: expensive, labor intensive, retrospective, one-way information flow
slide4

Failure to identify and enroll children living with HIV on treatment is a critical gap in the PMTCT cascade; many of these are in remote areas where UNICEF works

EID

Treatment

?

Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, 2011

slide5
Although Early Infant Diagnosis (EID) is a critical part of elimination efforts, many think that it is an intractable problem

Challenges with EID

  • Do not know true transmission rates in countries
  • Lengthy transport of samples to the central labs
  • Long distances that mothers have to travel for multiple visits
  • Long turnaround times
  • Do not know whether mothers receive results
  • Other approaches have failed
  • PCR turnaround time has been the focus, but turnaround time is not enough
  • No cohort data, only cross-sectional so hard to know longer-term results
  • Faster results do not necessarily mean that infants are being treated
  • Lack of community interaction
  • Point-of-care solutions are far away from being implemented

Mwana is the response to that is faster, cost-effective, and approaches the problem at a systems level TODAY

slide6

Programme Mwana utilizes two main software components

  • Health system focused, trained Clinic Staff
  • Community focused, trained Community Health Workers (CHWs)
  • All SMS are free to end users
slide7

To build the software for Programme Mwana we moved to rural Zambia and spent six weeks co-creating it with clinic staff

slide10

Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes

56% improvement in Turnaround Time of results

Sidenberg et. all, Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results, Bulletin of the World Health Organization 2012;90:348-356

slide11

Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes

30% more results delivered using SMS

Schaefer, Nicholson, Mugala; Monitoring and Evaluation Presentation to the Zambia Ministry of Health; 2011

slide12

A MoH Tiered Management plan allows for redundancy in accountability

Primary Support

Secondary Support

Lab Team

Software Development Team

slide16

EID before Mwana was primarily an “ad hoc” system

Previous Follow-Up/Tracking System

Steps in EID Cascade

Infant born to HIV+ mother

?

Ad hoc

Clinic DBS test within 2 months

Physical paper system in clinic but data not utilized at district or national level

PCR lab analysis

DBS result back to clinic

?

Ad hoc

CHW finds mother

?

Ad hoc

?

Mother comes back to clinic

Ad hoc

?

Ad hoc

Mother goes to ART clinic

slide17

Mwana addresses every step of the EID cascade to ensure timely, accurate and consistent communication and to decrease loss to follow-up

Mwana Follow-Up/Tracking System

Steps in EID Cascade

Infant born to HIV+ mother

CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic

Clinic DBS test within 2 months

DBS sample traced up to lab

PCR lab analysis

Result sent to all clinic staff for retrieval

DBS result back to clinic

Clinic can initiate TRACE on mother

CHW finds mother

CHW tells system it has TOLD mother

Mother comes back to clinic

Mother goes to ART clinic

slide18

Potential next steps would be to add ART clinics in to Mwana – providing a complete real-time monitoring and management tool

Mwana Follow-Up/Tracking System

Steps in EID Cascade

Infant born to HIV+ mother

CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic

Clinic DBS test within 2 months

DBS sample traced up to lab

PCR lab analysis

Result sent to all clinic staff for retrieval

DBS result back to clinic

Clinic can initiate TRACE on mother

CHW finds mother

CHW tells system it has TOLD mother

Mother comes back to clinic

Next steps: FEEDBACK/VERIFY (protocol & study design)

?

Mother goes to ART clinic

mwana is scaling nationally in both countries more sites more women and infants served
Mwana is scaling nationally in both countries (more sites, more women and infants served)

% National

Coverage

% National

Coverage

1% 10% 38% 60% 100%

11% 22% 55% 100%

this scale up is being led by government and supported by a wide range of partners
This scale up is being led by government and supported by a wide range of partners.

Government & UN

Implementing Partners

Mobile Network Operators

Donors

slide27

Through mobile technology, Mwana has a huge potential to positively impact health systems and reach “the last mile” more quickly and effectively

Improves program outcomes and increases health impacts

Simplicity allows wide use and uptake in low-resource/rural settings

Real-time data enables real-time management & strengthened M&E

Builds on existing infrastructure, partnerships, and lessons learned

Engages communities in the process

slide28

Thank You

Merrick Schaefer

merrickweb@gmail.com

@unimps

http://github.com/rapidsms/rapidsms/