Supportive mHealth: Using mobile systems in prevention of mother to child transmission & HIV support services

1. Supportive mHealth: Using mobile systems in prevention of mother to child transmission & HIV support services Dr Peter Benjamin peter@cell-life.org Skype ID: peterbenjamin @PeterB_CellLife www.cell-life.org.za

2. What will be covered? • Introduction to Cell-Life • mHealth to support Prevention of mother-to-child HIV transmission • Other mHealth for HIV applications • mHealth next steps: beyond the hype

3. What will be covered? • Introduction to Cell-Life • mHealth to support Prevention of mother-to-child HIV transmission • Other mHealth for HIV applications • mHealth next steps: beyond the hype

4. What is Cell-Life is? • Not-for-profit making tech & services accessible to improve health & meet social challenges • Started 2010, UCT & CPUT • Cape Town, SA • 10 African countries (mainly SA) • 25 staff (mainly techies) • Open Source

5. What do we do? • Applying eHealth (especially mHealth): • Social & behaviour change communications • Primary health system strengthening • We are one of the few mHealth organisations active in • Technical development • Proof-of-concept pilots at sites • Larger health system implementations • Developing business models • Research • Policy

6. What will be covered? • Introduction to Cell-Life • mHealth to support Prevention of mother-to-child HIV transmission • Other mHealth for HIV applications • mHealth next steps: beyond the hype

7. mHealth and PMTCT • Initial Randomised Controlled Study • RahimaMoosa Mother & Child Hospital, Jo’burg • RCT 320 mothers (½ test, ½ control), informed consent • SMS info & reminders (30 messages over 10 weeks) • Msgs help women deal with status, ‘psycho-social’ support • “Text messaging improved infant follow-up rates in this urban South African context”, small effect • Great difficulty in collecting & verifying all data

8. mHealth and PMTCT (Cont) • Scaling up, 2012 – 2013 • Funding: UN Innovation Working Group (Norad) • Partners larger orgs (RTC) & DOH districts • Mothers about to give birth (birth week) or baby < 3 months • Advice on PMTCT, breastfeeding, keeping healthy, signs of illness, baby care • Expecting mothers • Advice on PMTCT, pregnancy care, preparing for labour, breastfeeding and baby care

10. SMS Themeses

11. Hello. PMTCT means preventing a mother from infecting her baby with HIV. The treatment is free at the clinic. HIV+ mothers can have HIV-negative babies. SMSBaby Please eat well. So fruit, vegetables, cereals & whole grains (like brown bread & oats), meat & eggs. Don't want to eat? Try many small meals. SMSBaby You can help stop your baby getting HIV by going to all clinic checkups, having the right medicines, & feeding breastmilk ONLY for the first 6 months. SMSBaby Good day good Mom. Your baby will love the sound of your voice. He will show you by his smiles and wriggling. Talk and sing to him every day. SMSBaby

12. Issues scale & integrating with health system • Hawthorne Effect • Little staff time for new procedure: opt-in • Pilots often have people who can ‘help out’ • Just for HIV+ or all pregnant women? • HIV explicit? (Now 40% use HIV words) • Data flows to make information useful to management • Health economic study (Cost to Qualy)

13. What will be covered? • Introduction to Cell-Life • mHealth to support Prevention of mother-to-child transmission of HIV • Other mHealth for HIV applications • mHealth next steps: beyond the hype

14. Mobile Data Collection

15. Clinical data collection in SA public sector • Dept of Health cellphone rollout • 12,000 phones • Data collection for all 4,332 health facilities • First application: monitoring of HCT & ARV • Project awarded to Cell-Life and HISP • Initial rollout in 950 facilities June 2012 • Full rollout from Sept - Nov 2012 • Infrastructure for clinical mHealth

16. Communicate applications

18. What will be covered? • Introduction to Cell-Life • mHealth to support Prevention of mother-to-child transmission of HIV • Other mHealth for HIV applications • mHealth next steps: beyond the hype

19. mHealth issues • Every trial shows people like messaging • Most well-designed studies show small impact • Great potential – but more hype than reality • Growth sector (feeding frenzy) • MAJOR issue of going to scale • Cost of SMS / limitations of USSD • Integrate to weak Health Info Systems • Take data security & privacy seriously

20. Next steps in mHealth in SA • SA DoH & private interest for NHI • ICT4 Health Stakeholders Forum • Need national integrated systems: • Data collection system, MAMA messaging • Enabling regulation • “Ecosystem model” • Sustainability beyond pilots & donors: 2 - 3 years to embed what works

21. Nkosi Siyabonga Ke a leboga Dankie Thank you Dr Peter Benjamin peter@cell-life.org Skype ID: peterbenjamin @PeterB_CellLife`