HIV (27)

HIV’s still a global epidemic affecting most Low and Middle Income Countries (LMIC).  Some 4% of people in Africa are HIV+. At 12% of all deaths, HIV/AIDS is the biggest cause.

Lesotho’s no exception, in fact it’s much worse. According to the UNAIDS Gap Report, 310,000 people in Lesotho are living with HIV, about 23% of the population. Only 42% of adults receive Anti-Retroviral Treatment (ART).  Most of Lesotho’s population live in rural areas, making healthcare access challenging.  

One of the benefits of mHealth is meeting challenges of poor healthcare delivery, especially for HIV treatment. To address this challenge, The Guardian has reported that Lesotho’s Ministry of Health (MOH) has introduced an mHealth programme developed by Vodacom. It’s a combination of a smartphone app for healthcare providers and M-Pesa, a mobile money service for the patients. M-Pesa is a money transfer service for people to receive or send money using a mobile phone. It’s widely available throughout Sub-Saharan Africa. Since women and young children are most affected by the HIV epidemic, the programme focuses mainly on them.

The programme allows healthcare providers to undertake on-site HIV testing through a mobile clinic in remote areas where travelling’s difficult so that community members can receive care. Healthcare providers can register HIV+ patients in the central database that’s used to provide patients with funds through M-Peas for transport costs. Health care providers can also use the database to plan, record and access treatment.

If the mHealth programme’s delivered as planned, it should achieve three benefits set out by Ken Congdom of Health IT Outcomes:

  • Improved data accuracy
  • Improved data access
  • Improved patient care

HIV is an immense healthcare crisis for the people of Lesotho. This programme aims to ensure that thousands of mothers and young children in some of the poorest communities in the world receive the care and support they need.  

Texting young women in Kenya with regular information about sex, contraception, and sexually transmitted diseases has encouraged them to seek HIV tests. This’s an achievement in a country where stigma surrounding the virus is widespread, says an article in allAfrica. Some 600 female college students in Kenya received monthly surveys as text messages about their sexual behavior. In addition, 300 were sent weekly messages about HIV prevention, for a study by mSurvey.

Two-thirds of the 300 group said they were tested for HIV within six months of the study. Only half of those who had monthly surveys reported testing for the virus. "Young women across Kenya lack knowledge about HIV, but many have mobile phones and love texting," said Njambi Njuguna, a doctor and researcher at Nairobi's Kenyatta National Hospital.

Over 80% of people in Kenya own a mobile phone, according to a 2015 study by the Pew Research Center, a US think tank. "Women like receiving health surveys by text message because it's anonymous and they can do it at their convenience," Njuguna told the Thomson Reuters Foundation ahead of World AIDS Day on 1 December.

Kenya has reduced its HIV prevalence rate among adults to 6% from 11% in 1996, according to the United Nations Programme on HIV/AIDS (UNAIDS). The World Bank tables show it was slightly less than 6% in 2014. Even so, it’s still the leading cause of death in Kenya, responsible for nearly 30% of deaths, with roughly 1.6 million Kenyan infected. An average for Africa’s 12% of all deaths.

Almost 75% of women in the study hadn’t had an HIV test. Stigma and a lack of awareness about the risk of contracting the virus may be to blame, Njuguna said. The study found that most of the young women who sought testing said they chose to visit health facilities far away from where they lived to avoid being recognised.

The SMS campaign’ll be expanded next year to reach up to 15,000 women in ten of Kenya’s counties, It builds on the effective surveys already completed says mSurvey. It’s also looking to expand beyond SMSs such as using social media, such as Facebook.

The first national CD4/viral load monitoring dashboard has been launched in Johannesburg, South Africa, by Right to Care in collaboration with the Department of Health, the National Health Laboratory Service (NHLS), the National Institute of Communicable Diseases and Boston University. An article in IT-ONLINE says it‘ll help doctors and nurses monitor the health of HIV/Aids patients and reduce fatalities caused by illnesses linked to the virus.

The dashboard supports the Joint United Nations Programme on HIV and Aids (UNAIDS) 90: 90: 90 target for 2020. It’s goals are 90% of people infected with HIV should be diagnosed, 90% of them should be on treatment and 90% should have their viral load suppressed.  The initiative will be rolled out to all nine provinces between January and March 2017 to provide information at a national, provincial, district and individual level.

Nearly 6.8 million people are infected with HIV in South Africa. Some 3.3 million are on treatment. Of those who have undergone viral load testing, over 80% are viral load suppressed. Viral load is the best predictor of an HIV positive patient’s response to treatment. The dashboard will help improve the follow-up care of patients with high viral loads. Viral load is the best predictor of HIV positive patients’ responses to treatment. The dashboard will help improve the follow-up care of patients with high viral loads.

Dr Yogan Pillay, DG of the National Department of Health, says although the programme will be used by health practitioners, patients will benefit as their quality of life improves. Pillay said while the number of people accessing treatment increases, there’s a concern that the number of those defaulting will also increase. “Two things happen when patients default treatment. One, they get sick … we think they are taking medication but they are not. The second thing is that they can transmit the virus. That is why viral suppression is good for the patient, and good for the community they are living in.” He stressed the importance of early access to treatment to help to suppress viral load.

Dr Sergio Carmona, a pathologist at the NHLS, said the data will help to identify hotspots and where attention needs to be given. “The better we understand how patients are being managed, the better control we have of the epidemic. It will also help to swiftly allocate resources where needed such as infrastructure, nurses and doctors, monitor hotspots and expedite the right responses, as well as evaluate the effectiveness of interventions to contain the epidemic.”

There’s only 36 months left to reach the 90: 90: 90 target. South Africa still has a long way to go to achieve it.

At 12%, HIV/AIDS is still Africa’s biggest, but reducing cause of death. Lower respiratory infections is close behind. A research project reported in BioMed Central could help to bring it down further. It starts from the position that HIV-related mHealth interventions have shown efficacy in supporting treatment adherence, but evidence for promoting HIV testing’s inconclusive. The team attributes this deficit to two factors. One’s a limited understanding of processes used to develop interventions. The other’s weak, theoretical underpinnings. The goal is developing better, theory-based mHealth interventions to promote HIV testing of city-dwelling African communities.

Findings from 48 people in six focus groups are:

  1. Relatively low perception of HIV risk, especially amongst men
  2. A range of social and structural barriers to HIV testing
  3. Need for communities and professionals to work together to build a context of trust through co-location in, and co-involvement of, local communities
  4. This should enhance confidence in, and support for, HIV testing of health professionals
  5. Messages should avoid an exclusive focus on HIV, be tailored and personalised, come from a trusted source, allay fears and focus on support and health benefits
  6. Community outreach and community involvement is essential in order to create a more enabling environment for discussion and action on HIV
  7. Need to demonstrate cooperative working relationships with health professionals to enhance community trust.

The team says the prevailing context of mistrust and stigma associated with HIV lends strong support for mHealth interventions. When people are provided with information about HIV privately, and are in control of who to discuss the texts with, and whether or not to take action, improved testing is a likely outcome.

The challenge now is to turn these findings into action. Africa’s HIV’AIDS communities need it.

About 2.5 of Africa’s population live in Mozambique. Some 7% have HIV, so it’s a big health priority for the country. The WHO Atlas of African Health Statistics 2016 shows that HIV/AIDS is Africa’s biggest killer at 122 deaths per 100,000, and about 12% of all deaths.

The United Nations Children's Emergency Fund (Unicef) has partnered with government ministries in Mozambique to launch Biz, a youth-led SMS service. It uses Unicef’s U-Report social platform, a social monitoring system of free SMSs that promotes participation by, and counselling of, young people and adolescents on sexual and reproductive health and HIV/AIDS.

An article in allAfrica says the plan’s to use the potential of mobile phones to promote open dialogues on sexuality, reproductive health and HIV prevention. Adolescents and young people want more information as they explore their sexuality, personalised channels that respect their privacy, and they want to be at the centre of the response to their challenges.

In Mozambique, Unicef worked with government and Coalizao, a youth association, to adapt the SMS-based U-Report and roll out a pilot programme in four provinces. Now, SMS Biz can help adolescents and young people aged between 10 and 24 to express the problems they face and help to consolidate responses A counselling hub is managed by twelve young counsellors, equipped with ICT facilities and guidelines to respond to queries about HIV, gender-based violence, alcohol and drug abuse and other issues.

Francelino Murela, SMS Biz manager, said "We currently have 36,428 young people registered users on the system since its launch in October 2015. Our plan is to reach 50,000 adolescents and young people by the end of 2016 in the four provinces that the programme is currently running Most of the information given is available at local clinics but young people are scared to go to clinics because they don't want to be seen by their family relatives. Stigma and discrimination are real challenges for young people.”

SMS Biz also provides valuable insights into youth behavior and issues that need addressing. Several adolescents and young people engaged in peer discussions have expressed gratitude for having been reached by the initiative, particularly those in the rural areas who are further away from health services.

This simple service addresses a real need in communities. It provides youths with accurate healthcare information on sensitive topics, enabling them to make better informed and healthy decisions regarding their sexual and reproductive health. It’s a safe and private platform where open questions can be asked and answered.

South Africa has a high HIV prevalence. The World Bank put it as high as almost 19% in 2014. In Africa, Botswana, Lesotho and Swaziland had higher rates, with Namibia and Zimbabwe at about 2 percentage points lower. HIV/AIDS deaths account for 12% of all deaths, top of the list. While the death rate’s falling, HIV’s still a huge challenge.

 At this week’s 2016 International Aids Conference in Durban, a device like an Automated Telling Machine (ATM) will be launched that dispenses antiretroviral (ART) drugs.

A report in The Guardian says the device, a prototype that include robotics and costs about US$80,000, was developed at the Right to Care project based in Johannesburg’s Helen Joseph Hospital.

The team plan for it to make a big difference to combating HIV/AIDS, especially in Southern Africa. Four devices’ll be installed this week in Alexandra, a Johannesburg suburb with stubbornly high HIV rates. Two more are planned for later this year. Patients will be able to collect other medication for chronic conditions too. They include diabetes and TB.

The Guardian says half the people with HIV access treatment. The device aims to ensure people comply with to their regimes. It’ll help to alleviate the long waiting times at dispensaries. It will take its place alongside new diagnostic tests such as Samba, adding to the initiatives to deal with HIV.

The African Innovation Foundation (AIF) has announced the top ten nominees for its landmark programme, the Innovation Prize for Africa (IPA). Now celebrating its fifth year under the theme Made in Africa, IPA offers a grand share prize of $150 000 to spur growth and prosperity in Africa through home-grown solutions, an article in IT-Online says.

The IPA has seen considerable growth in applications and increasing interest from both innovators and innovation enablers over the years. IPA 2016 attracted a record of over 3,600 innovators and received 985 successful submissions from 46 African countries. African ingenuity this year showcases new breakthroughs in public health, including malaria, HIV/AIDS and cancer, smart solutions for farmers and dynamic energy initiatives. 

AIF will host the IPA 2016: Made in Africa awards ceremony on 22 and 23 June 2016 in Gaborone, Botswana. Collaborating partners include the Ministry of Infrastructure, Science and Technology (MIST), and the Botswana Innovation Hub (BIH). 

The healthcare solutions in the top 10 IPA 2016 nominees include:

Urine Test for Malaria (UMT)

Dr Eddy Agbo from Nigeria developed the UMT, a rapid non-blood diagnostic medical device that can diagnose malaria in less than 25 minutes. Africa has the highest number of malaria cases worldwide. The inability to quickly diagnose and commence malaria treatment can lead to various complications including kidney failure, build-up of lung fluid, aplastic anaemia and even death. UMT uses a dip-stick to get accurate results within half an hour. The technology detects malaria parasite proteins in urine of patients with fever due to malaria. UMT’is simple and affordable, and a potential game changer in managing malaria across Africa. 

Api-Palu

Valentin Agon from Benin also developed a solution to curb the spread of malaria. Api-Palu is an anti-malaria drug treatment developed out of natural plant extract. It is significantly cheaper than available anti-malarial drugs, and has great inhibitory effects on 3D7 strains of plasmodium falciparum the causative agent of malaria. According to the WHO, Sub-Saharan Africa is home to 88% of malaria cases and 90% of malaria deaths reported globally with some African governments spending up to 40% of their public health budgets on malaria treatment. Api-Palu manifests as a fast rate of malaria parasite clearance from the blood following short term treatment, with relatively lower doses. It is available in tablets, capsules or syrup. The drug has been approved in Benin, Burkina Faso, Tchad, and Central Africa Republic because of its therapeutic and non-toxic effects.

Exatype

Dr Imogen Wright, South Africa, solution addresses a different healthcare issue facing many African countries, HIV/AIDS. Exatype’s a software solution that enables healthcare workers to determine HIV positive patients’ responsiveness to Antiretroviral Drugs (ARV) drug treatment. According to WHO, 71% of people living with HIV/AIDS reside in Africa. 

A growing number of people on ARVs are resistant to drug regimens, leading to treatment failure, further exacerbating the continent’s HIV/AIDS burden. Exatype processes the highly complex data produced by the advanced next generation of DNA sequencing of HIV DNA in patients’ blood. A simple report detects drugs resistant to patients, then highlights the need to avoid these to ensure successful treatment. Exatype has the potential to contribute towards effectively managing HIV/AIDS in Africa, and also holds promise in helping detect drug resistance for other disease burdens such as Tuberculosis (TB) and malaria.

Aceso

Dr Kit Vaughan, also from South Africa, created an imaging technology, capable of performing full-field digital mammography and automated breast ultrasound at the same time, dramatically improving breast cancer detection. Annually, there are more than half a million cancer deaths in Africa and these numbers are expected to double in the next three decades. If diagnosed early enough, the chances of treating the cancer successfully increases dramatically. However, because 40% of women have dense tissue, their cancers cannot be seen on X-ray. Furthermore, a false negative finding can have devastating consequences. Aceso is a single device that can acquire dual-modality images, full-field digital mammography and automated breast ultrasound at the same time. This world first system’s protected by international patents and has been successfully tested in two separate clinical trials with 120 women.

Having four healthcare solutions emerging from the top ten Innovative solutions across the different sectors is very encouraging. All four address critical healthcare issues facing African health systems and have the potential to have a real impact and save lives across the continent.

Patients living with HIV/Aids in Uganda will soon be tracked and identified by a new system, thanks to a five-year project by the Centers for Disease Control (CDC). Monitoring and Evaluation Technical Support (METS), will use technology to scan patients fingerprints to help identify how many people are living with the disease and how many people are taking antiretroviral drugs. It’ll generate accurate, nationally accessible information on the HIV epidemic, says an article in allAfrica.

Prof William Bazeyo, dean of Makerere University School of Public Health and the METS principal investigator, said the project will be implemented in 48 districts across Uganda where CDC operates. The project also hopes to improve leadership in districts and hospitals, help in monitoring and evaluation and support data driven decision making.

Dr Elioda Tumwesigye, Minister of Health, said the surveillance area will focus on fingerprint technology to improve access to services andn tracking HIV patients, monitor drugs and generate information for decision making. Dr Tumwesigye, added "There is a lot of duplicity by patients. A patient can go to one testing centre and goes to another less than a month later and this goes on. If found HIV positive, some fear that a stockout may happen in an area and they register with different antiretroviral therapy clinics.” This duplication leads to drugs expiring if patients don’t collect their medicines, a waste precious resources that could have been used elsewhere. 

He explained that "With this technology, a patient will be identified using their fingerprint and the information can be shared with different clinics to avoid duplicity. We will able to know the exact number of people on treatment and how many more need it."

UNAIDS set a target that by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy will have viral suppression. CDC country director, Dr Steven Wiersma, said that even though the country is moving toward achieving the 90-90-90 target, there’s been lack of national data on HIV and its treatments.

The project’s expected to end in 2020. Other African counties struggling with the same challenges could benefit by incorporating this technology into their health system. It’ll help improve HIV surveillance and enable healthcare professionals and government officials make better informed decisions. It should also help cut down on waste and improve efficiency across the system.

Tracking HIV patients is not without controversy. It needs countries to make difficult choices between piracy and confidentiality and being able to share information to track infectious disease, and agree on how to plot a path through the complex regulatory issues that emerge.

Lesotho has one of the world’s highest HIV/AIDS rates with 23% of the two million population living with HIV. Antiretroviral treatments (ARTs) are available, but only a third of Lesotho’s estimated 19,000 children living with the virus have access to treatment. Lesotho is made up mostly of highlands where many villages can only be reached on horseback, on foot or by light aircraft. This makes healthcare facilities difficult to access for mothers and their children.  

ViiV Healthcare, a global specialist HIV company, and its partners, Vodafone Foundation, the Elton John AIDS Foundation, ELMA Philanthropies and the United States Agency for International Development (USAID), has launched the Mobilising HIV Identification and Treatment (MHIT) programme in Lesotho. The MHIT programme is a multi-million dollar three-year commitment led by the Vodafone Foundation through the Vodacom Lesotho Foundation says an article in BizTech Africa.

The programme hopes to double the number of children in Lesotho in care and on treatment within three years, ensuring their health and futures are not cut short due to a lack of access to HIV services. It also aims to improve uptake of services that address mother-to-child transmission of HIV to prevent more children from being born with the virus. 

The Vodafone Foundation is deploying mobile clinics to rural areas to reach children and mothers in hard to reach communities, providing primary care services (including antenatal checks and immunisation) and better access to treatment for HIV patients, using mobile money-based transport vouchers so they can reach clinics or hospitals. For many children and mothers, this could be the first time that primary healthcare services have been accessible to them. Mobile technology enables better management. and coordination of services, and communications to support the implementation of the programme.

Rishaad Tayob, Managing Director, Vodacom Lesotho says “Vodacom Lesotho Foundation and Vodafone Foundation are bringing money, marketing, management and mobile technology to challenge paediatric HIV. Partnership is critical and by working with private funders and the Government of Lesotho and USAID, we aim to double the number of children on treatment and in care. We are already saving lives.” It should offer other countries a way ahead too.

Drones are quickly becoming part of the healthcare landscape and their potential hasn’t been overlooked by African countries. Rwanda’s drone policies are already on the drawing board because Unmanned Aerial Vehicle’s (UAVs) will soon become a common feature in their skies, distributing medical equipment to the most remote areas, saving time and lives.

Rwanda isn’t the only African country embracing drones for their medical potential. Malawi has quickly followed suit. The first successful test-flight of a drone was an unhindered 10 km journey from a community health centre to the Kamuzu central hospital laboratory in the capital Lilongwe. Local community members were excited as the drone rose into the sky after its launch by the United Nations Children's Emergency Fund (UNICEF) and government of Malawi at the area 25 health centre, says an article in ALL Africa.

The first of its kind in southern Africa, the US manufactured machine was on trial till March 18 to determine if it could replace other modes of transporting dried blood samples from rural clinics to the main laboratories for early HIV screening in children. UNICEF hopes this innovation will help solve logistical problems in Malawi's rural areas due to the bad state of roads and high costs of diesel fuel.

Currently, motorcycles and ambulances transport blood samples between clinics and take up to 11 days to reach the respective testing centers and two months for the results to come back. The longer the delay between the test and results, the higher the default rate of the patients. G government figures show 10, 000 children died of Aids-related illnesses in Malawi in 2014. HIV screening in children with HIV positive mothers is more complicated than screening for adults. It needs more sophisticated equipment. It’s hard to access for most remote communities. 

The drones are operated through a mobile phone app. The drones can transport roughly 1 kg of blood samples from rural clinics to Malawi’s main laboratories. UNICEF and the Malawi government expect the drones to replace motorbikes and reduce waiting times for results, cutting time and costs in accessing test results and treating children with HIV positive diagnoses.

Transport cost for drones are cheaper than motorbikes because they only need electricity to recharge the battery. Maintenance’s cheaper too. Done’s prices could be a hindrance. Each drone costs MK5 million, approximately US$7,000.

However, health authorities believe drones’ advantages outweigh their costs. The minister of health, Peter Kumpalume, said "it is specialist testing that we do for youngsters. If you delay giving them treatment most of them won't live beyond two years age. So the earlier the detection and the earlier the intervention, the longer they live and become productive citizens of the country."

Kumpalume also said the new innovation was in line with the Malawi government's 90-90-90 agenda."Government intends to achieve the 90-90-90 target where 90% of Malawians know their HIV status, to have 90% of all those diagnosed with HIV receive sustained anti-retroviral treatment, and 90% of people on ART to have viral suppression” 

Malawi’s national HIV prevalence rate is 10%, one of the highest in the world. An estimated one million Malawians were living with HIV in 2013 and 48,000 died from HIV-related illnesses in the same year. It’s clear that improving the service is vital.

While the government has made impressive progress in their fight against HIV, with 90% of pregnant women now knowing their HIV status, there’s a gap with testing and treating babies and children. The drone tests will measure the performance with differing winds speeds, humidity and distance. If the results are positive, the experiment will be expanded.