Better eHealth can improve HIV monitoring and surveillance
Ambitions to eliminate HIV are enthusiastically in place. Achieving them, such as the 90-90-90 goals can benefit from better eHealth. An article in the Journal of Medical Internet Research (JMIR) says questions remain about the sustainability of the programmes and the value of data initiatives.
Five principles identified in Sustainable Monitoring and Surveillance Systems to Improve HIV Programs: Review are:Better quality, local, granular, and disaggregated data to design and support a sustainable responses to ending the AIDS epidemicSupporting the health services cascade needs a cascade of linked dataUsing surveillance data is an intervention in itself, allowing programmes and communities to improve services’ responsesSurveillance needs systematic investment of at least 5 to 10% of programme budgets so that remaining resources address the epidemic and its impact can be assessedIncreased support for routine, integrated, district health data as part of health information systems, including sexually transmitted infections and hepatitis, linked to real-time health decisions.
The study found that data’s been removed from healthcare settings and communities. It’s part of anonymous testing, national surveys, and modelling. It says that routine data’s part of implementation and an essential part of public health interventions, packages of prevention and care. Without routine data availability, it’s difficult to achieve an effective public health or community responses.
This highlights the need for Africa’s health systems to review their HIV data components to test how they fit the service requirements identified by the study. It seems that some development or resetting may be needed.
- 416 views
- July 19, 2018
- Ameera Hamid
Burkina Faso’s MOS@N muestra el valor de compromiso
Para alcanzar la Cobertura Universal de Salud (UHC) se necesita que el acceso a la atención médica sea mas amplio. En Burkina Faso, MOS@N, un proyecto de mHealth está ayudando a las poblaciones vulnerables del distrito de Nouna a mejorar su acceso y lograr una mejor salud. Tambien, al superar los prejuicios de género, ha mejorado el estatus de las trabajadoras de la salud.
Las altas tasas de mortalidad materna son un importante desafío de la salud pública para Burkina Faso. Nouna tiene 341 muertes maternas por cada 100.000 nacidos vivos. Solo el 70% de las mujeres recibe atención prenatal y el 34% da a luz en el hogar. Las tasas de VIH / SIDA siguen siendo altas, con alrededor del 30% de las personas infectadas que no siguen el tratamiento requerido.
El acceso a la atención materna enfrenta numerosos obstáculos. Incluyendo las distancias a los centros de salud, la escasez de personal de salud calificado, la falta de información sobre la salud sexual y reproductiva y los altos costos del tratamiento médico. La información de salud para mujeres embarazadas y proveedores de servicios de salud a menudo no se entrega en el momento adecuado y podria estar desactualizada. Los valores sociales paternalistas profundamente arraigados pueden llevar a que muchos hombres prohíban a sus esposas asistir a los centros de salud en lugar de trabajar en los campos.
Lanzado en 2013, el nombre de MOS@N se deriva de móvil y santé. Su objetivo es mejorar el acceso de la atención de calidad para madres, niños y personas con VIH / SIDA. Al principio, los investigadores del Centro de Investigación en Salud de Nouna, un instituto de investigación del Ministerio de Salud, se dispusieron a determinar si las TIC y los teléfonos móviles podrían mejorar la administración de la salud para un acceso más equitativo a la asistencia sanitaria. Financiado por el Centro Internacional de Investigaciones para el Desarrollo (IDRC) y llevado a cabo en colaboración con la Universidad de Montreal, MOS@N se desplegó en centros de salud que prestaban servicios en 26 aldeas.
El estudio, Posicionamiento de la Salud Movil: un estudio cualitativo de las expectativas de mHealth en el distrito de salud rural de Nouna, Burkina Faso, publicado en Springer, confirmó el éxito de MOS@N en el fortalecimiento del sistema de salud y la mejora del acceso. A fines de 2016, 2.161 mujeres embarazadas habían recibido atención prenatal. Los partos asistidos aumentaron en un 50% a más del 97%. Los trabajadores de la salud pudieron rastrear a casi 260 pacientes que viven con el VIH y lograron una baja tasa de abandono de solo el 1.6% de los casos.
MOS@N también aumentó la equidad y la participación en la administración de la salud. Las mujeres fueron fundamentales para la implementación del proyecto y ayudaron a determinar los servicios de salud materno e infantil ofrecidos. Unos contactos directos más fuertes con los centros de salud y un fácil acceso a la información les ayudará a mantener los logros alcanzados.
Un artículo del IDRC en la web de Relief dice que “marraines”, madrinas, que usan teléfonos móviles, se han convertido en actores centrales en la educación y movilización de la salud, roles que anteriormente desempeñaban los trabajadores de la salud de la comunidad masculina. Elegidos por los líderes de las aldeas para acompañar a las mujeres durante el embarazo y el parto, las “marraines” son intermediarias entre su comunidad y los trabajadores de la salud.
MOS@N enfatiza el papel de la comunidad en la entrega de tratamiento, el seguimiento de pacientes y la entrega de mensajes y recordatorios de concientización. Integra los roles de los centros de atención primaria de salud local, trabajadores de salud, técnicos de TIC, “marraines”, líderes comunitarios e investigadores de salud pública.
Se desarrolló localmente utilizando software de código abierto y permite el acceso a la información sobre atención médica materno e infantil y la vida con VIH. Los sistemas de mensajes de texto e interactivos brindan mensajes en cinco idiomas locales, personalizados para satisfacer sus necesidades específicas, que incluyen recordatorios de citas para madres, asegurando la inclusión y una mayor accesibilidad. Todo el contenido cumple con las pautas nacionales para una amplia gama de atención médica. Incluye atención pre y posnatal, parto asistido, vacunación contra la polio y el tétanos, prevención del paludismo y seguimiento de pacientes. Otras características son un sistema central de información de salud desarrollado e integrado en las instalaciones de salud del distrito para recopilar los datos necesarios para el seguimiento y toma de decisiones.
MOS@N y los hallazgos del estudio ayudarán a guiar las iniciativas de mHealth. El diseño y la implementación que satisfagan las necesidades específicas de los usuarios optimizarán las posibilidades de éxito. Proporciona lecciones para mHealth de África.
- 605 views
- November 14, 2017
- Matt Jones
Burkina Faso’s MOS@N to improve access to quality care for mothers, children and people with HIV/AIDS
Achieving Universal Health Coverage (UHC) needs expanded healthcare access. In Burkina Faso, MOS@N, an mHealth project’s helping vulnerable populations in the Nouna district improve their access and achieve better health. By overcoming gender biases, it’s enhanced women health workers’ status too.
High maternal mortality rates are a major public health challenge for Burkina Faso. Nouna has 341 maternal deaths per 100,000 live births. Only 70% of women receive prenatal care and 34% give birth at home. HIV/AIDS rates remain high, with about 30% of people infected not following up required treatment.
Accessing maternal care confronts numerous obstacles. They include distances to health centres, shortages of skilled health staff, lack of information on sexual and reproductive health and high medical treatment costs. Health information for pregnant women and health providers is often not delivered at the right time and can be out-of-date. Deep-rooted paternalistic social values can lead many men forbidding their wives attend health centres instead of working in the fields.
Launched in 2013, MOS@N’s name’s derived from mobile and santé. Its goal’s to improve access to quality care for mothers, children and people with HIV/AIDS. At the outset, researchers at the Centre de Recherche en Santé de Nouna, a Ministry of Health research institute, set out to determine if ICT and mobile phones, could improve health governance and more equitable healthcare access. Funded by the International Development Research Centre (IDRC) and carried out in collaboration with the University of Montreal, MOS@N was deployed in health centres serving 26 villages.
The study, Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso,published in Springer, confirmed MOS@N’s success in strengthening the health system and improving access. By the end of 2016, 2,161 pregnant women had received prenatal care. Assisted childbirths increased by 50% to over 97%. Health workers were able to track almost 260 patients living with HIV and achieve a low drop-out rate of only 1.6% of cases.
MOS@N also increased equity and participation in health governance. Women were central to the project’s implementation and helped determine the maternal and child health services offered. Stronger direct contacts with the health centres and ready access to information will help them maintain the gains made
An article by IDRC in Relief web says marraines, godmothers, using mobiles, have become central players in health education and mobilisation, roles previously played by male community health workers. Chosen by village leaders to accompany women through their pregnancy and childbirth, marraines are intermediaries between their community and health workers.
MOS@N emphasises the community’s role in delivering treatment, monitoring patients and delivering awareness-raising messages and reminders. It integrates the roles of local primary healthcare centres, health workers, ICT technicians, marraines, community leaders and public health researchers.
It was developed locally using open source software, and enables access to information about maternal and child healthcare and living with HIV. Text and interactive voice messaging systems provide messages in five local languages, customised to meet their specific needs, including appointment reminders for mothers, ensuring inclusiveness and greater accessibility. All content complies with national guidelines for a wide range of healthcare. It includes pre and postnatal care, assisted delivery, vaccination against polio and tetanus, malaria prevention, and patient follow-up.
Other features are a core health information system developed and integrated in district health facilities to collect data needed for follow-up and decision-making.
MOS@N and findings from the study will help guide mHealth initiatives. Design and implementation that meets users’ specific needs will optimise the chances of success. It provides lessons for Africa’s mHealth.
- 711 views
- November 07, 2017
- Matt Jones
Kenya launches app to protect health workers from HIV
HIV’s still a big public health challenge for Africa’s health systems and their health workers. Many health workers see HIV+ patients every day, so exposed to cross-contamination risks, such as accidental pricks from contaminated needles and surgical blades and blood and other body fluid splashes that can result in contracting the HIV virus. Kenya's Ministry of Health (MoH) has partnered with Care for Carers (C4C), a carers’ platform, to provide an app to help healthcare workers have prompt medical care for accidental exposure to infections.
It’ll provide a tool for health workers to ask for immediate attention says an article in Kenya Tech News. Post-Exposure Prophylaxis (PEP) drugs can reduce infection risk by over 80%, but have to be taken within three days of exposure. The dose’s needed for 28 days. They work by attacking and killing viruses before they cause HIV after they’ve multiplied. After the 28days, patients have to have two HIV done, each taking place after three months. Dr Martian Sirengo, head of the National Aids and STI Control Programme (Nascop), said “The time PEP is initiated, and the completion of the recommended dose is of great importance. And this new platform will help us with that.”
Health workers have to log into the C4C platform and register. It then records information such as personal, employment, demographic data and any treatments. It then provides users with detailed procedural advice the MOH guidelines. The app also sends follow-up messages to encourage and advise practitioners to adhere to the requirements and provide information on PEP drug side effects.
C4C enables county and national governments to monitor real time data on HIV exposure incidents in healthcare facilities. It also provides data on causes and risk exposure rates for locations. This can help to frame policies on safety in hospitals, creating safer working environments.
M-health and Nascop helped developed the app. It’s currently used in Kisumu, Turkana, Meru, Embu and Murang'a counties.
Kenya’ s not the only country struggling with these challenges. Other African countries need similar mHealth solutions to protect their healthcare workers.
- 943 views
- August 04, 2017
- Lesley Dobson
SANAC looks to eHealth to help combat HIV, TB and STIs
South African National AIDS Council (SANAC) is a voluntary association of institutions established by the national cabinet of the South African Government that embodies the government, private sector and civil society to build a controlled and coordinated response to the HIV, TB and STIs. It's not restricted to AIDS response challenges. Its obligations cover STIs and TB, both of which are associated with HIV and AIDS. SANAC advises the government on related HIV, TB and STI strategies and policies, mobilises resources domestically and internationally to finance projects and monitors progress against targets in the National Strategic Plan (NSP) for HIV and AIDS, TB and STIs (2017-2020).
A key focus is working towards the UN 90-90-90 goals i.e. to provide 90% of people with an HIV diagnosis (including 175 000 children) antiretroviral therapy and ensure that 90% of them (including 158 000 children) achieve HIV viral suppression, and attain a 90% treatment success rate for drug-sensitive and 70% for multi-drug resistant TB.
SANAC has an ambitious software development programme underway to build tools to support people working locally to combat HIV and AIDS. One of these projects provides a web-application in support of the Focus for Impact approach defined in the NSP. Health Information System Program South Africa (HISP-SA) has partnered with SANAC to build a web-tool that produces heat-maps that show high burden areas and associated factors affect different communities. It is already supporting decision-making for coordination of interventions planned locally. HISP's Greg Rowles and Jaco Venter have built the technical aspects, for SANAC. The team was led by SANAC's Petro Rousseau.
SANAC has set eight NSP goals, each supported by clear objectives and sub-objectives and activities to realise them:Accelerate prevention to reduce new HIV and TB infections and STIs Reduce morbidity and mortality by providing HIV, TB and STI treatment, care and adherence support for allReach all key and vulnerable populations with customised and targeted interventionsAddress the social and structural drivers of HIV, TB and STIs, and link these e orts to the NDP Ground the response to HIV, TB and STIs in human rights principles and approachesPromote leadership and shared accountability for a sustainable response to HIV, TB and STIs Mobilise resources to support the achievement of NSP goals and ensure a sustainable response Strengthen strategic information to drive progress towards achievement of the NSP goals
Thursday 13 July, SANAC's Petro Rousseau and Western Cape's Robin Dyers presented on GIS and HIV at ESRI's Applying the Science of Where Users Conference in San Diego. HISP's Jaco Venter was also there as technical support to the team.
- 1,763 views
- July 15, 2017
- Gontse Ramela
An SMS service improves HIV mothers’ and babies health
The UN’s SDG 3 has two goals to improve health and wellbeing for pregnant women and babies. A study reported in Taylor and Francis Online shows that SMSs can help to improve these.
An international research team from the University of Witwatersrand, the Karolinska Institutet, Johns Hopkins University, Princeton University and the United Nations Foundation evaluated the effectiveness of an SMS service aiming to improve the maternal health and HIV outcomes of HIV+ pregnant women.
Twice a week, SMSs were sent to 235 HIV+ pregnant women. They continued until their children’s first birthday. Content included maternal health advice and HIV support information.
Outcomes were measured as Ante-Natal Care (ANC) visits, birth outcomes and infant HIV testing. They were compared to a control group of 586 HIV+ pregnant women who received no SMSs. Results showed marked benefits. Intervention group women attended more than 31% more ANC visits, and were more likely to attend at least the recommended four ANC visits.
Birth outcomes of the intervention group improved too. The women had an increased chance of a normal vaginal delivery and a lower risk of a low-birth weight baby.
The intervention group had a trend towards higher infant polymerase chain reaction (PCR) testing for HIV within six weeks of birth. It also had a lower mean infant age in weeks for HIV PCR tests.
The team concluded that its results add to the growing evidence that mHealth can have a positive impact on health outcomes. It should be scaled nationally after comprehensive evaluation. For a large-scale mHealth programme, Africa’s health systems may have to invest in extra ANC and PCR testing capacity.
- 728 views
- July 13, 2017
- Tom Jones
The pressure’s on for South Africa’s health system
South Africa's credit rating was downgraded by Moody’s, the rating agency, on 12 June 2017. This came after Fitch and Standard & Poor's downgraded the country to junk status in March. The consequences of the downgrade are far reaching. It will affect the countries’ ability to borrow money and the healthcare system will feel the pressure too. It’ll probably knock on to eHealth too.
Health systems and policy manager at the Rural Health Advocacy Project (RHAP), Russell Rensburg, in an article in allAfrica, warns that "We are facing a financial crisis in health and it is being ignored." He says the recession will reduce the level of taxable income as companies become reluctant to invest and create jobs in South Africa. Public spending’s also likely to shrink as more cash goes to service debt.
So what does this all mean for the healthcare sector? There’s going to be far less money to spend on an already fragile system.
The real life impacts will be immense and felt sooner rather than later. In September 2016, South Africa introduced new HIV treatment guidelines that now offer Antiretroviral (ARV) drugs to all people who’ve tested HIV positive. As a result, the number of people on HIV treatment will double from 3.5 million to over seven million.
The health department's deputy director general for HIV, Yogan Pillay has said "By 2025, the health department aims to have 90% of all people diagnosed with HIV on treatment, and by then, the number of people with HIV would also have increased. "Increasingly limited resources and competing needs are real problems to us,"
But Rensburg says there may not even be sufficient funding to sustain existing programmes. Symptoms of the budget constraints are already showing. Specialists are still fleeing the under-resourced public sector. The South African Medical Association (Sama) says KwaZulu-Natal has only two public sector oncologists left. Durban has none. The situation isn’t much better for other specialists with only two urologists left in the province.
Information presented at the health budget vote in March shows KwaZulu-Natal Department of Health running a deficit of more than ZAR1-billion this year. This includes a ZA R500 million shortage for HIV treatment for 2017/2018. While KwaZulu-Natal may be the first to crumble, Rensburg warns that the public health system is failing nationally, and other provinces may not be far behind.
The North West Department of Health has already started closing clinics and will cut 2,000, or 20%, of its public sector health jobs to curb rising costs. North West’s spokesperson Tebogo Lekgethwane confirmed the cuts are needed to accommodate smaller budgets.
How will the restricted resources and added pressure to the healthcare systems impact innovation and implementation of eHealth and mHealth initiatives? Their value and benefits now need to be more explicit, measurable, clear and tangible than ever before to make it worth the investment in the setting of shrinking resources.
- 1,183 views
- June 28, 2017
- Lesley Dobson
eThekweni District has an HIV/AIDS app
HIV/AIDS remains one of the leading causes of death worldwide. Avert has estimated that more than 7 million people in South Africa live with HIV. About 70% of the total global prevalence lives in sub-Saharan Africa, with South Africa carrying the highest burden of the epidemic in the world in 2015. HIV/AIDS is a major health concern in South Africa, with 380,000 HIV incidences and 180,000 HIV/AIDS fatalities in 2015 as reported by Avert. KwaZulu-Natal tops the chart of the country’s nine provinces with nearly 20% of HIV/AIDS patients.
In 2015, eThekweni District in KwaZulu-Natal’ started using mHealth to help improve services for people living with HIV. Access to HIV/AIDS treatments services remains a challenge, with only 48% of adults receiving Antiretroval Treatment (ART) in the country. South Africa, like many other African countries, face many health challenges, patient and community barriers against the smooth delivery of HIV/AIDs treatment and services.
Health system barriers include a growing shortage of staff due to high turnover, highly congested and poorly coordinated healthcare facilities and a knowledge gap between healthcare providers and their patients. Patient barriers are long distances, transport costs and longer waiting times before receiving primary healthcare or treatment. Lastly, HIV/AIDS related stigma and discrimination remains prevalent in communities.
Health-e News has a report saying the project includes an app so healthcare providers can track individual performances of caregivers in every ward, while indicating where health services are inefficient. The app enables healthcare providers to login with their own personal username to report on their activities and interventions. Managers can use the app to monitor activities in each ward. The project focuses on HIV patients and has received a twelve-month grant of £96,944 roughly R1 547 086 in 2015.
Integrating apps like these in healthcare can increase efficiency in the delivery of HIV treatment and services and can build trust between healthcare providers and their patients. It should help improve co-ordination, address staff shortages, allow healthcare providers to monitor and track their patients’ status, and enable managers to improve the functioning of facilities. It could help other districts too.
- 755 views
- March 14, 2017
- Ndzalama Shivambu
Self-testing HIV kits will soon be coming to Rwanda
HIV in Rwanda’s below Africa’s average, but it’s still a priority for the Rwanda Ministry of Health who has planned to introduce an HIV Self-Testing (HIVST) service to support the country’s existing testing services, such as those offered at health facilities or mobile voluntary testing and counselling. HIVST’s an innovative approach that can increase access to HIV testing services, particularly among populations with the lowest coverage and highest risk.
People can buy the HIVST kit and perform a HIV diagnostic test and interpret the result in private, an article in allAfrica says. They can use oral fluid or blood-finger-pricks to check their status. Results are ready in 20 minutes, sometimes less.
The Rwanda Biomedical Centre (RBC) advises people with positive results to seek follow-up tests at health clinics to check the results. WHO recommends that peoples who test positive receive information and links to counselling and rapid referral to prevention, treatment and care services.
Self testing isn’t only convenient and fast. It will support earlier detection of the virus too. "Once introduced, people will be diagnosed earlier by bringing the services closer to where people live, and create demand for HIV testing," says Beata Sangwayire, a voluntary counselling and testing (VCT) senior officer at RBC.
This is particularly relevant for people facing barriers to accessing services.
Groups who’ll benefit from self-testing include people with tight work schedules, groups with higher risks of catching the virus, mainly female sex workers, men who have sex with men and injectable drug users.
RBC says the new service is an innovative measure to achieve the '90-90-90 targets' for 2020. The aim’s to diagnose 90% of all HIV-positive people, providing antiretroviral therapy (ART) for 90% those diagnosed and achieving viral suppression for 90% of those treated, by 2020. It’s also in line with WHO's new guidelines for countries to consider self-testing services as a means to meet the UN target of diagnosing 90%of all people with HIV by 2020. So far, 23 countries have adopted HIV self-testing policies. Many others are developing them.
Statistics from RBC show Rwanda has succeeded in containing the HIV prevalence at 3% in its general population for people between the ages of 15 - 49. This is a remarkable feat. In June 2016, Rwanda launched the Test-and-Treat-All programme. Latest estimates indicate that roughly 80% of people needing ART receive it, not far off its 90% target for 2020. Additionally, evidence shows the HIV transmission rate from mother to child is estimated at less than 2%.
Rwanda’s working with different stakeholders looking at the feasibility of these new services, where it can be piloted, and instructions on how to use the kit. HIVST could easily be combined with a mobile app that provides information on HIV and AIDS, treatment options, information on where to go to receive medication and counseling services. Mobile solutions helping to tackle HIV are already underway in Lesotho too.
- 686 views
- February 28, 2017
- Lesley Dobson
mHealth can help Lesotho’s huge HIV challenge
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 accuracyImproved data accessImproved 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.
- 898 views
- February 14, 2017
- Tshiamo Mmotsa
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