• HIV
  • 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 all
    • Reach all key and vulnerable populations with customised and targeted interventions
    • Address 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 approaches
    • Promote 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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 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.  

  • SMSing’s still effective in fighting HIV

    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.

  • South Africa’s HIV dashboard to improve viral load monitoring

    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.

  • HIV/AIDS testing needs improving

    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.

  • SMS helps Mozambique’s HIV prevention

    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.