• UNAIDS pilots new HIV mHealth service in Cote d'Ivoire

    Starting this March, a thousand people living with HIV in Côte d'Ivoire will receive additional health information through their mobile phones. The four-month pilot project in Abidjan is part of a collaboration between the Joint UN Programme on HIV/AIDS (UNAIDS) and the telecommunications operator Orange, says an article in All Africa.

    This project uses cost-effective technology that’s easy to use. It ensures that healthcare workers can provide the highest quality of services for people living with, and affected by, HIV. By using the web-based platform, Orange Mobile Training EveryWhere (M-Tew), healthcare workers will be able to communicate via text messages, calls and voice messages, with people enrolled in care. 

    The people involved in the pilot are those most affected by HIV. It includes 300 sex workers and men who have sex with men.

    All information collected is anonymous and confidential, which is crucial when dealing with such sensitive data. The project aims to improve HIV services so patients stay in care and treatment, and to break down stigma and discrimination. The programme also collects and analyses data to identify gaps and act to improve the quality of care.  

    The programme has Government support as part of its strategy to reduce HIV prevalence to below 1% by 2020. In addition to the Ministry of Health and Public Hygiene and the Autonomous District of Abidjan, UNAIDS and Orange Côte d'Ivoire are also collaborating with civil society partners.

    If successful, the project will be rolled out to other areas of Abidjan, and could be expanded to other priority countries in the region.

  • What makes African eHealth different?

    EHNA’s post extracting some of Africa’s data from The Economists Pocket World in Figures 2016 didn’t show the countries. For some topics they were too numerous. This’s the fourth of a series of follow-ups that does. It deals with HIV/AIDS, immunisation and obesity. 

    For HIV/AIDS prevalence in 15 to 49 year olds, African countries dominate the highest rankings across a wide spread of rates from 2.2% to 27.4% in 2103. The top nine, all Southern African countries, are above 10%, from 10.3% to 27.4%. The countries are Swaziland at 27.4, then Lesotho, Botswana, South Africa, Zimbabwe, Namibia, Zambia, Mozambique and Malawi. 

    Countries below 10% are Uganda with 7.4%, then Kenya, Tanzania, Cameroon, Gabon, Central African Republic, Guinea-Bissau, Nigeria, Rwanda, Cote d’Ivoire, Chad, Congo, Angola, Togo and South Sudan. For these countries, eHealth’s emphasis may be to improve and sustain their prevalence rates.

    Deaths per thousand population from aids show a wide spread to HIV/AIDS prevalence. It’s from 60 in Angola to 755 in Lesotho. African countries are Lesotho, South Africa, Swaziland, Mozambique, Zimbabwe, Malawi, Botswana, Namibia, Zambia, all above 200.

    Equatorial Guinea, Uganda, Tanzania, Cameroon, Cote d’Ivoire, Gabon, Nigeria, Guinea-Bissau, Kenya, Congo, South Sudan, Chad, Togo and Angola are below 200. The range’s 60 to 194. 

    For measles immunisation, Africa has 14 of the 18 lowest percentage of children aged 12 to 23. The countries are: Central African Republic at 25%, then South Sudan, Equatorial Guinea, Somalia, Chad, Nigeria, Ethiopia, Guinea, Benin, Madagascar, Congo, South Africa, Niger and Guinea-Bissau at 69%.

    For diphtheria, pertussis, commonly known as whooping cough, and tetanus (DPT), the rankings have some similarities to measles’ rates at the lower percentages. Countries are Equatorial Guinea at 3%, then Central African Republic, Somalia, South Sudan, Chad, Nigeria, Guinea, South Africa, Benin, Congo and Niger, at 71%

    eHealth that supports high, sustained immunisation rates and vaccine supply chains offer proven net benefits. It can help to make a considerable impact for Africa’s health systems and healthy Africans.

    For men’s obesity, only one African country, Libya, is in the highest 24 countries globally. It’s rates 26.6% in a range of 24.4 % to 40%. Libya’s also in the women’s high rankings, with Egypt, South Africa and Tunisia. Their range is 33.8% to 39.5%. The range for the top 24’s 29.2% to 49.7%. eHealth’s role here could be to help Africans sustain their low rankings and avoid obesity’s health and healthcare demands.

    The next post in the series is about mobile phones, broadband and healthcare resources. It’s where mHealth fits.

  • eHealth or meHealth for HIV in Africa?

    Some people see mHealth as different to eHealth. Others see mHealth as a subset of eHealth. Jesse Coleman, the mHealth programme manager at Wits Reproductive Health & HIV Institute in Johannesburg and a researcher at the University of the Witwatersrand sees it as a combination, so meHealth. He describes it in an article about HIV in De vex.

    meHealth services provide personalised health support to people in health systems, whether patients, nurses, doctors, Community Health Workers, administrations, or anywhere in between. Using eHealth for personalised healthcare hasn’t needed the combined definition so far, and it applies to people outside health systems, such as family and informal carers.

    He describes meHealth as about communicating information within a health care system to improve desirable health outcomes. For effective population health management, it sometimes has to extend beyond the health system to citizens who aren’t patients. 

    Africa’s seen as the global hotbed of meHealth pilots, projects and programmes to improve HIV outcomes. Part of the reason’s that Africa has over 70% of diagnosed HIV cases in the world. The content of meHealth interventions vary but range across: 

    Electronic patient databases, such as EHRs and patient registries HIV test reminders Medical data collection Partner status notifications Links to care SMS-based laboratory results Treatment adherence alerts Appointment reminders Health education Preventing Mother-To-Child Transmission (PMTCT) messaging Health worker decision support. 

    Realising net benefits depends on several factors. Asking leads of proven, successful meHealth projects inevitably produces explanations with several caveats about what’s not worked, or what remains uncertain. Sometimes, when an intervention has worked, its exact opposite’s worked somewhere else in a different situation. 

    His reinforces the view that enabling personal devices to communicate information isn’t enough. It needs to work at human levels, and humans are not as simple as technology. They’re complex, dynamic, and change to match their contexts. meHealth cannot be everything to everyone at all times.

    Nuanced differences between interventions may seem slight on paper, but research is now revealing the extent to which small tweaks matter. So meHealth pilots should scale up when we know they work. Why the work’s important to know too. These need a continuous pursuit of a deeper understanding of different human contexts around interventions because we don’t have the answers. This applies to mHealth and eHealth too.

  • Merck's innovation will transform Africa's HIV monitoring

    Merck’s in discussions with researchers regarding their intention to launch its innovative Muse Auto CD4/CD4% System. It’s a portable instrument for monitoring the progression of the HIV/AIDS virus, and can be used throughout Africa, says an article in IT-Online. Regulatory approval has been already been granted in Nigeria, Cote d’lvoire, Cameroon and Angola, and is currently pending in South Africa.

    Of the 35 million people with HIV worldwide, 25 million, about 70%, live in Africa, says a 2014 UNAIDS report. Of the 25 million, only 19 million, about three quarters, are aware of their status. Many patients in Africa lack access to regular medical care, with treatment options hindered by the long distances from the patient’s village to the nearest hospital or clinic, lack of adequate facilities and a shortage of healthcare workers. 

    “As a life science leader, we aim to deliver the most innovative, highest quality products and services to help our customers improve human health and life every day, everywhere,” says Udit Batra, president and CEO of Merck’s life science business. “Through the launch of the Muse CD4/CD4% system, we are enabling health professionals in Africa to more effectively respond to the health care needs of their patients and make progress towards the treatment, cure, and prevention of HIV/AIDS.”

    For people infected with HIV, CD4 cells provide an indication of the disease’s progression. In the course of an HIV infection, CD4 cells indicate the state of the immune system and act as markers for T cell lymphocytes. Patients with a low count of these cells in their blood are at increased risk of opportunistic infections.

    Merck developed the Muse Auto CD4/CD4% system for rapid, simple and accurate monitoring of T cells in adults and children. The low-cost system is designed to be easily portable and operational with minimal training, making it the ideal solution for clinics serving patients living in remote areas. The Muse Auto CD4/CD4% system has a user-friendly touchscreen interface and intuitive software that works together to simplify operation and analysis.

    Clinical testing was completed by a partnership of Merck and the University of Yaounde in Cameroon. The output was successful in both adult and child patients. An evaluation by a team from the University of California San Francisco concluded that “Muse AutoCD4/CD4% system allows for accurate and precise determination of CD4 count and percentage in whole blood samples. The combination of the simplified and small instrument platform with rapid easy assay protocol and guided touch-screen interface should greatly facilitate rapid and accurate CD4 measurements in an accessible and affordable format in resource-constrained settings.” 

    Muse has the potential to transform HIV monitoring in Africa. We look forward to its wide launch and adoption in African countries soon.

  • SNOMED CT benefits Kenya's healthcare

    Sub-Saharan Africa (SSA) experiences various challenges in delivering healthcare. While some of the challenges such as privacy and security concerns are encountered in developing and developed countries, others, such as overworked and often poorly trained health workers, inadequate computer resources, and unreliable electric power and Internet access, are unique to developing countries. As SSA countries continue to invest in EHRs to improve the quality of patient care, these challenges have to be overcome to maximise benefits.

    Transferring patient records between health facilities electronically or accessing records on a shared database is often a challenge. Clinicians who previously saw patients prepare treatment histories may use terms and parameters local to their health facility. These may not have the same meaning at other facilities. For example, the temperature range used to describe a fever at one clinic may be different from the range in another.

    Lack of standard definitions of clinical terms such as diagnoses, observations, signs and symptoms can compromise the continuity and quality of care when patients are seen by different clinicians during different hospital visits. Clinicians often use different terms to refer to the same thing; for example one clinician may record a diagnosis as “shingles” and a different clinician records the same diagnosis as “herpes zoster”. The two terms refer to the same diagnosis.

    In HIV care, the recorded diagnosis, signs and symptoms during a patient visit to a clinic is often used as part of the decision support process to determine whether or not the patient is eligible for anti-retroviral therapy (ART). The World Health Organization (WHO) classifies HIV-related opportunistic infections into four clinical stages that are indicative of HIV disease progression. This helps clinicians in resource-limited settings with no immediate access to an advanced laboratory to make decisions on ART eligibility. It needs accurate, unambiguous diagnoses and correct recordings of results as these determine whether to prescribe ART or not. Wrong, ambiguous diagnoses or incorrect recordings could result in under-treatment or over-treatment. The effects are serious, possibly leading to drug-resistance or in some cases, even death.

    To address these challenges, there’s a need for a standardised system for coding and recording terms used in clinics to ensure consistency. SNOMED CT is one of the most comprehensive and precise clinical health terminology products in the world and can be used to standardise terminology of clinical recording. The Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu County, western Kenya, recognised the challenges in continuity of care and the need for standardised recording of data for decisions on ART eligibility for more than 7,000 HIV patients enrolled at the facility. They developed a concept dictionary; a collection of common terms used to describe procedures, diagnoses and signs and symptoms associated with HIV infection. Each term’s linked to a SNOMED CT ID, a unique identifier that ensures terms have consistent meanings across the hospital. The concept dictionary is part of the EHR, which is built on an OpenMRS platform to manage patients’ health records at JOOTRH and at several other clinics in Kenya. Many developing countries use this model too.

    Since SNOMED CT also contains alternative terms, its synonyms, for many concepts, clinical users have options of using a preferred term or a synonym. All these options are displayed on the EHR’s data entry screen. It provides a flexible and accurate way to record information so clinicians can use local terms that their colleagues are most familiar with. The local concept dictionary can be updated whenever new parameters are defined that are not already stored. If a clinical expression does not exist in SNOMED CT, users can create it using a pre-coordination or post-coordination process.

    Although there has been a significant improvement of completeness of patient records since introducing SNOMED CT’s concept dictionary, a formal evaluation is planned to assess the effect of its use as a terminology system on data and healthcare quality by using accurate recordings of diagnoses and automated inferences of ART eligibility for HIV patients in a resource-limited setting. This should set the direction for the SNOMED CT’s use across Africa’s healthcare.

  • A step up in e+mHealth for HIV/AIDS

    eHealth and its mHealth subsidiary are already used extensively by many African countries as part of the healthcare needed for HIV/AIDS patients. Two initiatives from the USA have set it into a second generation. They offer development models for African countries in developing their eHealth services.

    Health Data Management says the USA’s Centers for Medicare and Medicaid Services (CMS) is working with the VillageCare Wellness Innovations project to develop and provide an integrated mHealth application and web portal as a medication planner. It’ll include:

    Personalized medication adherence plans Peer mentoring Social networking Text reminders Virtual support groups Virtual access to health coaches.

    VillageCare has already won an Innovation Award for Treatment Adherence through the Advanced Use of Technology (TAAUT). Its track record points to the new HIV/AIDS project succeeding at the end of its three-year timescale. The contract is $8.7 million.

    In parallel, the Department of Health and Human Services (HHS) has launched its Positive Spin project developed by AIDS.gov. It’s a digital educational tool. Clinical Innovation and Technology says it has stories of the personal experiences of five HIV-positive gay black men who have had successful HIV care. Black men are one of the largest groups of HIV people.

    It describes there healthcare journey from diagnosis to treatment then viral suppression. The aim is to show others with HIV how to stay healthy, live longer and dramatically reduce their chances of passing the virus to others. The need to encourage the take-up of HIV healthcare may still be important. The Centers for Disease Control and Prevention estimates that in 2011, 86% of people with HIV were diagnosed, but only 40% followed on into care, with only 30% achieving viral suppression.

    These new developments for HIV/AIDS offer some insights for African countries to follow. It seems that the role of eHealth needs frequent refreshment.

  • Airtel and UNAIDS partner to reduce HIV in Nigeria

    The Airtel partnership with the Joint United Nations Programme on HIV/AIDS (UNAIDS) will create more opportunities to promote the Touching Lives initiative. It aims to positively impact the lives of Nigerian citizens and residents by improving healthcare quality and delivery.

    BIZTECH Africa says Airtel has been involved in many healthcare initiatives over the years. In 2005, Airtel rolled out the National Call Contact Centre. It helped to activate hotlines which provided guidance and counseling to Nigerians about HIV/AIDS and related health issues. The pilot’s regarded as a great success.

    In 2012, Airtel provided the network backbone for an ultra-modern call centre. The facility has toll free lines and can process 30 callers simultaneously. The network currently offers Nigerians accurate health information which supports public enlightenment on HIV/AIDS, tuberculosis and malaria.

    The partnership, sealed through a Memorandum of Understanding, allows Airtel’s subscribers to benefit from information on how and where to access prevention of mother-to-child transmission of HIV services in Nigeria. The information will be disseminated through regular text messages.     

  • An app for HIV can help to suppress the virus

    USA patients with HIV who use an mHealth app that reminds them about refills, dosages and general prescription management are 2.9 times more likely to be adherent than the overall HIV population. The study by mscripts and Avella Specialty Pharmacy found that the Proportion of Days Covered (PDC) for Avella’s HIV patients taking single and multi-source medications, including Atripla® and Truvada® were:

    79% for patients using the mscripts’ app achieved more than a 90% adherence rate 65% not using the app achieved more than a 90% adherence rate.

    These compare with areport in 2014 from the Centers for Disease Control and Prevention (CDC) found only 30% of HIV-positive Americans achieved viral suppression. The 90% target needs sustained adherence to achieve viral suppression otherwise patients risk increased treatment failure. The study also found that Avella’s HIV patients who use mscripts’ app are nearly three times less likely to discontinue their medication refills.

    While the findings may not translate directly to African countries, the value of the app seems compelling enough for them to invest in it. An integrated project with other mHealth solutions for HIV, like the Columbia University HIV diagnosis app posted on eHNA may offer bigger benefits for a modest extra cost.

  • A new HIV diagnostic app's on its way

    There’s almost 24 million people who are HIV-positive in sub-Saharan Africa. It’s more than 20% of the population and 70% of the total HIV-positive people in the world. More than 90% of the world’s HIV-positive children live in Africa. The campaign Do Something has lots of data about HIV and AIDS.

    Columbia University in New York has done something. Its research team led by Samuel K. Sia, associate professor of biomedical engineering, has developed a low-cost smartphone accessory that does a test at the point-of-care that detects three infectious disease markers from blood from a finger prick. The results are reported in 15 minutes. There’s a video demonstration on the University’s website.

    The device replicates all mechanical, optical, and electronic functions of a blood test analysed by a laboratory. It performs an Enzyme-Linked Immunosorbent Assay (ELISA) using its mobile phone’s power. Piloting was completed in Rwanda and findings are published in Science Translational Medicine.

    The fast report time isn’t the only good news. Prof Sia estimates that the device will cost about $34 to make. ELISA equipment used in laboratories can cost about $18,450. It’s an essential mHealth initiative for African countries.

  • Treatment adherence is never easy

    When was the last time that you completed a full course of medication prescribed by your GP, taking each pill as prescribed, on time, every time? The truth is very few of us comply, which creates all kinds of problems both small, when it takes longer for us to recover, and big, when we help drug-resistant super bugs to take hold even more.

    It seems that South Africans know a thing or two about treatment adherence. This is not surprising, given the long, hard battle being fought in South Africa to bring challenges such as Tuberculosis and HIV, and their nefarious combination, under control, without creating escalating problems associated with poor treatment adherence, particularly drug resistance.

    Over the last decade South Africans have made valuable contributions to real-time support for treatment adherence. Dr David Green, as inventor and innovator of Simpill, and Ricci and Lloyd Marshall, a husband and wife team, as entrepreneurs and owners at Wisepill Technologies are good examples. Both use a portable medication dispenser with a GSM communicator, connected to Internet software that drives adherence services customized to patients’ unique medication regimens.

    Simpill was a pioneering concept, invented in the early 2000’s by Dr David Green to help TB patients remain compliant. It’s now used in a number of countries to help patients manage their chronic conditions and avoid costly and unpleasant hospital admissions needed to deal with poor treatment adherence.

    Wisepill was founded in 2007, contributing a suite of solutions to the real time adherence support. Wisepill’s been selected by Family Health International (FHI360) for their trials of antiretroviral agent Truvada and used by Massachusetts General Hospital (MGH), Harvard and Columbia Universities in HIV research in Uganda and in South Africa.

    In 2011, Wisepill won South Africa’s Department of Trade and Industry (DTI) Technology Award in the category of small businesses. Director and owner Ricci Marshall said, “Our focus has been on providing innovative products and service excellence in the field of medication adherence. It is gratifying to see our solutions being used more and more for personal adherence management as well as in clinical trials internationally.”

    So why don’t we see more of these technology solutions helping people stay healthy and avoid running up unnecessary costs? There are probably a number of reasons, though cost, often regarded as the key deterrent to serious scale-up, should not be one of them.

    When I first came across these devices I was curious about the cost question, so produced a cost minimisation assessment of a SIMpill pilot, with Prof Maurice Mars of University of KwaZulu-Natal. Our assessment published in January 2012 found that the discounted net present value, the estimated value for money quantified by the accumulated economic benefits less costs over a project cycle, was nearly half a million US dollars. It also showed substantial improvements in health outcomes.

    So either “if it sounds too good to be true it is” or something else is the limiting factor to their increased use, not costs. The real difficulty is that pilots do not deal with a wide range of additional, complicated issues necessary for wider implementation. Important factors such as integrating the new solution into regular working arrangements and dealing with affordability and the extra cash needed to finance the project.

    Economic assessments usually don’t address these issues, though they do help to point in the right direction, so that more substantial cost benefit analyses, or eHealth impact assessments can be applied to tease out the hard work that’s needed to realise real benefits.

    Without a doubt, real-time treatment adherence support is here to stay, and sound economic assessment methods will be critical tools to help position them properly. On both of these topics, South Africans are likely to continue to contribute, helping eHealth improve health and healthcare in Africa and elsewhere.