• mHealth
  • An HIV-free future: improving adherence to antiretroviral treatment

    It is common knowledge that HIV and AIDS has long been an overwhelming challenge in Africa. East and sub-Saharan Africa is the most affected region in the world.  Statistics indicate that at least 19.4 million people are living with HIV in this part of the continent. South Africa alone has the biggest HIV epidemic in the world with 7.1 million people living with HIV.  In 2016, there were at least 270 000 new infections and 110 000 AIDS-related deaths in the country.

    These statistics are worrying, but there is hope. It is estimated that 61% of adults and 51% of children in East and Southern Africa are on anti-retroviral therapy (ART). Antiretroviral medications (ARVs) are life-saving drugs that have turned HIV into a manageable chronic condition. The disease is no longer a death-sentence and when HIV-positive people take their ARVs responsibly and strictly.

    Adherence to ART is often an overlooked issue despite its incredible importance. In order for an HIV-positive person to achieve an effective level of viral suppression, adherence to ARVs needs to be more than 95%. This means that there is very little room for those living with HIV to skip their ARVs.

    Remembering when to take medication on time can be challenging for many reasons. People use different methods to remind themselves, but in most cases, these methods are not always reliable or effective.

    MyTherapy, a medication reminder and health tracker app designed in Germany, is an effective and easy-to-use app that has been proven to raise adherence levels significantly. In a short space of time, the app has improved adherence by over 45% and currently has over 500,000 users.

    While the app’s main function is to help its users keep track of their medication intake, it has also been designed to improve their overall health and sense of wellbeing. Users can record important measurements, like blood pressure and weight, and track their symptoms, and for those living with HIV, the app allows users to enter lab-results data, such as blood tests, kidney-function tests and viral load.

    The app is easy-to-use and all users have to do is enter the relevant data and set alarm times. The app is designed to handle complex medication regimens, perfect for ART which requires multiple medication intake per day, and all recorded data can be printed out at the end of each month in easy-to-read graphs, which is useful for the user’s doctor. Furthermore, while the app does rely on self-efficacy and self-discipline, users can invite family and friends on the app to help them stick to their treatment plans, ensuring that various parties are involved to promote adherence further. MyTherapy also takes data protection and privacy seriously, and users also have the option to use a passcode to prevent others from accessing the app and seeing personal data.

    ARVs are exceptional drugs that have changed the face of HIV and AIDS forever.  There is potential for an HIV-free future, only if those living with the virus are responsible and take their ART strictly.

    Knowledge of HIV/AIDS is continuously expanding. Information in the article's taken from Avert and the NCBI. 

  • mHealth’s proven impact still seems elusive

    Africa has an expanding, diverse mHealth core to its eHealth initiatives. The Journal of Medical Internet Research (JMIR) found limited evidence of mHealth’s impact, and hinted that in low-income countries, mHealth’s still at an early development stage.

    JMIR’s systematic review covered 10,689 mHealth articles, including 23 systematic reviews of 371 studies with over 79,609 patients. Seventeen reviews included studies of low- and middle-income countries’ initiatives. 

    SMS for a wide range of purposes seems to be the most common type of mHealth. It includes reminders, alerts, educations, motivation and illness prevention. Ten reviews gave them an Assessment of Multiple Systematic Reviews (AMSTAR) score of 0 to 4, low quality. Seven were rated as moderate quality, an AMSTAR score of 5 to 8. Six were rated as high quality, an AMSTAR score of 9 to 11. 

    mHealth for  chronic disease management scored well for impacts of:

    Improved symptoms and peak flow variability in asthma patients and fewer hospital admissions and improving forced expiratory volume in one secondImproving Chronic Obstructive Pulmonary Diseases (COPD) symptomsImproving heart failure symptoms and fewer deaths and hospital admissionsImproving glycaemic control in diabetes patientsImproving blood pressure in hypertensive patientsReducing weight in overweight and obese patientsBetter attendance ratesBetter adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decreased viral loads.

    While these are positive results, the benefits may still be moderate.  JMIR concluded that “Evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist.”

    The lack of reliable evidence doesn’t mean that Africa should slow down its mHealth investment. Instead, it means it should set up a reliable methodology to reveal the range of good and bad impacts. Lessons from these will be invaluable.

  • A smart watch can detect epilepsy

    Epilepsy is a leading serious neurological condition worldwide.  It has particularly significant physical, economic and social consequences.  Recognising the need for an intervention, Empatica Inc. has developed a smart watch to detect seizures in epileptic patients.  They’re calling it Embrace.

    Embrace uses machine learning algorithms to monitor and detect different seizure types, including grand mal or generalised tonic-clonic seizures. Electrodermal Activity (EDA)* sensors in the watch are used to measure multiple indicators of a seizure. 

    It’s also accompanied by an app that will send an alert, via text message, to a healthcare provider or caregiver once a seizure is detected.  Additionally, the app serves as an electronic seizure diary and health record for the user.

    During a clinical study involving 135 epileptic patients, Embrace’s algorithm was shown to detect 100% of the seizures, including the 40% of silent seizures that were unreported in patient clinical diaries.  Following this, the smart watch has received FDA approval as well as approval in Europe as a medical device for epileptic monitoring.

    Embrace’s high sensitivity is revolutionising seizure reporting.  It serves as a much awaited alternative to wearing an EEG, that is automated, and isn’t bulky or cumbersome to wear.

    *signals used to quantify physiological changes in the sympathetic nervous system 

  • Three mHealth apps help with treatment adherence

    Adherence to medication is an increasing problem in primary health care in Africa. It is important for many things, from birth control to antibiotics to ARTs. When medications are forgotten or skipped, most treatments are no longer as effective.  This becomes both costly for the healthcare system and detrimental to a patient’s health.

    Factors impacting adherence are multifaceted and include social, economic and psychological motives.  A sub-Saharan study in 2017 reported the most common barriers to adherence were;

    ForgettingLack of access to adequate foodStigma and discriminationSide-effects of the medicationTraveling

    With the uptake of smartphones in Africa, mHealth apps targeting treatment adherence could be a simple solution.  Here are the top 3 downloaded treatment adherence apps on Google Play Store. 

    PatientPartner

    This app turns patient education into an adventure game and shows patients the importance of sticking to a treatment schedule.

    Medisafe

    In addition to medication reminders, this app will notify friends and family if the user defaults. Medisafe also launched a low-tech version that sends reminders through automated phone calls and text messages. 

    MyTherapy

    After logging their medications on the MyTherapy app, users will receive reminders and alerts to take their medications.  Other features on the app include symptom tracking, healthy lifestyle tips and friends and family support groups.

    Improved adherence means a healthier society and ultimately, a reduced burden on healthcare systems.  Moreover, access to adherence data from these apps could help doctors and policy makers make better informed decisions about how to improve the healthcare system.

  • EMGuidance web-platform to simplify medication look-up in South Africa

    Since the launch of their clinical support platform in 2016, EMGuidance has become one of the most popular medical apps in South Africa, even extending to other parts of the globe.  Its popularity is largely due to the comprehensive, up-to-date and locally relevant clinical guides and protocols made easily available to health professionals.

    In fact, the response from health professionals has been so great that EMGuidance is now available as a web-based platform.  The web-based platform essentially functions as a Google search engine with a twist.  This niche search engine only returns locally relevant information – fulfilling a great gap in clinical support tools in South Africa.  Health professionals will now be able to search for relevant South African therapies by trade name, active ingredient or registered indication. 

    Realising the potential for other African countries, EMGuidance has launched a slim-line version of their tool in Sierra Leone.  The positive response from the local community has spurred plans to expand to Kenya, Tanzania and other African countries.  It’s activities and initiatives like EMGuidance that will springboard eHealth in Africa to first-world healthcare delivery.

  • Ghana will have a national telemedicine service next year

    Pilotitis become a phenomenon a few years ago as scaling-up eHealth pilots became too challenging. Good scale-up news is the recent  telemedicine initiative by Ghana Health Service and The Novartis Foundation, They’ve announced the successful integration and scale-up of a telemedicine service. National coverage’s planned for 2019. 

    The 24-hour telemedicine service uses mHealth for community health workers to consult specialist health professionals at teleconsultation centres on a range of health topics, including emergencies. It builds from the telemedicine pilot started in 2011 in the Ashanti Region’s Amansie West District.

    An important lesson for other African countries’s the timescale. Seven years may seem like a long time, but eHealth does take time to come to fruition. Over the period, telemedicine has encountered some specific changes. mHealth opportunities have replaced conventional conferencing technology, now obsolete and looking a bit clumsy and chunky.

    Ghana may have set a standard for other African countries to follow. It represents a considerable technological achievement in modernising and transforming healthcare. 

  • mHealth to drive Cote d’Ivoire's immunisation project

    Like falling snow, announcements at the World Economic Forum come thick and fast. Taking place in Davos Switzerland, Thursday 25th, 2018, one of the world’s leading telecommunications operators, Orange SA and the Vaccine Alliance Gavi announced a partnership with Côte d’Ivoire’s Ministry of Health to boost immunisation rates in the countries’ regions and districts with the lowest vaccine coverage.

    A report in Ventures Africa says it’s a joint US$ 5.47m five-year project. Half the money’s from the Gavi Matching Fund, a mechanism financed by the Bill & Melinda Gates Foundation to motivate and provide incentives for private sector investment in immunisation. It builds from Gavi’s longstanding role in the country starting form 2001, Gavi supported Côte d’ Ivoire in introducing eleven vaccines.

    It all fits with the M-Vaccin Côte d’ Ivoire initiative. It uses Orange mobile technology to inform parents about the importance of vaccination. Sending text and voice messages in local languages and targeting messages about keeping immunisation sessions are standard themes. Reminders of their children’s schedules and dates are the main goals.

    The initiative should be transferrable to all African countries. It’ll be good to see vaccination rates above 95% soon.

  • mHealth sigue expandiéndose, pero África y Sudamérica están detrás

    El mercado de mHealth ha estado creciendo constantemente y se mantendrá. En su informe “mHealth App Economics 2017 Current Status and Future Trends in Mobile Health”, Research2Guidance (R2G), una empresa de asesoramiento de estrategia e investigación de mercado, evalúa cómo los intrusos digitales se están apropiando del mercado de la salud.

    Este año, hay 325,000 aplicaciones de salud y acondicionamiento físico disponibles en todas las principales tiendas de aplicaciones. Son 78,000 más que el año pasado.

    La mayoría de los profesionales de eHealth vienen de Europa, 47% y 36% de los EE. UU., Un 83% combinado. Asia-Pacífico representa el 11%. Sudamérica y África están en el 4% y 2% respectivamente, lo que confirma la necesidad de un mayor desarrollo de capacidad humana. 

    Otros hallazgos incluyen:

    Android adelanta a Apple en los números de aplicaciones de salud84,000 editores de aplicaciones de salud lanzan aplicacionesAmpliación de la demanda y la brecha de oferta, con un alto número de desarrolladores y bajas tasas de crecimiento de las descargasInversión de US $ 5.4bn en empresas de eSalud que abastecen al mercadoLos usuarios descargarán aproximadamente 3.6bn de aplicaciones en 201718% no está desarrollando aplicaciones de salud debido a regulaciones inciertas53% de los profesionales de eHealth esperan que los seguros de salud sean el canal de distribución futuro con el mejor potencial de mercado. 

    Dos tipos de aplicaciones pueden tener un gran impacto en la atención médica. La Inteligencia Artificial (IA) es vista como la tecnología más disruptiva. Se considera que la combinación con el monitoreo remoto es la tecnología que más perturbará la atención médica. El perfil: 

    AI 61% Monitoreo remota y asistencia 43% Wearables 34% IoT 30% Realidad virtual e inteligencia 27% Impresión 3D 22% Blockchain 18% 5G 8% Otro 5%. 

    Parece que hay una oportunidad para que los sistemas de salud de África respalden y amplíen su oferta de aplicaciones de salud local.

  • South Africa’s mHealth has opportunities and bigger barriers

    Much has been made of the growth in mobile phones and their opportunities for Africans’ better health. A qualitative study in Science Direct found that there may not be a high positive correlation. It says while mobile phones have been evolving to fill South Africa’s primary care services gaps, there are barriers to access. Poor digital infrastructure and low digital literacy are two main longstanding inhibitors. 

    The study investigated mobile phone use by a wide range of people. It included patients with chronic diseases, pregnant women and health workers in Mpumalanga, South Africa. In 2014, semi-structured in-depth interviews were completed with 113 patients and 43 health workers from seven primary healthcare clinics and a district hospital.

    Some health workers and patients used their own mobile phones for healthcare, bearing the cost themselves, Bring Your Own Device (BYOD) initiatives. Patients used their mobile phones to remind themselves to take medication or attend clinic visits. They appreciated receiving voice call reminders.

    Some patients and health workers accessed websites and used social media to gather health information, but lacked web search strategies. Patients and health workers’ use of websites and social media was intermittent due to affordability constraints for airtime. Many didn’t know what to search for and where to search. 

    Doctors developed their own informal mobile health solutions for their work needs. It also overcomes resource constraints due to rurality. 

    Removing these seemingly unresponsive barriers needs investment in people and infrastructure. It’s a critical component of successful eHealth.

     

  • eHealth Africa pilots AVADAR to track Toward Polio Eradication progress

    In response to the reported cases of wild poliovirus in Nigeria, eHealth Africa (eHA) partnered with Bill & Melinda Gates Foundation, the  WHO, and Novel-T to pilot a mobile surveillance app for Acute Flaccid Paralysis (AFP) in children. It’s a condition of a rapid onset of weakness of people’s extremities, and includes Guillain-Barré syndrome.  AFP often causes weakness of respiration and swallowing muscles, progressing to maximum severity within one to ten days. 

    WHO defines AFP surveillance as six goals:

    Track wild poliovirus circulationUse data to classify cases as confirmed, polio-compatible or discardedMonitor routine coverage and surveillance performance using standard indicators in all geographical areas and focus efforts in ones that are low-performingMonitor seasonality to determine low season of poliovirus transmissions to help to plan National Immunisation Days (NID)Identify high-risk areas to plan mop-up immunisation campaignsProvide evidence to certification commissions of interruptions of wild poliovirus circulation. 

    Standard indicators are: 

    >90% of expected monthly reports>1/1000,000 annualised non-polio AFP rate per 100,000 children under 15>80% of AFP cases investigated within 48 hours>80% of AFP cases with two adequate stool specimens collected 24-48 hours apart and less than 14 days after onset>80% of specimens arriving at laboratories in good condition>80% of specimens arriving at a WHO-accredited laboratories within three days of despatch>80% of specimens for which laboratories’ results sent within 28 day turn round. 

    AFP surveillance’s one of four cornerstone strategies of polio eradication. The objective’s to identify all cases of polio through a system that targets any case of AFP as a potential case of polio.  AVADAR’s a surveillance tool on android mobile devices provided to health workers and community informants. It aids AFP detection and reporting both in health facilities and local communities.