Using Mobile Phone Networks to Combat Infant HIV

| November 15, 2011 | 0 Comments

By Cameron Johnstone
Maternal & Child Health Columnist

A nurse takes dried blood spot samples from an infant. The Clinton Health Access Initiative tests for infant HIV using this procedure and communicates results via mobile-equipped printers. Photo courtesy of USAID/James Pursey on Flickr.

Mobile phones hold great promise for aiding global health interventions. According to a World Health Organization research report, with the number of worldwide mobile phone plans approaching five billion, “the use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe.”[1] This potential is quickly becoming apparent in global health programs aimed at infant HIV treatment and prevention.

In 2009, an estimated 1,000 new infant HIV transmissions occurred per day despite the fact that antiretroviral therapy regimens can reduce the probability of mother-to-child transmission (MTCT) to under two percent.[2],[3]  For infants who do contract HIV, early antiretroviral treatment can substantially reduce mortality.[4]

Mobile phone interventions are growing increasingly relevant in South Africa where 74 percent of the population now owns a cell phone.[5] An estimated 3.2 million women and 280,000 children were living with HIV in South Africa in 2008.[6] MTCT prevention treatments – including antiretroviral drugs during pregnancy and HIV testing for the infant – are available through government health facilities, but there are significant problems with post-pregnancy follow-up. At Rahima Moosa Mother & Child Hospital in Johannesburg, 70 to 75 percent of mothers fall out of contact by the time the infant HIV test results are ready ten weeks after delivery.[5]

The hospital, in partnership with the non-profit organization Cell-Life, implemented a program to send Short Message Service (SMS) texts to mothers for ten weeks after delivery. Findings from the program suggest SMS messages significantly improved follow-up participation: 74 percent of mothers receiving texts brought their babies in at six-weeks post-delivery for an HIV-test compared to 58 percent of control mothers.[5]

Mobile phone technology can also prove useful by reducing the time taken for test results to arrive. The Clinton Health Access Initiative (CHAI) expanded early infant diagnosis testing across Sub-Saharan Africa in 2010, but found that the six-week wait for test results to arrive led to high follow-up losses and slowed antiretroviral treatment for diagnosed infants.[4]

In response, the CHAI implemented a pilot program in 11 countries in which lab scientists enter test results directly into a software program, sending data directly to printers equipped to Global System for Mobile (GSM) Communication networks located in community clinics. The CHAI worked with engineering companies to design small, easily operable printers to eliminate the need to wait for physical test results to arrive. Turn-around time for test results has been cut substantially by this initiative. In Nigeria, the wait for test results was reduced from 33 to 14 days, allowing quicker treatment for infected infants.[4]

While this program demonstrates the promise mobile networks hold for improving medical test efficiency, two drawbacks should be considered. First, although turn-around time was reduced by more than half in Nigeria, a wait of two weeks still may pose problems in remote areas where patient access is limited. Perhaps the program could be expanded even further to include remote analysis of test results, eliminating the delay created by the need to send physical samples to laboratories entirely. Second, at a cost of $300 to $450, GSM-equipped printers may be a substantial investment for clinics with limited resources, perhaps reducing access in some especially disadvantaged areas.[4]

Despite these questions, this program undoubtedly demonstrates the promise that mobile-phone interventions hold for improving HIV diagnostics in developing nations. Because treating HIV in infants early with antiretrovirals is key to reducing mortality risk, improvements in diagnostics turn-around time and follow-up losses can directly save lives. Rising worldwide mobile phone use will only increase the potential for such programs to improve global infant and maternal health.

 


[1] World Health Organization. Global Observatory for ehealth series – Volume 3. “mhealth: New horizons for health through mobile technologies.” Switzerland, WHO: 2011.

[2] UNICEF. Unite for Children Unite Against AIDS. “Mother-Baby Pack update: More efforts needed to prevent mother-to-child transmission of HIV. New York, UN: 25 April 2011.

[3] World Health Organization. WHO technical consultation. “Towards the elimination of mother-to-child transmission of HIV.” Switzerland, WHO: 2010.

[4] United Nations. The Global Campaign for the Health Development Goals 2011. “Innovating for Every Women, Every Child.” Oslo, UN: 2011.

[5] de Tolly, Katherine, Karl Gunter Technau, and Peter Benjamin. “Helping HIV+ mothers protect their babies: Improving follow-up and HIV testing rates of exposed infants through SMS.” Cell Life. http://www.celllife.org/images/downloads/PMTCT%20Poster.pdf

[6] United Nations. United Nations AIDS Data. “South Africa: Country Situation.” UN, 2008.

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