MobileActive.org

[Adapted from Abstract]

This paper presents a year long study protocol for a trial, to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India (Chennai and Bangalore).

Researchers plan to enroll 600 treatment naïve patients for first-line treatment as per the national antiretroviral treatment guidelines at two clinics in South India. Patients will be randomized into control and intervention arms. The control arm will receive the standard of care; the intervention arm will receive the standard of care plus mobile phone reminders.

Each reminder will take the form of an automated call and a picture message. Reminders will be delivered once a week, at a time chosen by the patient. Patients will be followed up for 24 months or till the primary outcome i.e. virological failure, is reached, whichever is earlier.
Self-reported adherence is a secondary outcome. Analysis is by intention-to-treat. A cost-effectiveness study of the intervention will also be carried out.

A step-by-step outline of designing a 24-month long trial to determine effectiveness of phone reminders for anti-retroviral adherence.

Background: The objectives are to compare the effectiveness of cell phone-supported SMS messaging to standard care on adherence, quality of life, retention, and mortality in a population receiving antiretroviral therapy (ART) in Nairobi, Kenya.

Methods and Design: A multi-site randomized controlled open-label trial. A central randomization centre provided opaque envelopes to allocate treatments. Patients initiating ART at three comprehensive care clinics in Kenya will be randomized to receive either a structured weekly SMS (’short message system’ or text message) slogan (the intervention) or current standard of care support mechanisms alone (the control). Our hypothesis is that using a structured mobile phone protocol to keep in touch with patients will improve adherence to ART and other patient outcomes. Participants are evaluated at baseline, and then at six and twelve months after initiating ART. The care providers keep a weekly study log of all phone based communications with study participants. Primary outcomes are self-reported adherence to ART and suppression of HIV viral load at twelve months scheduled follow-up. Secondary outcomes are improvements in health, quality of life, social and economic factors, and retention on ART. Primary analysis is by ‘intention-to-treat’. Sensitivity analysis will be used to assess per-protocol effects. Analysis of covariates will be undertaken to determine factors that contribute or deter from expected and determined outcomes.

Discussion: This study protocol tests whether a novel structured mobile phone intervention can positively contribute to ART management in a resource-limited setting.

Two challenges to successful antiretroviral therapy (ART) scale-up in resource-limited settings (RLS) are human resource and healthcare infrastructure limitations. 

We read with interest the modeling study by Bärnighausen et al. which describes the complexities of ensuring adequate human resources to treat HIV/AIDS (HRHA). The authors suggest that factors needed to achieve universal ART coverage include “changes in the nature or organization of care,” training health workers with skills specific to the developing world to reduce emigration, and developing systems that decrease the number of traditional HRHA required to treat a fixed number of patients.

The Rakai Health Sciences Program (RHSP) PEPFAR-funded ART program has been actively pursuing innovative HIV care strategies that directly address these important points. In 2006, we piloted a novel program utilizing peer health workers (PHW) and mobile phones to monitor patients in a rural ART program in Rakai, Uganda.

This paper presents a case study of the efficiency gains resulting from the introduction of electronic technologies to monitor and support adherence to highly active antiretroviral therapy (HAART) in Guguletu, South Africa. It suggests that the rollout of HAART to such resource-poor communities can be assisted significantly by the introduction of modified cellphones (to provide home based support to people on HAART and improve the management of adherence data) and simple barcoding and scanning equipment (to manage drug supplies). The cellphones have improved the management of information, and simplified the working lives of therapeutic counsellors, thereby enabling them to spend less time on administration and to devote a constant amount of time per
patient even though their case loads have risen threefold. It has helped integrate the local-level
primary health service provision of HAART with the kind of centralised data capture and analysis
that could potentially support a national HAART rollout.

This White Paper, written by a team of researchers at the Center for Global Health and Economic Development at the Earth Institute, Columbia University, examines and synthesizes the existing mHealth literature to assess the current state of mHealth knowledge, evaluate the impact of mHealth implementations in LMICs and to examine programming, policy and research-related barriers to and gaps in mHealth scale and sustainability.

The paper is divided into two main sections. The first section reviews and summarizes the peer-reviewed literature on mHealth initiatives (focus on LMICS) to highlight trends and challenges. The second section examines the existing mHealth policy environment, barriers and gaps, and key drivers needed for an enabling policy environment.

The major thematic areas include:

• Treatment Compliance
• Data Collection and Disease Surveillance
• Health Information Systems and Point of Care Support
• Health Promotion and Disease Prevention
• Emergency Medical Response

The review identified significant gaps in mHealth knowledge stemming from the limited scale and scope of mHealth implementation and evaluation, a policy environment that does not link health objectives and related metrics to available mHealth tools and systems, and little investment in cost-benefit studies to assess mHealth value and health outcomes research to assess success factors and weed out poor investments.

The ability to collect data is key to the success of many organizations operating in the developing world. Given the weaknesses of current tools and the surge in mobile phone growth, there's an opportunity for mobile and cloud technologies to enable timely and efficient data collection. This paper discusses Open Data Kit (ODK), a suite of tools that enable efficient and timely data collection on cell phones. ODK is designed to let users own, visualize, and share data without the difficulties of setting up and maintaining servers. The tools are easy to use, deploy, and scale. They also go beyond open source - they're based on open standards and supported by a larger community.

The overall goal of the PDAs for Malaria Monitoring in Maputo and Gaza Provinces, Centre was to improve the management of public health dat using handheld computers in order to provide the malaria program the Lubombo Spatial Development Initiative (LSDI) with appropriate assessment tools and the ability to make informed decisions.

The specific objectives of the project that would contribute to the achievement of the overall goal were

1. to enable personnel from District level of the health service to collect data and provide it to the Provincial level in a timely fashion;
2. to develop training courses and appropriate collection tools designed for use with handheld computers; and
3. to evaluate the utility of handheld computers for the malaria control program to provide data rapidly and accurately to allow better targeting of interventions and resources.

AED-SATELLIFE developed and successfully deployed electronic data collection tools which catalog drug and rapid diagnostic test stocks; spray operators daily work performance; weekly health facility data; localization of individual households with GPS, including demographic data on household members, house structure and divisions; and health facility surveys linked to GPS positioning. Training materials were developed inPortuguese.

Independent evaluation confirmed that the electronic data collection/transmission tools proved to be a useful, adoptable, and result in higher user satisfaction compared to paper based approaches. Some challenges need to be addressed before there can be widespread adoption of the technology, such as limited infrastructure, especially cellular coverage.

The  usage  of  mobile  phones  is  abundant  in  our  daily  lives  in  various  aspects from making phone calls or sending text messages to checking e-mails or news updates to planning our activities or managing our budget. This project aims at making use of this wide spread usage of mobiles to help in the  data  collection  process.  It  designs  and  develops  a  web  based  system  called “MobiCollect”  that  is  used  for  creating  forms  or  questionnaires  to  be  later accessed  by  the  data  collectors  using  their  mobile  phone  web  browser  in  order fill in the form with the appropriate data. 
 
Once  the  system  design  and  implementation  is  completed  it  will be  tested  and evaluated to ensure the satisfaction of at least the minimum requirements of the proposed system.

This paper provides an overview of the implications of this trend for the delivery of healthcare services and population health. In addition to addressing how mobile phones are changing the way health professionals communicate with their patients, a summary is provided of current and projected technologic capabilities of mobile phones that have the potential to render them an increasingly indispensable personal health device. Finally, the health risks of mobile phone use are addressed, as are several unresolved technical and policy-related issues unique to mobile phones. Because these issues may influence how well and how quickly mobile phones are integrated into health care, and how well they serve the needs of the entire population, they deserve the attention of both the healthcare and public health community.

The Swedish International Development and Cooperation Agency (Sida) recently published a report that gives an overview of the current state of mobile phone applications for social and economic developments in East Africa. Drawing on successful adoption of mobile applications in the Philippines, this Sida report seeks to answer “what hinders the take off of m-applications for development in East Africa and what role donors play in the process.” While mobile phones is the one of the most widely accessible gateways for information in East Africa, with mobile penetration covering over 40% of the population, sustainable, scalable mobile services for social and economic development are limited. The report is supported by secondary data, statistics, and field work carried out in Kenya, Rwanda and Tanzania, along with numerous interviews, meetings and discussions with key stakeholders in East Africa. Major trends in mobile usage, barriers for increased use of m-applications, as well as opportunities for scaling are discussed.

A how-to guide on using and implementing RapidSMS for mobile data collection and communication.

The aim of this paper is to encourage reflection and discussion around the
potential of mHealth in developing countries and to consider how early experiences
can inform the way forward. Toward this aim, I synthesize many reviews and
presentations from the eight years I have been studying the evolution of mobile
phones and health in developing countries. I include observations and discussions
that are now shaping the creation of mHealth as a field, to highlight the ingredients
we need to move from a series of pilot projects and isolated business opportunities
to a full-scale maximization of health-related benefits.

I begin by reviewing the strategic priorities within global health, where mobile
telephony can have the greatest impact, along with organic health-related uses of
mobile phones, and examples of formal mHealth interventions. I then demonstrate
the potential for mobile phones to become an extension and an integral
component of eHealth, describing how information and communication technology
(ICT) can be used in health care, as well as mHealth, as a subset of mServices:
using mobile devices to deliver services such as banking and health. I also show
how trends and interests are converging among key stakeholders within the
mHealth ecosystem, thus forming a foundation on which we can scale up and sustain
more and better mHealth activities. Finally, I present some tactical guidance
for a way forward that will further the objectives of both public health and business,
particularly in outreach efforts to emerging markets, the bottom of the pyramid,
and the next billion mobile phone subscribers.

Baseline under five child mortality in Sauri, Kenya as of 2005 was estimated to be 148 deaths per 1000 live births. By 2008, the rate had dropped to 81 deaths per 1000 live births due to Millennium Village Project (MVP) interventions. A review of child deaths revealed that among other causes, such as malaria, acute febrile illnesses, diarrheal illnesses and HIV, malnutrition contributed to more than 50% of all child deaths. Community health workers (CHWs) led several interventions, namely community-based management of acute malnutrition, home-based testing for malaria and diarrheal illnesses and immediate dispersal of appropriate treatments.

To support these interventions, MVP ran a pilot project where CHWs were equipped with mobile phones to use SMS text messages to register patients and send in their data with the goal of improving child health and empowering community health workers. This report seeks to detail the methods used, illustrate early results and initial findings of the ChildCount mHealth platform that CHWs have now been using since early July of 2009.

An overview of the components, approaches and techniques used to build mobile phone-accessible applications that use SMS text messages as a conduit for data collection and service delivery. SMS-based applications represent a paradigm shift allowing innovative new approaches to monitoring and data collection fundamentally changing the way we can approach the delivery of critical health, economic and social services in resource-poor settings. SMS has the potential to fill significant connectivity and service gaps, particularly
for the world’s poor, until data networks and phones that can support them become more ubiquitous.