NHLS Patient Result App

mHealth: A means to deliver health servicesJesse Coleman, mHealth Programme Manager Wits Reproductive Health & HIV InstituteJohannesburgmHealth at RHIVodacomLinkage to care and adherence (HIV)SMS; YoungAfricaLive B-Wise.mobiMobile Alliance for Maternal Action (MAMA)Knowledge (Maternal and child health)SMS; USSD; Mxit; AskMAMA.mobi MomConnectSmart Linkage to Care (SmartLtC)Linkage to care (HIV)Smartphone application (Android)Vodacom mHealth SMS (2011-2014)CD4 count lab results (2 CoJ clinics)SMS with CD4 count lab resultResults forthcomingAdherence support and appointmentreminders (3 CoJ clinics)Preliminary results show patients receiving first 6 months of SMSs were 2.8 times more likely to attend on time!YoungAfricaLiveYouth-oriented health mobisiteRe-branded by NDoH as B-Wise.mobiB-Wise.mobiMAMA South Africa (2012-2014)MAMA SMS (6 CoJ clinics)12 500 women signed upSMS user research study>430 interviews done50% Zimbabwean, 78% share MAMA info, 81% saythey breastfed their baby (within average of 12 months)AskMAMA.mobi and MXitMaternal and child health mobisite870 000 unique visitors and registered users (AskMAMA.mobi)105 000 unique visitors and registered users (MXit)MAMA USSD35 000 women signed upMAMA SMS and USSD are now MomConnect across allprovinces!Mobisite platform currently being converted to MomConnectAskMAMA.mobi and MomConnectOther mHealth ProjectsPrEP study (SMS)Appointment remindersCustomised support messaging (seven key areas)RCT based on Vodacomproject (SMS)CD4 count lab resultsAppointment remindersAdherence messagingEMPOWER study (SMS)Appointment reminders (SA andTanzania)Adolescents (SMS)Appointment remindersCustomised support messagingCD4 count lab resultsReferralsChoices study (SMS)Appointment remindersShaReMo (mobisite)RegistrationClinical trial informationNew: Smart Linkage to Care(Smart LtC) AppBackgroundResearch shows smartphone applications (apps) improve adherence through engagementPerera et al. (New Zealand, 2014) found decreased viral load at 3 months (p=0.023) in patients (n=28)High smartphone use in SAOwnership = 35-50% smartphoneNew sales = 85% smartphoneObservation of high smartphone (70-80%) use in Hillbrow CHCSmart LtC HypothesisProviding smartphone-owning patients theirlaboratory results immediately and securely from the moment of HIV diagnosis, with linked explanatory information about what the results mean, along with prompts to link and re-link with care, will lead to improved linkage to care, better retention in care, higher patient satisfaction, better knowledge of CD4 and viral load results, improved healthcare worker requests for results, decreased additional blood tests, clinic decongestion, and higher rates of viral suppression.Study OverviewMethodMulti-centre RCT in five medium-to-large HCT/ART sites in Johannesburg on 2 000 newly diagnosed HIV clients50% male and under 25Smartphone app vs. Standard of carePrimary OutcomeLinkage to care (defined as attending for a CD4 count measurement PLUS one other NHLS test within 6 months of HIV diagnosis)Smart LtC App: Key FeaturesPassword-protected (username, password and PIN)Lab results, health information and appointment remindersHIV, TB, STI, healthy living information content and linksEnglish and isiZuluConsuming minimal network dataNon-descript app icon and nameFor lab results Simple notificationCall-back number for technical problemsAutomated prompts if client not noted to have entered careApp usage monitored, including during clinic visitsNotification by client in case of self-transferRegistration and Log-inCD4 and Viral Load ResultsContentMore ContentProgrammatic and Social ServicesFAQsSmart LtC: Vision and Policy ImplicationsAvision of an AIDS free Johannesburg

All patients would have immediate access to their lab results though smartphoneAll HIV clinicians with direct access to lab results for case managementPatient better linked to health service and receiving personalised information client-centered.Other mHealth PlatformsSMS / USSDNurseConnect (training / support to nurses and midwives)MobisitesChoma (young girl adolescents): choma.mobiHi4Life (general health for all groups): hi4life.mobiILoveLife (adolescents; CCT): ilovelife.mobiAppBeyondZero (SmartLtC extension; patient management):www.beyondzero.org.zaSoftwareMobenzi (POC; data capturing, collection and reporting; referral for maternal health): www.mobenzi.comemocha (data capturing; education; data management):www.emocha.comThank You!Jesse ColemanmHealth Programme ManagerWits Reproductive Health & HIV Institute

Phone: +27(11) 358 5528Mobile: +27(72)676 9854E-mail: jcoleman@wrhi.ac.za Website: www.wrhi.ac.za