Mobile health technology has the power and potential to make PMTCT more efficient and effective

1. Programme Mwana2Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and Underserved Areas

2. Mobile health technology has the power and potential to make PMTCT more efficient and effective • The Problem • Overburdened health system and difficult to reach areas • The Innovation • Strengthen entire PMTCT system using mobile technology How Programme Mwana improves this • Now: Decrease turnaround time for PCR test results, increase number of results, enable real-time problem-solving • Future: Track women and children to ensure that all individuals living with HIV are tested, enrolled in care, and treated

3. There are huge challenges implementing programs and tracking progress in line with the Global Plan and MDGs • The Global Plan seeks to eliminate vertical transmission by 2015 • Reduce new HIV infections among children by 90% & AIDS-related maternal deaths by 50% • However, we have no way to accurately identify the number of children currently infected • Using current methods, we will not know if we have reached the MDGs until the date has passed • Current monitoring: expensive, labor intensive, retrospective, one-way information flow

4. Failure to identify and enroll children living with HIV on treatment is a critical gap in the PMTCT cascade; many of these are in remote areas where UNICEF works EID Treatment ? Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, 2011

5. Although Early Infant Diagnosis (EID) is a critical part of elimination efforts, many think that it is an intractable problem Challenges with EID • Do not know true transmission rates in countries • Lengthy transport of samples to the central labs • Long distances that mothers have to travel for multiple visits • Long turnaround times • Do not know whether mothers receive results • Other approaches have failed • PCR turnaround time has been the focus, but turnaround time is not enough • No cohort data, only cross-sectional so hard to know longer-term results • Faster results do not necessarily mean that infants are being treated • Lack of community interaction • Point-of-care solutions are far away from being implemented Mwana is the response to that is faster, cost-effective, and approaches the problem at a systems level TODAY

6. Programme Mwana utilizes two main software components • Health system focused, trained Clinic Staff • Community focused, trained Community Health Workers (CHWs) • All SMS are free to end users

7. To build the software for Programme Mwana we moved to rural Zambia and spent six weeks co-creating it with clinic staff

10. Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes 56% improvement in Turnaround Time of results Sidenberg et. all, Early infant diagnosis of HIV infection in Zambia through mobile phone texting of blood test results, Bulletin of the World Health Organization 2012;90:348-356

11. Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes 30% more results delivered using SMS Schaefer, Nicholson, Mugala; Monitoring and Evaluation Presentation to the Zambia Ministry of Health; 2011

12. A MoH Tiered Management plan allows for redundancy in accountability Primary Support Secondary Support Lab Team Software Development Team

13. Reports provide aggregated health information for the MoH

14. Alerts allow for real-time management of the health system

15. Geo-locative dashboards provide real-time information on maps

16. EID before Mwana was primarily an “ad hoc” system Previous Follow-Up/Tracking System Steps in EID Cascade Infant born to HIV+ mother ? Ad hoc Clinic DBS test within 2 months Physical paper system in clinic but data not utilized at district or national level PCR lab analysis DBS result back to clinic ? Ad hoc CHW finds mother ? Ad hoc ? Mother comes back to clinic Ad hoc ? Ad hoc Mother goes to ART clinic

17. Mwana addresses every step of the EID cascade to ensure timely, accurate and consistent communication and to decrease loss to follow-up Mwana Follow-Up/Tracking System Steps in EID Cascade Infant born to HIV+ mother CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic Clinic DBS test within 2 months DBS sample traced up to lab PCR lab analysis Result sent to all clinic staff for retrieval DBS result back to clinic Clinic can initiate TRACE on mother CHW finds mother CHW tells system it has TOLD mother Mother comes back to clinic Mother goes to ART clinic

18. Potential next steps would be to add ART clinics in to Mwana – providing a complete real-time monitoring and management tool Mwana Follow-Up/Tracking System Steps in EID Cascade Infant born to HIV+ mother CHW registers birth and is prompted at 6 weeks to remind mother to go to clinic Clinic DBS test within 2 months DBS sample traced up to lab PCR lab analysis Result sent to all clinic staff for retrieval DBS result back to clinic Clinic can initiate TRACE on mother CHW finds mother CHW tells system it has TOLD mother Mother comes back to clinic Next steps: FEEDBACK/VERIFY (protocol & study design) ? Mother goes to ART clinic

19. Mwana is scaling nationally in both countries (more sites, more women and infants served) % National Coverage % National Coverage 1% 10% 38% 60% 100% 11% 22% 55% 100%

20. This scale up is being led by government and supported by a wide range of partners. Government & UN Implementing Partners Mobile Network Operators Donors

21. Mwana is also expanding in scope across the continuum of care

22. Mwana as a pilot

23. Mwana starts scaling nationally

24. Mwana replicates in other countries

25. New modules are added

26. Scale across countries and continuum

27. Through mobile technology, Mwana has a huge potential to positively impact health systems and reach “the last mile” more quickly and effectively Improves program outcomes and increases health impacts Simplicity allows wide use and uptake in low-resource/rural settings Real-time data enables real-time management & strengthened M&E Builds on existing infrastructure, partnerships, and lessons learned Engages communities in the process

28. Thank You Merrick Schaefer merrickweb@gmail.com @unimps http://github.com/rapidsms/rapidsms/