Mobile phones are changing health care — and according to a new study, have the potential to save and improve lives in low-resource areas of the world. The study on mobile phone usage to treat HIV positive clients in Kenya, published by The Lancet, indicates that simple “how are you” texts delivered weekly increase the likelihood that Kenyans who are HIV positive will follow their medication regime, helping them stay healthy and also reducing the spread of the disease (since they then have a lower viral load).
Earlier this week, lead researcher Dr. Richard Lester presented the team’s findings at the 2010 mHealth Summit in Washington, DC, a gathering of 2,000 participants from academic, government and private sector including philanthropists Bill Gates and Ted Turner.
Why mobile phones work
According to Science Daily, Dr. Lester, a clinical assistant professor in the Division of Infectious Diseases at the University of British Clumbia Faculty of Medicine said, “ART (antiretroviral treatment) requires patients to take their medication very consistently to ensure the virus stays dormant and to prevent the person from developing resistance to the drugs. But adhering to such a regimen can be particularly difficult in the developing world, where visits to clinics can be arduous and time-consuming, and where civil strife, food shortages, economic hardship and even wars can disrupt people’s lives.”
Mobile phone usage in countries like Kenya is very high, with nearly 75 percent of people over the age of 15 subscribing to mobile phones in 2008.
“Considering the ubiquity of mobile phones and the minimal expense in sending text messages, this practice can be an extremely cost-effective way of improving outcomes for HIV patients — not only in Africa, but around the world, particularly with transient, low-income populations,” Dr. Lester said.
Mobile study results
The study, conducted by a team of researchers from the US, Canada and Kenya and funded by the US President’s Emergency Plan for AIDS Relief, focused on 538 patients from three clinics. Between May 2007 and October 2009, the patients were divided into two groups: half were randomly selected to receive text message support and half were not. Those in the support group received a weekly friendly message and were expected to respond within 48 hours. If they did not respond, or responded saying they had a health problem, the clinic followed up with the patients. The messages were not intended as medication reminders, but participants reported that they felt “like someone cares” and had an opportunity to address any health problems quickly before they turned into larger issues. The study found that the group who received the check-ins were 12 percent more likely to have an undetectable viral load a year after starting treatment.
This was the first randomized controlled trial to examine the effectiveness of mobile phone support system with patients, but other groups, such as nonprofit health organizations, are also using mobile technology to improve HIV care. This summer in Tanzania I travelled with community home-based care workers who were employing mobile phones to help HIV positive clients in Dar es Salaam, Tanzania.
Mobile health technology expanding
I saw that in areas where HIV is highly stigmatized, and patients are often reticent to travel to nearby clinics for fear of being identified as HIV positive, community home-based care workers use mobile phones during their visits with clients to check in on their health and provide advice.
Pathfinder International in collaboration with D-Tree International has developed a phone-based tool that simplifies the collection and transfer of data to a general database and offers decision support to the health workers. The phone has a checklist of activities to be performed at each home visit, including reminders of appointments.
So far, Pathfinder has provided 107 community health workers with a mobile phone and the project will roll out the phones to another 190 community health workers in 2010-2011. Benjamin Mrema, a Pathfinder staff member working on the project, said, “We have seen increases in patient confidentiality since providers don’t need to carry the usual forms when visiting clients. We’ve also seen an increase in number of completed referrals, better use of health protocols, improved record keeping, better planning (for the community health worker) and an increase in the use of data to show trends in health worker activity.”
There have also been challenges however, including the literacy level of the community home-based care providers, security threats as mobile phones can be targets for robbery, and the cultural acceptability of using mobile phones to manage health related issues.
It is clear through The Lancet study and pilot projects such as Pathfinder International and D-Tree’s that mobile technology has the potential to significantly impact the health of those in need.
Photo I took of a home-based care provider meeting with a client for HIV testing during a trip to Dar es Salaam, Tanzania on behalf of Pathfinder International.