Programme Mwana 2 Leveraging Mobile Technology to Strengthen Health Services for Women and Children in Rural and Underserved Areas

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

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

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 Source: Global HIV/AIDS Response: Epidemic update and health sector progress towards Universal Access, 2011 Treatment EID ?

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

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

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

56% improvement in Turnaround Time of results Mwana increased results to mothers and decreased turnaround time, which translates into better health outcomes 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:

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

Health Facility District Medical Office Provincial Medical Office National IT Management Team Implementing Partner Lab Team Software Develop ment Team Secondary Support Primary Support A MoH Tiered Management plan allows for redundancy in accountability

Reports provide aggregated health information for the MoH

Alerts allow for real-time management of the health system

Geo-locative dashboards provide real-time information on maps

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

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

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

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

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

Mwana is also expanding in scope across the continuum of care

Mwana as a pilot

Mwana starts scaling nationally

Mwana replicates in other countries

New modules are added

Scale across countries and continuum

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

Thank You Merrick