The distribution of Cell Phones to Mothers of EID HIV positive Infants in Haiti: A model for Increasing Adherence?

Background : EID Test every infant born to an HIV +ive mother. The DNA PCR = HIV Dx from 4 wks of age. Rapid ELISA = 18 months of age – Maternal antibodies Early diagnosis Early treatment Untreated, mortality is over 50% < 2 years. HIV positive child < 2 years old age to start ARV treatment upon diagnosis.

The number of children infected is the ultimate measure of the success of the PMTCT program Without the EID its impossible to know when the “Elimination of Transmission From Mother to Child” has been met.

Pregnant women HIV +ive OPTION B + ARVs Birth & Feeding Plan Infant Prophylaxis (AZT/NVP 6 WKS) Infant PCR 4-6 Wks Positive Infants Start ARVs Negative Infants re-test after weaning FP Discussion

Methods May 2010 Given to mothers of newly diagnosed HIV + infants through the PCR program Regularly communicate with the mothers about the child Mothers who gave consent and signed “Contract” Consent of Mothers with pre-existing cell phones Contacted weekly - health status, appointments, drug adherence.

Results # Sites# Women Given Phones # Women Own Phones # Active Phones /108 (70.4%) # Phones Inactive # Phones Stolen # of Children with phones in active follow up, on ARVs and Adherent 21/108 (19.4%) 11/108 (10.2%) 76/76 (100%)

Questionnaire Why were you given a phone? 50 Respondants of 70 Given 90% to check if my child is healthy/ ok/ to check on my child’s health 74% ‘ to remind me of my appointments’ 60% ‘ to contact someone if my child is sick or needs help’

Why were you given a phone? 50 What do you feel when you are called by the team? 76 respondents ( 50 donated phones and 26 own phones ) 76 Felt Positive about being contacted 100% Does being contacted by the team help you? 76 Respondents Yes 75 No 1

Why is it helpful to be called? 76 Respondents 61 (80%) It was helpful as an appointment reminder 63% It helped them to remember medication for their children 51% It was helpful when their children were ill.

What problems have you had with the phone? 76 Respondents 75% Problems buying credit or minutes for their phones. 40% Difficulty in charging the phone. 25% Poor phone reception 21% Fear of the phone being stolen

Limitations Small Sample Size :The EID program diagnoses 150 children per year in Haiti No biologic markers of adherence No Pre and Post follow : Given phones close to the time of diagnosis. Not a randomized controlled trial. We did not want to risk losing children to follow up.

Anecdotes LOOK away if Offensive! Phones given close to the time of diagnosis, Phones helped start treatment earlier. When children become acutely ill, mothers can ask for advice esp : cholera epidemic. Links to health agents : drugs shortages/ transport issues One Mother planned to commit suicide, but because of regular contact she felt more positive about the future. One of our mothers was beaten by her partner Phone as a security deposit for food.

Other uses of Mobile technology in Haiti EID program Live, online spreadsheet that is linked to the reference labs. In 2010 median of 1 day for result transmission to the providers children. Smart Phone Access the spreadsheet Communicate with Pregnant Women Adolescent Outreach

Conclusions Using cell phones with families of HIV-positive children has helped monitor these children. Approx. 20% of PCR positive children identified are lost to follow up within 12 Months Phones 20 USD in Haiti; not prohibitively expensive. The use of cell phones, as part of an active community tracking program has benefitted the Haiti EID program.

Thanks and Acknowledgments MSPP USAID/ PEPFAR Voila Foundation Caris Foundation Directors