Best Practices, Experiences and Lessons learnt on using mobile phones to impact HIV/AIDS Behavioral Change AIDS2012 July 2012 Eunice Namirembe

Developing countries have more mobile phones than “developed” countries  6 billion Mobile Phone subscriptions Globally (ITU,2011)  433 million in Africa (GSMA 2011)  53% have access to mobile phones in Africa (ITU)  95% of messages is read within 4min  6 billion Mobile Phone subscriptions Globally (ITU,2011)  433 million in Africa (GSMA 2011)  53% have access to mobile phones in Africa (ITU)  95% of messages is read within 4min

 Over 14 million mobile subscribers in Uganda as at June 2011  At least 50% of Ugandans can access a mobile phone  5 Major Mobile Operators  Over 14 million mobile subscribers in Uganda as at June 2011  At least 50% of Ugandans can access a mobile phone  5 Major Mobile Operators  At least 1.2 million people infected in Uganda in 2011  At least 130,000 new infections every year  More women than men infected Ref: Global AIDS Response Progress Report: Uganda Jan Dec 2012  At least 1.2 million people infected in Uganda in 2011  At least 130,000 new infections every year  More women than men infected Ref: Global AIDS Response Progress Report: Uganda Jan Dec 2012 Uganda: Mobile & HIV/AIDS Statistics

 NGO founded in 2007 in Amsterdam  Social Mobile Service & Content provider  TTC develops Interactive and Incentive based mobile programs  Pioneer in mHealth in Africa – 1 st Mhealth programme in Africa in 2008  Mobile Tools for Health, Education & Social Impact: SMS, Voice, Data  NGO founded in 2007 in Amsterdam  Social Mobile Service & Content provider  TTC develops Interactive and Incentive based mobile programs  Pioneer in mHealth in Africa – 1 st Mhealth programme in Africa in 2008  Mobile Tools for Health, Education & Social Impact: SMS, Voice, Data

Text to Change has active programs in 8 countries (red) and upcoming programs in 7 more (yellow) Family planning/re p health PMTCT Medicine adherence Mobilisation health services Drug stock outs HIV/ AIDS TB Data collection Antentatel care mHealth

 First TTC program in Mbarara ( 2008)  Target: Celtel subscribers  HIV/AIDS Quiz  Results: 20 % response rate  Uptake in HCT of +40% at AIC  Built our own platform + toll free short code  First TTC program in Mbarara ( 2008)  Target: Celtel subscribers  HIV/AIDS Quiz  Results: 20 % response rate  Uptake in HCT of +40% at AIC  Built our own platform + toll free short code

Do you think a healthy looking person can have HIV? 1.Yes 2.No To reply send: QUIZ to 8181 Do you think a healthy looking person can have HIV? 1.Yes 2.No To reply send: QUIZ to 8181 Users participate in free Health quizzes Well done! Someone who looks healthy may be HIV positive and could infect others. To know your own and your partners’ status, you should test for HIV together

Lira District 2010 After 3 hours radio show 4000 people opt-in 7000 people reached Health Quiz Response rate: 53% SMS mobilization HCT Duration: 3 months Program costs: 6000 USD Costs per person: < 1,- USD

SMS mobilization Increased uptake for VCT after SMS message Increased uptake for VCT after SMS message Week in which message was sent Tomorrow there is FREE HIV testing at the clinic in Lira. Please come and bring your partner! Tell your friends and family to come also!

Started in April clients – 104 clients (93% ) were active on the program Sending reminders to clients to take ARVs Increased adherence after SMS use :87% adherence above project start and 93% after 3 months Testimonial from partner ‘A greatly successful project as seen in the results below, the clients adherence increased, their viral load reduced and their CD4 also went up’ Started in April clients – 104 clients (93% ) were active on the program Sending reminders to clients to take ARVs Increased adherence after SMS use :87% adherence above project start and 93% after 3 months Testimonial from partner ‘A greatly successful project as seen in the results below, the clients adherence increased, their viral load reduced and their CD4 also went up’ + Providing Comprehensive Holistic Care to Clients with TB, HIV/AIDS and Cancer AdherenceBelow 95%Above 95% Baseline13%87% 3monts7%93% End of project8%92% PEPFAR SMALL GRANTS

Reminders Medicine Information HIV changes your life, but don't panic. If you live healthy and take medication when you need to, you can live a good, long life. Greetings! Please do not forget to take your medicine. Please call if you have any problems.

Combining strengths: Public Private Partnerships Combining strengths: Public Private Partnerships Reach people at workplace Quizzes on HIV/AIDS HCT Mobilization Time and cost effective 4 companies joined Scientific research (in progress) Reach people at workplace Quizzes on HIV/AIDS HCT Mobilization Time and cost effective 4 companies joined Scientific research (in progress) Text at work and stay healthy! Health & company messages Participants1500 /company Health SMS Quiz40 questions Response rateover 50% VCT mobilization3 Company messages 10 Total / company80000 messages Duration:12 months + +

Testimonial Sarah Mukuru, Community member Kinyara “I never knew that one can get health messages from a phone. It is very interesting except that I am not sure I will get airtime. I am planning to just read the message on condom use to my husband so that we start a serious discussion. For a long time I have wanted to talk about these things but as you know our men here, it is not easy” Testimonial Sarah Mukuru, Community member Kinyara “I never knew that one can get health messages from a phone. It is very interesting except that I am not sure I will get airtime. I am planning to just read the message on condom use to my husband so that we start a serious discussion. For a long time I have wanted to talk about these things but as you know our men here, it is not easy” Cure for HIV/AIDS?

EPMTCT/ Mother Reminder program in rural Uganda  Increase number of ANC visits to a minimum of 4.  Increase PMTCT uptake & adherence for HIV positive pregnant women  Increase number of women delivering at the health clinic  Provide postnatal support; examples: info about nutrition and hygiene.  Increase number of ANC visits to a minimum of 4.  Increase PMTCT uptake & adherence for HIV positive pregnant women  Increase number of women delivering at the health clinic  Provide postnatal support; examples: info about nutrition and hygiene.

To enquire on sites offering MC services send: WAPI to 1504 Promotion of Medical Male Circumcision via SMS Promotion of Medical Male Circumcision via SMS High uptake of SMS inquiries suggests that use of mobile phone technology has ability to increase access to MMC for HIV prevention services To receive post MMC health messages send: BAADA to To learn about Male circumcision and its advantages send: TOHARA to 1504

Response

How do you get users to participate?

Social incentives Scalable Sustainable Scalable Sustainable

Incentives with monetary value Examples: Airtime Merchandise Health products Examples: Airtime Merchandise Health products Mosquito net Barcelona shirt Airtime

Our Impact Increased uptake in people going for health services after receiving the messages from TTC Health awareness is promoted via the interactive and incentive-based messaging Adherence improvement (Improved Health seeking behavior) Increased uptake in people going for health services after receiving the messages from TTC Health awareness is promoted via the interactive and incentive-based messaging Adherence improvement (Improved Health seeking behavior)

Mhealth is Cheap, Mhealth is expensive Text Vs Voice  Text: cheap, can be retrieved any time,  Voice: closes illiteracy gap, expensive, Text Vs Voice  Text: cheap, can be retrieved any time,  Voice: closes illiteracy gap, expensive,

Combining with other media:  Radio  Television  Newspapers  Posters Combining with other media:  Radio  Television  Newspapers  Posters

Lessons learnt CONTENT Sustainability/ Pilot disease; Create a win-win situation, Business Model?; Not always demand for M&E; Phone Sharing – Advantage and Disadvantage; Male cell phone ownership; Local partnerships: relevance and responsiveness to local needs and conditions; Timing of SMS messages Data inaccuracy is always an issue when collecting data Lessons learnt CONTENT Sustainability/ Pilot disease; Create a win-win situation, Business Model?; Not always demand for M&E; Phone Sharing – Advantage and Disadvantage; Male cell phone ownership; Local partnerships: relevance and responsiveness to local needs and conditions; Timing of SMS messages Data inaccuracy is always an issue when collecting data

Text to Change: Why does it work?  Simple in Concept powerful in Result;  Multimedia approach ;  Partnerships with mobile operators, telecom industry, NGO‘s, private sector and governments;  Software that works in Africa;  Toll free services;  Demand driven programs;  Local content;  Focus on the end-user  Flexible SMS system Text to Change: Why does it work?  Simple in Concept powerful in Result;  Multimedia approach ;  Partnerships with mobile operators, telecom industry, NGO‘s, private sector and governments;  Software that works in Africa;  Toll free services;  Demand driven programs;  Local content;  Focus on the end-user  Flexible SMS system

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