1. Supportive mHealth: Using mobile systems in prevention of mother to child transmission & HIV support services Dr Peter Benjamin peter@cell-life.org Skype ID: peterbenjamin @PeterB_CellLife www.cell-life.org.za

2. What will be covered? Introduction to Cell-Life mHealth to support Prevention of mother-to-child HIV transmission Other mHealth for HIV applications mHealth next steps: beyond the hype

3. What will be covered? Introduction to Cell-Life mHealth to support Prevention of mother-to-child HIV transmission Other mHealth for HIV applications mHealth next steps: beyond the hype

4. What is Cell-Life is? Not-for-profit making tech & services accessible to improve health & meet social challenges Started 2010, UCT & CPUT Cape Town, SA 10 African countries (mainly SA) 25 staff (mainly techies) Open Source

5. What do we do? Applying eHealth (especially mHealth): 1. Social & behaviour change communications 2. Primary health system strengthening We are one of the few mHealth organisations active in Technical development Proof-of-concept pilots at sites Larger health system implementations Developing business models Research Policy

6. What will be covered? Introduction to Cell-Life mHealth to support Prevention of mother-to-child HIV transmission Other mHealth for HIV applications mHealth next steps: beyond the hype

7. Initial Randomised Controlled Study Rahima Moosa Mother & Child Hospital, Jo’burg RCT 320 mothers (½ test, ½ control), informed consent SMS info & reminders (30 messages over 10 weeks) Msgs help women deal with status, ‘psycho-social’ support “Text messaging improved infant follow-up rates in this urban South African context”, small effect Great difficulty in collecting & verifying all data mHealth and PMTCT

8. Scaling up, 2012 – 2013 Funding: UN Innovation Working Group (Norad) Partners larger orgs (RTC) & DOH districts mHealth and PMTCT (Cont) Expecting mothers Advice on PMTCT, pregnancy care, preparing for labour, breastfeeding and baby care Mothers about to give birth (birth week) or baby < 3 months Advice on PMTCT, breastfeeding, keeping healthy, signs of illness, baby care

10. SMS Themeses Introductory messageLifestyle Opt out informationMedication Clinic attendanceNutrition Baby clinic & advicePostnatal BirthPregnancy prevention BondingSTI BreastfeedingTB HygieneTesting Infant illnessVaccines

11. Hello. PMTCT means preventing a mother from infecting her baby with HIV. The treatment is free at the clinic. HIV+ mothers can have HIV- negative babies. SMSBaby Please eat well. So fruit, vegetables, cereals & whole grains (like brown bread & oats), meat & eggs. Don't want to eat? Try many small meals. SMSBaby You can help stop your baby getting HIV by going to all clinic checkups, having the right medicines, & feeding breastmilk ONLY for the first 6 months. SMSBaby Good day good Mom. Your baby will love the sound of your voice. He will show you by his smiles and wriggling. Talk and sing to him every day. SMSBaby

12. Hawthorne Effect Little staff time for new procedure: opt-in Pilots often have people who can ‘help out’ Just for HIV+ or all pregnant women? HIV explicit? (Now 40% use HIV words) Data flows to make information useful to management Health economic study (Cost to Qualy) Issues scale & integrating with health system

13. What will be covered? Introduction to Cell-Life mHealth to support Prevention of mother-to-child transmission of HIV Other mHealth for HIV applications mHealth next steps: beyond the hype

14. Mobile Data Collection

15. Dept of Health cellphone rollout 12,000 phones Data collection for all 4,332 health facilities First application: monitoring of HCT & ARV Project awarded to Cell-Life and HISP Initial rollout in 950 facilities June 2012 Full rollout from Sept - Nov 2012 Infrastructure for clinical mHealth Clinical data collection in SA public sector

16. Messaging for prevention & testing Soul City, SANAC, Brothers for Life, Just tested (+ve & -ve) Mass information for positive living TAC Adherence Clubs, Siyayinqoba Linking patients & clinicsECHO, Kidz +ve, DTHF, RHRU / WRHI CounsellingNational AIDS Helpline Building capacity of HIV- related organisations CARIS, HIVAN, TAC... – over 100 organisations Maternal healthMobile Alliance for Maternal Action (MAMA), PMTCT Communicate applications

18. What will be covered? Introduction to Cell-Life mHealth to support Prevention of mother-to-child transmission of HIV Other mHealth for HIV applications mHealth next steps: beyond the hype

19. Every trial shows people like messaging Most well-designed studies show small impact Great potential – but more hype than reality Growth sector (feeding frenzy) MAJOR issue of going to scale Cost of SMS / limitations of USSD Integrate to weak Health Info Systems Take data security & privacy seriously mHealth issues

20. SA DoH & private interest for NHI ICT4 Health Stakeholders Forum Need national integrated systems: Data collection system, MAMA messaging Enabling regulation “Ecosystem model” Sustainability beyond pilots & donors: 2 - 3 years to embed what works Next steps in mHealth in SA

21. Nkosi Siyabonga Ke a leboga Dankie Thank you Dr Peter Benjamin peter@cell-life.org Skype ID: peterbenjamin @PeterB_CellLife `