Mobile health technology supports HIV status reporting, monitoring and treatment initiation
There have been significant advances in the management of HIV/AIDS over the years. However, the management of HIV-exposed infants (HEI) has been hampered by challenges of tracking the testing process and communication of results to the mothers for initiation of care in a timely manner. Early infant diagnosis (EID) of HIV infection is essential in ensuring timely initiation of antiretroviral therapy (ART) and reducing the high morbidity and mortality that occurs among HIV-infected infants. Without early initiation of ART, one third of infants who are HIV positive will die before their first birthday and more than half will die before they reach 2 years of age.
The HIV infant tracking system (HITSystem) is a web-based mHealth intervention developed by Global Health Innovations (GHI) that seeks to improve EID outcomes, including timely reporting of EID results and tracking of HIV-infected infants for early initiation of ART. Since 2013, MHRP’s PEPFAR program in Tanzania, in collaboration with GHI, has been piloting the HITSystem in the Southern Highlands. has been piloting the HITSystem in the Southern Highlands of Tanzania to address the following challenges within the continuum of care of EID:
- inadequate and late enrollment of infants for EID;
- delayed or lost samples being shipped to testing lab;
- long turnaround times for test results;
- passive communication of results to the mother/guardian;
- few HIV+ infants initiated on ART;
- infants tested but results not received at health facility;
- lack of re-testing of HEI with initial HIV-negative results.
The HITSystem tracks different interventions for an HEI according to the Tanzania Ministry of Health and Social Welfare guidelines. The infant is tracked up to 18 months of age when it transitions out of the EID program. The system is able to communicate with the mother/healthcare worker via a mobile phone message notifying her to go to the clinic once test results are ready for pick-up. If an intervention is skipped, HITSystem utilizes automated alerts to ensure prompt action from PMTCT providers and laboratory technicians using a computer installed at the sites and at the main PCR laboratory.
The Key HEI interventions that are monitored include:
- PCP Prophylaxis at 6 weeks;
- HIV DNA PCR testing at 4-6 weeks;
- HIV DNA PCR sample sent to lab;
- HIV DNA PCR processed at lab and results posted to clinic;
- Mother notified of results;
- Eligible infants initiated on ART;
- Re-testing “initial negative” at cessation of breastfeeding;
- Re-testing at 18 months to rule out vertical transmission
Since the initiation of the HITSystem in the Southern Highlands in 2013, it has been piloted in over 100 Health facilities offering EID services in the regions of Mbeya, Ruvuma, Rukwa and Katavi with very promising outcomes. To date more than 6,000 infants have been enrolled in the system and are being monitored. The programmatic turnaround time (TAT) from sample collection to reporting results to the healthcare worker and mother has reduced drastically from over 2 months to 3 weeks on average. Additionally, more than 91% of the mothers have been notified of their infants test results, and more than 70% of infants who were HIV-positive have been initiated on care with more than 97% of all infants being started on cotrimoxazole prophylaxis.
All EID test samples are accounted for in the system as they are tracked from the time they are collected at the health facility to the time they reach the testing laboratory. This has helped to monitor resource allocation and measure the impact EID services offered in the facilities where the HITSystem is being used. The system has also helped to improve documentation practices at the health facilities. Based on these highly positive outcomes, there are plans to roll out the HITSystem to all EID facilities in the Southern Highlands of Tanzania and to improve follow-up testing at 13 and 18 months of age for the infants who were negative at the initial test.