Daily Archives: July 23, 2012

July 23, 2012 · 4:53 pm

Using Mobile Technologies to Eliminate Pediatric HIV: Evidence the Future is Bright for mHealth

By Michelle Betton

Photo: Dr. Seble Kassaye (Left) and Dr. John Ong’ech (Right)

Mobile health technology (mHealth) is a pretty hefty topic to delve into at 7 a.m., but this morning’s mHealth presentation at IAS – sponsored by the Elizabeth Glaser Pediatric AIDS Foundation, mHealth Alliance, and Johnson & Johnson – provided encouraging insight into how mobile technology can positively affect pediatric HIV work.

Several studies over the past few years have highlighted the impact of mHealth on pediatric HIV, which were cited by William Philbrick, consultant with the mHealth Alliance. Findings showed that when receiving SMS (short message service) messages and reminders, women were more likely to attend antenatal visits – one study showed this increased by as much as 25 percent through the use of mobile phones. Additionally, women were 57 percent more likely to adhere to HIV treatment when receiving SMS reminders and health information. Other areas in which SMS messaging has improved outcomes are exclusive breastfeeding, stigma, and water and sanitation.

EGPAF’s Seble Kassaye described a pilot study in Kenya to address the high prevalence of HIV in Nyanza Province. Kenya was a good test case, as 63 percent of Kenyan households have mobile phones. Mobile phone technology was used to reinforce key messages for women and men around maternal and child health, exclusive breastfeeding, prevention of mother-to-child transmission of HIV, and male involvement. An important point to note about the messages is that they were HIV-neutral; some women and men share mobile phones with others, so neutral messaging was important to protect study participants from stigma. Despite positive feedback from the study such as increases in exclusive breastfeeding among women who received the messages, barriers still hinder the full effectiveness of mHealth, particularly fear of stigma.

Merrick Schaefer of UNICEF illustrated Programme Mwana, a project that has now been scaled up nationally in Malawi and Zambia to decrease turnaround time for clients to receive HIV test results, and to manage health systems in real time. The program consists of two components: Results160, which is focused on health systems and targets clinic staff; and RemindMi, a community-focused application that helps community health workers follow up with and report on client health status through SMS. Results160 allows clinic staff to alert central laboratories through SMS that samples have been sent for testing; in return, laboratories send electronic test results to clinic staff, which are sent to clients (confidentiality is preserved through PINs). RemindMi alerts community health workers to follow up with clients around child births, clinic visits, and adherence to medications.

Overall, the future seems bright for mHealth interventions, although some issues, like stigma, need to be addressed for optimal effectiveness in the long run.

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Filed under Kenya, Malawi, Uncategorized, Zambia

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· 3:18 pm

“Eliminating pediatric AIDS and keeping mothers alive from an implementation perspective” – Satellite Session on best practices, programmatic barriers and bottlenecks in the field

By Alex Ekblom

On Sunday, EGPAF, mothers2mothers (M2M) and Johnson & Johnson (J&J) hosted a satellite entitled “Eliminating pediatric AIDS and keeping mothers alive from an implementation perspective – best practices, programmatic barriers and bottlenecks in the field.” This was a four-part/panel series of presentations moderated by John Donnelly, a journalist from GlobalPost.

EGPAF Swaziland’s Caspian Chouraya

The first part had to do with country-level approaches around building capacity of HIV service implementers, which highlighted Kenya’s mentor mothers approach (where HIV-positive mothers are trained to coordinate access to and retention in care among other HIV-positive mothers), EGPAF-Zimbabwe’s experiences in reducing costs of all-level health care worker training by reduction in time of training and facilitators (saving $185.00 per participant), and SAATHI’s experience in engaging the private sector to increase local PMTCT capacity (including collaboration of 17 NGOs to increase private site coverage, which has reached 1.2 million women with PMTCT care).

The second panel focused on supporting continuity of care and featured m2m’s work on mother mentors in retaining women through use of smartphones and SMS reminders, and NASCOPs implementation of a courier system to shorten turnaround time for early infant diagnosis of HIV.

The next panel was centered around how to create demand to increase uptake of PMTCT. Examples included the use of m2m mentor mothers, who increase quality of care to clients by relieving health worker burden/task shifting, EGPAF-Zambia’s integration of syphilis and HIV testing (through innovations in rapid testing) and the use of 8 steps to roll out effective integration, and EGPAF-Lesotho’s implementation of integrated health services and the use of Family Health Days, or mobile health services which offer a variety of testing and treatment options for HIV, opportunistic infections.

EGPAF Zambia’s Susan Strasser

The final panel focused on data use and highlighted m2m’s “let’s SOAR” initiative, which included a quarterly data review component, where site coordinators could review daily recorded data and assess areas for needed improvement, EGPAF-Swaziland’s data collection and review mentorship activities, EGPAF-Rwanda’s implementation of an excel macro tools to issue feedback to supported facilities through reports of facility and district data (from which facilities could see where improvements were needed), and EGPAF-Tanzania’s experience implementing quality improvement initiatives to strengthen pediatric care.

Delegates brought interesting questions into the discussion. One of which was how can we better prioritize the “keeping their mothers alive” portion of the global plan. It’s an important point for upcoming work on elimination of MTCT.

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Filed under EGPAF, Global Plan, Implementation, India, Kenya, Lesotho, MCH, mHealth, Pediatric Treatment, PEPFAR, PMTCT, Rwanda, Swaziland, Syphilis, Tanzania, Zambia, Zimbabwe

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· 1:20 pm

“Together We Can” – EGPAF Zimbabwe Satellite Session on Eliminating New Pediatric HIV Infections through Public-Private Partnerships

By Alex Ekblom

On Sunday, the Zimbabwe team hosted their satellite, “Together We Can: Achieving Virtual Elimination of New Pediatric HIV Infections in Zimbabwe by 2015 Through Strategic Public-Private Partnerships”, which featured introductory remarks from Chip Lyons, and presentations from Nick Hellman, Agnes Mahomva, Auxilia Muchedzi, Batsi Chikwinya, Caroline Zinyemba, Angela Mushavi, Theresa Ndoro of OPHID and Peter McDermott, Managing Director of CIFF.

The satellite focused on Zimbabwe’s pediatric HIV context (151,000 children are living with HIV in Zimbabwe), engagement in the national pediatric HIV elimination agenda in Zimbabwe, and key innovations that will be rolled out to achieve this goal.

Angela presented on national strategies, including implementation of a results-based management system,  integration of health services, implementation of a multi-disciplinary approach, supportive engagement with people living with HIV, and how to strengthen human resource capacity, supply chain management, and lab capacity. Angela underscored the need for community involvement to achieve elimination.

Agnes presented on the recent rapid coverage expansion of PMTCT services  (especially in the accelerated coverage of more efficacious drug regimens) through a variety of approaches, including use of district focal persons, implementation of point-of-care CD4 testing, and mass communications on PMTCT. She indicated that meaningful partnerships with other NGOs and government agencies are instrumental in achievement of this national goal.

Batsi discussed implementation of the district focal person and how EGPAF trained 30 nurses to support districts to roll out increased coverage of PMTCT.

Auxilia presented on the national roll-out of 50 point-of-care CD4 machines, which (based on a quasi-experimental study of the intervention) have effectively increased testing of HIV and enrollment in care.

Carol focused her presentation on a national communications strategy deployed by EGPAF, in collaboration with the Ministry of Health and Child Welfare in Zimbabwe, which has included a training of 30 journalists on PMTCT, and newspaper and radio announcements on the importance of engagement in PMTCT.

Peter McDermott presented on a donor perspective focused on strengthened cost/data analyses. He indicated that what we should aim to not just change policy and practice in one geographic location for the better, but to build a body of knowledge around good HIV programming for global policy and practice change. He highlighted what it will take to eliminate pediatric HIV, which includes strengthened HR, M&E, task-shifting, record-keeping, and addressing  gaps  in the PMTCT cascade.

Nick discussed EGPAF strategies in achieving virtual elimination of pediatric HIV and highlighted challenges. The discussion portion of this satellite brought about interesting remarks, including how stigma is being addressed, how adolescents are being approached, what will happen with district focal persons after 2015, first ANC attendance and how it has been affected by the communications strategies, and issues around loss to follow-up.

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Filed under Advocacy, Countries, EGPAF, Global Plan, IAC 2012, Implementation, Pediatric Treatment, PMTCT, Public-Private Partnerships, Zimbabwe

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· 12:18 pm

Growing Up With HIV

By Jane Coaston

Children and adolescents living with HIV face unique challenges and questions, and they are often ignored in the discussions surrounding HIV/AIDS. At EGPAF, we’ve focused on the needs of children and young adults living with HIV for over twenty years. And we’re excited to see more attention paid to this key group.

Today on WAMU - American University Radio – reporter Kavitha Cardoza reported the first of a three-part story on youth living with HIV. On this morning’s broadcast, Cardoza brought listeners the stories of two young people living with HIV, Kendra and Luke (both names were changed to protect their privacy.)

Kendra was born HIV-positive, and learned of her status from a doctor when she was 13 years old.  Now 20, Kendra says that being HIV-positive has affected every facet of her life. ”I have a younger sibling and an older sibling who are perfectly normal,” she says. “I’m not saying I’m not normal, I’m saying I have to wake up and think of this. Every day.” She feels isolated from her peers, most of whom do not know about her HIV status. She says that she feels most comfortable at her hospital, where she can be free to discuss her status without worrying about the stigma.

Luke learned of his positive HIV status when he donated blood at the age of 16. He told Cardoza that he knew about HIV/AIDS, but he never thought that he could be infected. ”I was young,” Luke says. “That’s everyone’s thought. As kids, you think nothing’s going to happen. Kids are just so ignorant.” Luke has not told his family about his status, and has stopped planning for his future.  ”I’m not thinking of money, I’m not thinking of jobs, I’m just trying to make myself happy,” he says.

As we enter the International AIDS Conferences, the stories of young people like Kendra and Luke are vital to helping us understand the needs of youth living with HIV. Thank you to WAMU to bringing much-needed attention to the lives of young people living with HIV.

Today at IAC, we’ll be presenting a session on adolescent HIV: “Addressing the Psychosocial Support Needs of Transitioning Adolescents Living with HIV since Childhood: A Global Perspective” at 2:30 PM. There will be an additional session tomorrow at 11:00 AM in the Global Village.

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Filed under Advocacy, IAC 2012, Pediatric Treatment, U.S.

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