Saturday, January 3, 2009

Antiretroviral Texting


Grace Kamera runs the HIV treatment program at St. Gabriel's. She oversees atiretroviral therapy (ART) for the catchment area - which includes 250,000 people and an HIV prevalence rate of 15%. While there are a few government-run health centers in the area, St. Gabriel's Hospital is the only facility offering HIV tests, and the only place to get treatment.

Many of the CHWs are ART monitors - they are trained to check in on HIV patients, to see if they're complying with the treatment regimen. Noncompliance deducts from the treatment's efficacy and contributes to drug resistence. Given a limited number of choices for drugs, patient adherence is critical.

Before FrontlineSMS and the accompanying cell phones arrived, Grace was receiving 25 paper reports, per month, from the ART monitors. With 21 ART monitors equipped with cell phones and trained in text messaging, she's received 400 adherence updates since the outset of the project (15/week).

If the paper trail had continued, each report would have been hand-delivered by a CHW. The average round trip is about 6 hours, so the SMS program has saved ART monitors 900 hours of travel time.

If Grace receives an SMS regarding a patient's missteps, she will counsel them when they return for more drugs. The patients are well aware that the CHWs have cell phones, and they're grateful for the connection to the hospital (and Grace). Of all the patients who enroll in the ART program, 80% agree to be monitored. The remainder fear stigmatization within their communities.

Some patients do not turn up to receive their HIV medication. Grace says this is rare - "They usually come a day or two late" - but it happens. She's used the SMS network to track 25 patients who have failed to show, asking the nearest CHWs to report on their status. Sometimes they've left, other times they're unable to travel or they've passed away.

The hospital and the people it serves can't afford a lack of connectivity. With Grace at the reigns, ART monitors will continue serving their communities, 160 characters at a time.

5 comments:

Isaac Holeman said...

Hey Josh,

Wanted to let you know I've been reading every post. It's a very cool perspective - having been gone for a while and coming back to all this DATA! I'm excited to see (and learn from) how you synthesize and make use of all of it all. I can hardly wait to take a similar model to Burundi.

cheers
Isaac

Josh said...

Hey Isaac,

Many thanks for reading. It was certainly exciting to return to Malawi, welcomed by a hospital that truly made this project their own. The data from the recent posts exists because of the hospital's drive to use the tools - FrontlineSMS, cell phones, solar panels, etc. - to their patients' advantage.

I'll be writing soon about what this data means, moving forward. I'm extremely excited about your upcoming work at VHW - your plans hold tremendous potential, and I'm looking forward to helping however I can!

Best,

Josh

AVIF Volunteers in Kenya said...

Happy New Year! & Well done Josh! RESULT! & a fantastic New Year start for you & St Gabriels. I looking forward to hearing from you re. Kayole-Soweto, Nairobi http://www.arrowwebhospital.org/

Josh said...

Thanks for the post, Alison!

Just sent you an update. Everything is very much moving forward with Arrow Web Hospital, and we'll be in touch soon!

Josh

kaney said...

Leg lymphedema is a common side effect of surgery for vulvar cancer, but investigators from the United Kingdom have discovered that women who wear compression stockings post-surgery may experience less severe swelling. When a woman has cancer removed in the vulvar area, the lymphatic system may also be compromised.

Adrenopath UltraClear PLUS