Tamar Kahn , Science And Health Editor
29 September 2004
Johannesburg — Cape project reconfigures mobile software to assist with crucial drug therapy
SISTER Lulu Mtwisha used to laboriously write by hand the details of every home visit made by her counsellors to HIV/AIDS patients cared for by the Hannan Crusaid treatment centre in Cape Town's Guguletu township.
It was a time-consuming process that grew worse as the clinic's caseload increased.
Now, thanks to an innovative application of cellphone technology, the clinic is on the verge of becoming a paperless operation.
A Cape-based project called Cell-Life has developed software and data management systems that enable the centre's health workers to monitor patients who are on AIDS drugs and pick up problems before they become life-threatening.
Most of the 525 HIV patients who get their pills from the centre take three drugs D4t, 3TC and either nevirapine or efavirenz. They take two pills in the morning, and three at night, roughly 12 hours apart.
It is vital that patients take their pills without fail; even missing one in 20 can cause the medicines to become less effective against HIV, which rapidly mutates to develop resistant strains if the concentration of antiretroviral drugs in the bloodstream falls too low.
Hannan Crusaid's 40 counsellors have been trained to use cellphones equipped with a special menu that allows them to capture data about patients' symptoms and pill taking as well as other factors that might affect their health such as lack of money to pay for transport to the clinic, or a shortage of food.
The information is relayed instantly over Vodacom's GSM network to a central database, which can be accessed by clinic staff over a secure connection.
In addition to their scheduled visits, counsellors arrive unannounced once every four months to do a pill count. The information they collect is compared with clinic data on the number of pills issued to patients , and enables staff to spot looming trouble.
"With Cell-Life we can pick up patients who are having a hard time taking their pills, before they go into virological failure (and the drugs stop working)," says centre manager Dr Catherine Orrell.
The cellphones are not used to remind HIV patients to take their pills, partly because they are encouraged to manage their own health, but also because it would not be practical to send mass alerts on a long-term basis, says Cell-Life project leader Ulrike Rivett, a senior lecturer in the civil engineering department at the University of Cape Town (UCT).
"People will be taking these pills for years. There's no way they'd respond to messages two or three times a day on a cellphone they'd switch them off."
The software was developed by engineering students at UCT and Cape Technikon, with funding from Vodacom and the National Research Foundation.
The package can only be used on Vodacom's cellular network, but talks are under way with MTN and Cell-C.
To protect patient identities and maintain confidentiality the database stores only their unique patient numbers, says Rivett.
The database is passwordprotected and secured with the same sophisticated technology used by financial institutions .
"Cell-Life has changed our lives. I didn't even know how to use a cellphone before," says counsellor Nobafundi Dondolo. It took her less than two hours to familiarise herself with the CellLife system.
Dondolo says she concedes it's tempting to use the cellphone for personal calls, particularly as her community has few fixed-line telephones. The phones are loaded with R55 in airtime each month, including a small "reward" allocation for personal use.
Rivett hopes to develop reverse billing software that will enable the clinic to be charged instead of the phone user. This will allow counsellors to contact clinic staff in emergencies, even if they have no airtime loaded .
Clinic staff use the phones to support flagging counsellors, many of whom are themselves HIV-positive. "If you don't do any visits, the cellphone will even ask you what's wrong," says Dondolo.
Cell-Life is also being used to monitor close to 500 patients in KwaZulu-Natal, and Rivett is investigating the prospect of sites in other provinces.
Since the government has only just begun to take the first tentative steps towards providing AIDS drugs to the estimated halfa-million people in immediate need of treatment, donors have focused on getting medicines to patients, says Rivett.
"Thousands of people in Guguletu alone need to be treated with AIDS drugs how could you hope to monitor them with paper?" she asks.
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