1 May 2016

Africa: Using Mobile to Fight HIV/Aids in Lesotho and Kenya - Breaking the Cycle of Infection With Data, M-Money and SMS

Lesotho has one of the highest infection rates for HIV/AIDS: 23% of the population live with HIV/AIDS. In Kenya young female students are an "at risk" group for HIV/AIDS. In both cases, the mobile phone has been used to tackle these problems in ways that have improved upon traditional ways of combatting the disease. Muchangwe Ferrao looks at the Lesotho experience and Russell Southwood describes an interesting approach to the issue in Kenya.

Lesotho has a population of over 2 million Basotho, 23% of whom are living with HIV/AIDS. It is one of the countries with the highest rates of HIV/AIDS infections in the world. It is estimated that hidden amongst the 600,000 children, nearly 20,000 are HIV+ and only 5000 are on life-saving treatment. These are the children The Vodacom Foundation through Moyo Lesotho and its partners, are committed to finding, treating, and giving a new lease of life.

Over the last decade, millions of dollars have been spent in the Kingdom in an effort manage the epidemic, but with little success. The United States Government alone, through its Presidential Emergency Plan for AIDS (PEPFAR), has spent USD $250m, with USD$70m in 2015. All this investment has done little to curb the rate of transmission, nor the deaths associated with HIV over the years.

It became apparent to the Vodafone Foundation that if Lesotho was to make significant strides in the battle against HIV, a new modus operandi would be needed. The company identified a crucial gap that needed to be closed in the prevention chain. It meant going back to the cradle and stopping mother - to child - transmission, and thus building an HIV free generation. This was the birth of Project Moyo.

The word Moyo, derived from Ki- Swahili, means close to the heart; precisely where Vodacom needs to be - close to the people. Close enough to give access to early testing in pregnant women and babies, close enough to give access to life saving Anti Retro Viral Drugs (ARVs), close enough for people to access Health Centres by cutting the distances walked to receive care. To achieve this, the company has used its greatest competitive advantage - mobile technology.

Vodafone Foundation Team Lead, Lee Wells emphasizes the importance of having mobile at the core of this project. He says: "The program is using Vodacom Lesotho's mobile network, marketing capacity, and mobile-money solutions to strengthen and coordinate the activities of partners in the field."

This point was reinforced by Vodacom Lesotho Board Chairman, N'tate (Mr.) Matjao Moteane: "Our company is committed to using technology that not only connects people, but also transforms life for the better."

The mobile outreach program which begun in September 2015, and officially launched on 5th April 2016, has been rolled out in Leribe and Maseru districts - two of the hardest hit in Lesotho. Residents in villages such as Nkoeng, have already begun to reap the benefits of this Private-Public-Partnership (PPP), as 58 year-old grandmother, M'e (Ms.) N'thabang explains: "We are really happy and benefiting from the mobile outreach program. Before we used to have to walk for over five hours to reach either Roma or Ha - Thalti Health Centres, but now we only walk two hours to Nkoeng mobile outreach clinic."

M'e N'thabang, has eight children, three of whom are HIV+. For the last several months she has brought her 10 month old grandson, Mosotho, for his pediatric check-up. Mosotho's mother discovered that she was HIV+ early in her pregnancy, and immediately begun to take drugs to prevent her from infecting her baby. When Mosotho was born, he was immediately put on the life saving treatment. Today, he is HIV-, a testament to the impact of what proper health care can do for people.

The Basotho are highly migrant both rural/urban and cross border with neighbouring South Africa, where many seek employment, thus making the spread of the disease highly fluid, a point Minister of Health, Dr. Molotsi Monyamane, a man passionate about putting an end to the epidemic stated at the launch of Moyo: "HIV does not need a passport to cross borders."

This trend has made it difficult to find, track and treat those needing help. To combat this, Vodacom Lesotho has developed a simple to use mobile platform that the nurses in the community health clinics use to register mothers and children that are HIV+ and need to commence treatment. This data is fed into a central system that helps to track, and monitor treatments levels for the mother and child. The app is linked to the M-pesa mobile money platform that sends money to the patient to enable them get to the closest health centre for testing and follow-up treatments.

In a country as poor as Lesotho funds received via M-pesa by patients are critical for survival. The main intended purpose is to use the funds for transport to health centres, but more often, they serve as a motivating factor for many to continue with follow up treatments. Mosotho's grandmother explains: "The R120 M-pesa has really helped me because now I am able to also buy Nan Two - baby formula for my grandson. He is very happy and healthy."

The Private Public Partnership (PPP) that is behind Moyo Lesotho includes the Ministry of Health, America Embassy through USAID, ViiV Health Care, Elma Philanthropies, and Elton John AIDS Foundation has raised nearly USD$10,000,000. It is the intention of all involved that over the next three years more Basotho children are found and ensure that they receive the treatment they need.

Other field partners, such as Baylor and Riders for Life are continuously providing skills training and transport, respectively, to community nurses on regular basis.

Winter is fast approaching in Lesotho and the days are getting shorter. During this time Health workers note a remarkable drop in number of mothers attending clinic as many are unable to make the often two-hour trek required. The roads too, become very dangerous for the mobile teams who sometimes have to abandon their vehicles and walk through harsh terrain to the villages.

Nurse Lebina proposes a solution: "We need more rural health clinics, and we need more partners such as the Army to join in the fight by providing air transport into the most difficult to reach places."

Despite the challenges, the benefits in these communities have been obvious:

"When I see a healthy baby and their mother, I am happy to know that I played a role in their lives", says Lebina as she commends the Moyo for the impact she is seeing.

The second use of mobile to combat HIV/AIDS was sending once a week SMS messages to Kenyan women students to encourage them to take HIV/AIDS tests. Canadian Government-funded researchers text weekly sex health information to 300 female students; 67 percent get HIV test within 6 months vs. 51 percent in control group

A newly published, Canadian government funded study documents how a simple, inexpensive effort to send short, informative text messages regularly to young women's phones could help significantly reduce the ongoing scourge of human immunodeficiency virus (HIV) infection in Africa.

Writing in the journal Sexually Transmitted Diseases, researchers describe the results of sending once-a-week texts about HIV, contraceptives, sexually transmitted disease, and pregnancy to 300 female college students in rural Kenya.

Within six months of the last message, roughly two-thirds (201 women, or 67%) in the intervention group had taken an HIV test, compared with roughly half (155, or 51%) of 300 women in a control group who were not sent text message.

As well, monthly surveys of all 600 participants in both cohorts showed that women receiving a weekly message sought testing much sooner than those who got tested but didn't receive regular texts (median time: 12 weeks from the end of texting vs. 20).

Supported with a CDN $112,000 (US$ 85,000, Ksh. 8.6 million) grant from Grand Challenges Canada, funded by the Government of Canada, researchers based in Kenya (led by Kenyatta National Hospital, in association with Kenya Medical Research Institute, and Jomo Kenyatta University of Agriculture and Technology) and the University of Washington, Seattle, recruited the 600 participants from four colleges in largely rural central Kenya between September 2013 and March 2014.

Over five months, 300 participants received the weekly texts and completed a monthly survey; 300 were only surveyed monthly.

Sample text messages:

· Did you know that not all STIs (eg, HIV) have symptoms? Use a condom to prevent acquisition of STIs.

· Protect yourself against HIV and unwanted pregnancy by using condoms correctly and consistently during sex.

· Abstinence is the only 100% effective way to prevent pregnancy. The second best way is to use contraceptives. Contraceptives are safe for use by young women. However, only condoms can reduce your risk of acquiring HIV.

Messages evolved to avoid repetition and maintain participant interest; all ended with the statement "Get tested for HIV."

"This study documents a simple, inexpensive program to promote sexual health and early identification of HIV-infected individuals," said project lead Dr Njambi Njugana of Kenyatta National Hospital. "These results are promising because HIV testing is a fundamental part of HIV prevention programs. The majority - 53% - of HIV-infected individuals in Kenya is unaware of their status, and only half of young Kenyan women have extensive knowledge about how HIV is transmitted and prevented."

"Our work shows the feasibility of providing health education and collecting data from young women via SMS. We're hopeful that text messaging programs could be implemented and scaled widely, resulting in significant increases in HIV testing among college students in Kenya and beyond."

Grand Challenges Canada's Stars in Global Health program provides seed funding for transformative solutions to global health problems identified by innovators in Canada and in low- and middle-income countries.

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