Two University of Colorado Denver | Anschutz Medical Campus professors combined their expertise in mobile platform technology and health mapping to improve HIV-related care in sub-Saharan Africa.
The interventions focused on children and pregnant women in the Misungwi District of northwest Tanzania. The pilot study was conducted by Dr. Deborah Thomas, chair of the department of geography & environmental sciences in the College of Liberal Arts and Sciences (CLAS) at CU Denver & professor at Colorado School of Public Healy, and Dr. Sheana Bull, chair of the department of community & behavioral health at the ColoradoSPH at CU Anschutz, along with Tanzania-based researchers Mr. Elias Nyanza and Dr. S.E. Ngallaba.
The reason for their study? While mobile platforms, such as phones and tablets, have great potential to improve health care delivery and outcomes in resource-limited settings, the evidence base for their potency is still limited.
Local workers gather data
28 local health workers fanned across a vast network of rural health facilities to gather information in spring 2015. They focused on seven health facilities, including a hospital, two health centers and four dispensaries; an identical composition of another seven sites served as the control facilities. They used cell phones and mobile tablets (mHealth) to document the capacity of the system – the Tanzania Health Information Technology (T-HIT) – for increased HIV testing, identification of new HIV infections and delivery of drug treatments to mothers and infants.
The mHealth intervention was aimed at health workers, who received their tablets at a kick-off ceremony that received widespread media coverage in Tanzania. All of the data from the T-HIT system were aggregated to health facility level for analysis. “This enabled us to compare data to the paper records, which are kept at the health facility level as well,” Dr. Thomas said. “The pre/post-test was aggregated to all health workers combined, and then by facility based on its distance from the district hospital.”
The pre/post test showed improved overall health-worker comfort with the T-HIT system.
In near real-time, T-HIT identified health facilities that were unable to conduct HIV testing due to a lack of a chemical testing agent, which is not captured in paper records, the current standard of care. This was significant because one especially far-removed dispensary site, which showed a very weak capacity for conducting HIV tests, was identified as actually having a high rate of HIV-positive patients.
In just the three months, health workers recorded almost 2,500 patient visits.
“What’s really exciting is that over the three months we saw a statistically valid improvement in overall use of the T-HIT system in a resource-limited setting,” said Dr. Thomas.
One study conclusion was that the system fosters rapid transmission of data to support decision-making, and improves care through integrated record-keeping and stepped-up oversight of HIV care delivery. The system also shows promise to better oversee HIV testing and treatment for pregnant women along the continuum of care. For example, taking the single precaution of ensuring that babies are delivered in hospitals results in greatly reduced HIV transmission.
Importantly, Thomas said, the pilot system also opens the door to scalable models for prevention of mother-to-child disease transfer – highly desirable in a country with an HIV rate of 5.3 percent.
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