Friday, March 31, 2017

Mobile phones can make the difference for infectious disease management

Imagine going to the doctor for an HIV test in sub-Saharan Africa. You will likely have to travel a long distance to get to a clinic and, once you arrive, the HIV test will require specimens to be sent to a central testing laboratory for the actual test to be performed. You will then have to wait for the results to be delivered to the clinic and travel back to get the diagnosis. In Zambia, it takes approximately 92 days for this process to be completed. When you are an HIV-positive mother waiting to find out if your newborn child needs anti-retroviral therapy, each of those 92 days can be the difference between life and death for your baby.

New work from Dr. William Moss of the Johns Hopkins Bloomberg School of Public Health and his group focuses on finding ways to shorten the 92-day wait for HIV test results. Capitalizing on the increasing amount of technology available in rural Zambia, Moss and colleagues conducted a study using text messaging to deliver the HIV test results directly to mothers or to the rural health clinics from the central testing lab. They found that by sending a text message to the mother directly, they could reduce the time from sample collection to receipt of diagnosis to just 18 days. Unfortunately, the use of mobile phones is still not widespread; only 30% of mothers in the study had ever used a mobile phone. Luckily, the local clinics do have mobile phones, so using text messaging to deliver results to the clinic can still decrease the time to diagnosis to 36 days. By cutting 56 days off the wait for the diagnosis, the HIV-positive children will receive anti-retroviral therapy nearly 2 months earlier. Reducing the time to treatment for HIV-positive children has been shown to significantly reduce the HIV-associated morbidity and mortality, vastly improving their quality of life.

This is not the first time mobile phone technology has been used in Africa to impact health care. As the number of cell phones throughout the area has increased, some clinics have chosen to provide expectant mothers with a mobile phone so that they can get expedited access to an experienced midwife or healthcare professional. In other areas across the continent, SMS services have been used to target pregnant women and new mothers to ensure early detection of life-threatening emergencies and adherence to treatment regimens for pathogen clearance. These methods and Moss’s study highlight the same conclusion: increased access to mobile phones throughout the area can have major positive impacts on health care. Funding and infrastructure for such technological advances remains a major issue hindering progress.

As noted by Moss in his recent BMC Pediatrics paper, implementation of the mobile phone messaging system for test result delivery was by no means trivial. It required the hiring and training of new staff members, along with the purchase of the study’s mobile phone and “talk time” for the phone. However, with the right funding and infrastructure, the spread of technology throughout Africa has the potential to have significant and widespread impacts on healthcare. Studies such as the one by Moss and colleagues highlight the great potential of available technology. This encourages governments and private sector investors to take note and get involved. Someday soon, nationwide mobile phone messaging systems may become common place, drastically cutting the time to diagnosis and improving individual’s access to care and treatment. 

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