InSTEDD PMTCT - M-E Health Tool Belt

“No child should be born with HIV; no child
should be an orphan because of HIV; no child
should die due to lack of access to treatment.”
--Ebube Sylvia Taylor, an eleven year
old born free of HIV, MDG Summit

mHealth to prevent maternal to child
transmission of HIV/AIDS
At InSTEDD, we are working to make the world a place where no child is born with HIV, no
matter where they live, regardless of how rich or poor their family is, and in spite of the issues of
discrimination and stigma they are met with. We work with program directors, researchers, and
policymakers to develop m/eHealth tools to use in the fight for an AIDS-free generation.

Despite proven medical solutions, roughly 370,000 babies contracted HIV from their moms last
year (1). Although this is down from 500,000 babies in 2001, we are still a long way from
achieving the UNAIDS campaign goal to eliminate maternal-to-child transmission by 2015. As
the global health community is preparing to scale-up testing, treatment, and prevention programs
worldwide, we must strengthen our efforts by using the latest knowledge and best practices to
deliver services to people in need or at risk. m/eHealth are an essential part of strengthening
health systems to address the HIV/AIDS pandemic.

In the hands of local leaders, m/eHealth tools can help moms to understand the real risks and
solutions around transmission; can help families to identify prevention and treatment resources
available to them during hard times; help clinical programs to provide consistently higher quality
health services from anywhere in the world; help communities to fight issues of HIV-related
stigma and discrimination; and, help policymakers to identify opportunities to leverage assets
and meet needs at a national and global scale.

the PMTCT tool belt, by InSTEDD
We are proud to present our modern tool belt for the prevention of maternal-to-child transmission
of HIV as well as other intractable problems in health, development, and disasters. Engineers at
InSTEDD and in our iLabs in countries around the world create platforms that are always free,
reusable, interoperable, open source, and customizable. Designed for low-resource settings, all of
our tools are built with our knowledge of how technologies are used in the real world. They have
been designed, tested, and constantly improved by communities with little access to electricity,
unreliable internet, no expensive hardware, and limited technological literacy. Our platforms are
used by local leaders working with limited budget, often over-stretched staff, and tremendous
demands on their time. Whether in Haiti, Bangladesh, Rwanda, Cambodia, or the United States,
our tools help communities to thrive.

Remindem is a free and easy-to-use tool that allows you to set up a list of tips, reminders, and advice that people can
subscribe to via text messages. Remindem sends important text reminders that you create, just when your subscribers need
them, and based on a schedule you define. Adherence to strict therapy regimens is one of the biggest challenges in
PMTCT. Remindem can be used to remind moms, families, and community health workers about drug schedules and
clinic appointments. We are confident in the impact of text reminders because of our own experiences in global health and
recent rigorous studies. Three randomized trials proved that simple text message reminder systems increased the number of
people attending clinics in low-income, urban, and low resource settings around the world (2-4). In addition, two clinical
trials found that text messages improved adherence to ARTs (5-7).

Verboice can be used to send interactive voice-based messages to anyone around the world who has a mobile phone.
Voice is powerful way to communicate, helping program managers to reach out by overcoming literacy barriers and to
listen by hearing the voices of their communities. Although this tool is too new to have been tested in randomized trials,
there’s a good chance that voice is even more effective than text, particularly in low literacy communities. A recent study
in poor communities in India found that people living with HIV/AIDS all preferred to receive voice reminders to take their
medication and attend clinic appointments rather than just text reminders, even those with higher literacy levels (8). Using
Verboice, voice-based education campaigns are easy to launch. You might even record a popular opinion leaders’ voice
communication and send these tailored messages to specific vulnerable communities to connect, educate, and remind.
Advocates can respond to a Verboice call with their own voice reports about human rights issues and other concerns in the
field. So many possibilities.

Resource map helps to record, track, and analyze resources geographically in a collaborative environment that is
accessible from anywhere. At a glance on a map, ministries of health and local organizations will be able to see the
location of organizations that have sufficient testing and treatment supplies and then get alerts when supplies are too high
or too low. The map of PMTCT prevention resources can be updated immediately online with a computer or simple text
messages with a mobile phone. This platform was built from our experiences tracking stock levels of malaria control
drugs, mapping national health facilities, and tracking health facility information in Brazil, Bangladesh, Thailand, and
around the world. Access to quality and up-to-date information has helped communities to collaborate in response to
everything from disaster relief to epidemic control.

Pollit allows you to conduct surveys and reach your audience for feedback at their convenience via text messages. This
mobile data collection tool allows program leaders to assess, in an instant, community knowledge, attitudes, behaviors,
needs and assets as they develop and evaluate PMTCT projects. Pollit uncovers stigma and discrimination in a private and
confidential way. Stigma has been directly attributed to lower uptake of HIV prevention services, particularly in rejection,
postponement and lack of adherence to treatment, care, and support (9). Pollit can also be used to engage people living
with HIV/AIDS in evaluating the programs and services that are intended for them. Engaging PLWHA in this way reflects
a central tenant of the global response to HIV.

Citations:
1. UNAIDS, UNAIDS Report on the Global AIDS Epidemic (Geneva, 2010).
2. Perron, N J, Dao, M D, Kossovsky, M P, Miserez, V, Chuard, C, Calmy, A, et al. (n.d.). Reduction of missed appointments at an urban primary care
clinic: a randomised controlled study. Bmc Family Practice, 11, 8.
3. Leong, K. C., Chen, W. S., Leong, K. W., Mastura, I., Mimi, O., Sheikh, M. A., et al. (2006). The use of text messaging to improve attendance in
primary care: a randomized controlled trial. Family practice, 23(6), 699-705..
4. Costa, T. M. da, Salomão, P. L., Martha, A. S., Pisa, I. T., & Sigulem, D. (2010). The impact of short message service text messages sent as appointment
reminders to patientsʼ cell phones at outpatient clinics in São Paulo, Brazil. International journal of medical informatics, 79(1), 65-70.
5. Lester, Richard T, Paul Ritvo, Edward J Mills, Antony Kariri, Sarah Karanja, Michael H Chung, and others, ‘Effects of a Mobile Phone Short Message
Service on Antiretroviral Treatment Adherence in Kenya (WelTel Kenya1): A Randomised Trial.’, Lancet, 376 (2010), 1838-45.
6. Chi, Benjamin H, and Jeffrey S A Stringer, ‘Mobile Phones to Improve HIV Treatment Adherence.’, Lancet, 376 (2010), 1807-8.
7. Pop-Eleches, C, H Thirumurthy, J P Habyarimana, J G Zivin, M P Goldstein, D de Walque, and others, ‘Mobile Phone Technologies Improve
Adherence to Antiretroviral Treatment in a Resource-limited Setting: A Randomized Controlled Trial of Text Message Reminders’, Aids, 25 (2011),
825-834.
8. Shet, Anita, Karthika Arumugam, Rashmi Rodrigues, Nirmala Rajagopalan, K Shubha, Tony Raj, and others, ‘Designing a Mobile Phone-based
Intervention to Promote Adherence to Antiretroviral Therapy in South India.’, AIDS and Behavior, 14 (2010), 716-20.
9. Parker R, Aggleton P, ‘HIV and AIDS-related stigma and discrimination’, Soc Sci Med 57 (2003): 13-24.

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