Early Infant Diagnosis of HIV Infection in Zambia through Mobile Phone Texting of Blood Test results/Depistage Precoce Du VIH Chez Les Nourrissons En Zambie Au Moyen De la Transmission Par SMS Des Resultats Des Analyses De sang/Diagnostico Temprano De la Infeccion Por VIH En Lactantes En Zambia Mediante El Envio De Los Resultados del Analisis De Sangre a Traves De Mensajes De Texto

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Despite over three decades of related research and intervention, the global epidemic of human immunodeficiency virus (HIV) infection continues to afflict more than 33 million people worldwide. (1) In Zambia, where the estimated prevalence of HIV infection is 14.3%, mother-to-child transmission accounts for 21% of all HIV infections. (2) Although the use of antiretroviral therapy (ART) for the prevention of mother-to-child transmission (PMTCT) is essential, effective programmes to achieve early infant diagnosis are critical when that prevention fails. There is strong evidence that the early initiation of ART in HIV-infected children can substantially reduce HIV-related morbidity and mortality. (3-6) In the guidelines it published in 2010, the World Health Organization (WHO) recommended the immediate initiation of ART upon diagnosis of HIV infection in infants and older children, irrespective of the children's CD4+ T-lymphocyte counts. (7)

The early initiation of ART in infants requires reliable early infant diagnosis. This is usually based on the testing of blood samples, collected from infants at least 6 weeks old, using a polymerase chain reaction (PCR) test for the detection of HIV deoxyribonucleic acid (DNA). For convenience, blood samples are usually spotted onto filter paper and allowed to dry before being sent to a laboratory for testing. In a resource-limited setting such as Zambia, the establishment of an efficient and robust system for the early diagnosis of HIV infection in infants is beset with difficulties including; the effective training of health workers in the testing of dried blood spots, the reliable transport of dried blood spots to the often distant regional laboratories or "hubs" for PCR-based testing, and the good management of the necessary supply chain. One component of the diagnostic process that could be made substantially quicker is the transmission of the test results from the regional laboratory to the tested infant's point-of-care health facility. If transmitted on paper via a courier service, laboratory results can take several weeks to arrive or can be lost in transit. After the test results have been physically transported to the relevant health facility, the infant's caregivers must return to the facility to receive the results, adding further, critical delays.

In this setting, mobile health (m-health) technology offers a reliable and sustainable solution to the slow transmission of test results. By using text (i.e. short message service [SMS]) to deliver test results to health facilities well ahead of traditional paper copies, unnecessary delays can be eliminated. Their expanding use and the extension of mobile phone network coverage to non-urban areas make mobile phones a potentially powerful public health tool in Zambia. (8) The mobile phone platform is increasingly being used across sub-Saharan Africa for functions other than conversations, including the dissemination of information about weather trends and commodity market prices to farmers, the provision of electronic food vouchers from the World Food Programme, and monetary transactions. (9-16)

Increasingly, mobile phone technology is also providing measurable benefit in programmes for HIV prevention and treatment, particularly in improving ART adherence through reminder calls and/or SMS messages to patients. In southern India nearly 75% of survey respondents stated that weekly automated voice reminders to patients' mobile phones for maintaining medication adherence would be acceptable. (17) In Kenya, weekly SMS messages from a clinic nurse significantly improved ART adherence and rates of viral suppression. (18) Despite the increasing number of anecdotal reports of the use of m-health interventions in the delivery of HIV services, there is little rigorous evidence of the efficacy of such inputs.

This report describes the design, implementation and evaluation of Project Mwana, a pilot project in Zambia's rural Southern Province. …


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