Mobile phones keep track of HIV treatments

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[CAPE TOWN] South African researchers have developed a novel application for mobile phone technology that helps health workers monitor HIV patients cheaply and efficiently.

The Cell-Life project, backed by local mobile phone giant Vodacom, has developed software and data management systems that let clinic workers use their mobile phones to monitor patients’ treatment and spot health problems before they become life-threatening.

The phones are equipped with a special menu that enables HIV counsellors to record data on a patient’s symptoms and whether they are sticking to drug regimes, as well as other factors that might affect their health — such as a lack of money to pay for transport to the clinic, or a shortage of food. The information collected is instantly relayed over Vodacom’s network to a central database, which clinic staff can access over a secure Internet connection.

Cell-Life has just completed successful pilot projects in townships in Cape Town and Durban, in which about 80 counsellors were trained to use the mobile phones and kept track of nearly 800 patients. Talks are now underway with provincial health authorities to expand the project’s reach into other provinces.

“Donors have understandably focused on getting medicines to patients, and too little attention has been paid to the vital task of improving South Africa’s lacklustre health infrastructure and monitoring systems,” says Ulrike Rivett, a senior lecturer in the University of Cape Town’s civil engineering department who heads the Cell-Life project.

South African HIV patients are eligible for free treatment from the government when their CD4 count — a measure of the strength of their immune system — falls below 200, or if they have an AIDS defining illness, such as oesophageal thrush.

With HIV treatments, monitoring is essential. Most HIV patients attending state-run clinics receive three different drugs — D4t, 3TC, and either nevirapine or efavirenz. Depending on which regime they are on the patients must take two or three pills in the morning and three at night.

For the treatment to work, patients must remember to take their pills without fail: even missing one in every 20 pills can reduce their effectiveness, and encourage the development of drug resistant strains of the HIV virus.

In addition to their scheduled visits, the Cell-Life counsellors arrive unannounced to do a pill count once every four months. The information they collect is compared with the clinic data on the number of pills the patients have received, enabling staff to spot looming trouble.

“With Cell-Life we can pick up patients who are having a hard time taking their pills before they go into virological failure, and the drugs stop working,” says Catherine Orrell, who manages the Hannan Crusaid treatment centre in Cape Town’s Gugulethu township.

The phones are currently loaded with R55 (US$8.50) in airtime each month, but Rivett hopes to develop ‘reverse billing’ software that will enable the clinic to be charged instead of the counsellors using the mobile phones. They could then contact clinic staff in an emergency even if they had no airtime left — a measure that could save lives in communities with few fixed-line phones.

Rivett hopes to bring South Africa’s other mobile phone networks, MTN and Cell-C, into the project. She is also investigating the prospect of developing programmes for other diseases that require continuous patient monitoring, such as tuberculosis.