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Implementing a National Mhealth System Improves Viral Suppression and Retention in Routine HIV Care in Kenya

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Implementing a National Mhealth System Improves Viral Suppression and Retention in Routine HIV Care in Kenya Implementing a National mHealth System Improves Viral Suppression and Retention in Routine HIV Care in Kenya 1A. Wachira, 1M. Kimani, 3K. Owuor, 2S. Maina, 1I. Mukui, 1B. Mambo, 1B. Kigen 1National AIDS and STI Control Programme, Ministry of Health, Directorate of Preventive and Promotive Health Services, Nairobi, Kenya. 2mHealth Kenya, 3Centre for Health Solution Kenya (CHS). Conflict of Interest • Nothing to disclose Outline • Background • Methods • Findings • Conclusion Background • Kenya guidelines support testing and treatment uptake • ART Guidelines, 2016 recommends Test & Start • HTS Guidelines, 2018 recommends partner notification and linkage • As the country scales identification and linkage, averting HIV associated disability and death becomes increasingly important • Barriers: • Challenges in retention over time • Viral Suppression remains a concern Background – mHealth • Text message interventions promote ART adherence (Strong evidence since 2010) • Increased adherence with SMS (OR=1.39) • Improved VL (OR=1.56) • Similar evidence emerging for PrEP Trends - Kenya ART Scale Up • Mobile Subscriptions 1,400,000 50 49.2 1,159,000 42.8 1,200,000 1,136,000 45 38.9 1,018,905 40 37.7 1,000,000 872,938 35 33.6 30.7 31.3 800,000 755,225 656,369 30 26.9 603,409 25 600,000 538,938 25 440,117 19.4 363,421 20 400,000 244,676 15 …172,764 200,000 110,000 55,000 10 10,000 - Total Mobile Sibscriptions (Millions) 5 0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Year In 2018, the number of mobile phone subscriptions in Kenya surpassed the total population • Text is the single most used feature on smart phone • In 2018, 64.7 billion domestic texts were sent; Average of 180m messages/day • Texts have a 99% open rate https://www.textrequest.com/blog/texting-statistics-answer-questions/ Methods • In Nov 2016, MOH-Kenya rolled out mHealth service “Ushauri” in 105 facilities with poor Viral Suppression outcomes •It is a web-based appointment management platform •Serves as the repository for patient data •Performs targeted message scheduling and delivery •Standardized messages prepopulated in the system •Reminders sent prior to the appointment date (2 days & 24 hours prior) •Additional Roles • Supporting adherence – Weekly educative and motivational texts • Broadcast – Communicating unanticipated events • Link with toll-free national Call Centre for a 2-way loop Ushauri Facility Process Flow The care and treatment team can add new client, book a new All registered patients are appointment, and trace all able to receive alerts on their defaulter form the comfort due appointments as well as of a mobile device. alert their care givers if they are not doing well. Your Automated Appointment Communicate reminder and Defaulter to your Tracing Diary system. patients/users. At Facility/Partner Level All consenting patients can receive wellness and educative information text messages from the system. Stakeholders/Partners are able to get reports based on their KPIs and make policy based on the live interactive data dashboard made available on the web system Methods Cont.. • Facilities receiving intervention were matched with those without for comparison based on: • Patient volume • Facility level • Baseline viral suppression and retention • County of operation and presence of implementing partner • Retrospective facility data extracted from the National Data Warehouse • Mixed effects linear regression analysis done on Stata (V 15.1) Findings • A total of 96,216 patients enrolled (as at Dec, 2018) • 72% of the target number • Enrolment rate varied across the facilities • 99.8% - 18.2%. • There was a statistically significant increase in the suppression and retention rates post intervention Mean Viral Suppression 72.0 74.0 76.0 78.0 80.0 82.0 84.0 86.0 Jan Feb Suppression inViral Change Mar April May Months (Jan 2017 Months (Jan 2017 Jun Jul SuppressionMonths By Viral Mean Aug Sep Oct Nov Dec Jan - Dec 2018) Feb Mar April May 2018 Jun Jul Aug Sep Oct Nov Dec Counties Pilot Sites Control Sites Pilot Pre-Post Intervention VS Category Pre- Post- Adjusted Change intervention Intervention in VS Rates* mean (%) mean (95% CI) P Value Pilot Sites 76.9 (72.6, 79.9) 82.9 (78.4, 87.9) 6.0% (4.8%, 7.3%) (Implementi P<0.001 ng Ushauri) Control Sites 78.1 (74.3 – 83.1) 82.2 (76.4 – 4.1% (3.6, 4.4) 86.1) P<0.001 Counties 80.6 (77.1, 83.6) 84.5 (82.9, 87.3) 3.9 (3.2% – 4.8%) P=0.009 *Adjusted for facility level and number of patients enrolled Mean Retention (%) 70.0 71.0 72.0 73.0 74.0 75.0 76.0 77.0 78.0 79.0 80.0 Jan Feb Mar Month by Trends Retention April May 2017 Jun Jul Aug Sep Oct Months Nov Dec Jan Feb Mar April May 2018 Jun Jul Aug Sep Oct Nov Dec Control Sites Control Sites Pilot Conclusions • Text messaging is a promising strategy in Improving Viral Suppression and Retention in Routine HIV Care • mHealth intervention is currently undergoing Nationwide scale up based on the results of the pilot. • Consideration should be made for communities with low mobile phone access Acknowledgement.
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