Over 5 million people in South Africa are living with HIV and the country has the highest burden of TB-HIV co-infection. TB treatment completion and cure rates fall below 50% in almost half of the districts. Project Masiluleke, Zulu for to give wise counsel or lend a helping hand, stepped up to the challenge and is using mobiles to provide end-to-end care through awareness, testing, and ensuring treatment compliance.
Monopolizing on the 90% of South Africans who own mobile phones, the iTEACH team — with collaborators from Pop!Tech, The Praekelt Foundation, and Frog Design — brought HIV awareness to the masses and improved treatment compliance through the use of text messaging. Social stigma towards those carrying the disease results in low rates of HIV testing, and an overburdened public health system discourages people from utilizing available services at local clinics.
iTEACH identified four links in a chain of care essential for HIV and TB treatment success: 1 Effective awareness, 2 Scale-up of early HIV testing, 3 Early anti-retro viral treatment (ART) initiation, and 4 Support for ART and TB treatment adherence. In October 2007, Project ‘Masiluleke’ (Zulu for ‘to give wise counsel’ or ‘lend a helping hand’) or ‘Project M’, was launched to address these challenges with a chain of interventions designed for replication and scale. Project M is a collaborative effort, lead by the iTEACH NGO, along with a diverse set of partners (The Praekelt Foundation, Frog Design, Pop!Tech, MTN and Vodacom, LifeLine Southern Africa, Ghetto Ruff Records and the National Geographic Society).
Briefly, each of the three components of Project M addressed a specific barrier for people seeking care and for health care workers managing care.
1. TxtAlert: Reminders for HIV clinic appointments were sent to patients’ mobile phones as text messages. Showing up to your HIV clinic appointment largely correlates with anti-retro viral treatment (ART) adherence. In June 2007, TxtAlert, an SMS-based automated ART clinic appointment reminder system was piloted in partnership with Right to Care at the Themba Lethu Clinic, the largest privately funded ART treatment site in South Africa. TxtAlert is a web service that is linked to the electronic medical record system.
Clinic appointment reminders are sent to patients who are receiving ARVs, both two weeks and one day before their scheduled appointments. Text messages are also sent one day after the appointment to either thank the patient for coming or to alert them of a missed appointment and encourage rescheduling.
2. SocialTxt: A mass mobile messaging campaign was launched to raise HIV awareness, and directed people to the National AIDS Helpline. In October 2007, a mass text message HIV awareness campaign was launched with the so-called SocialTxt technology developed by the Praekelt Foundation.
One million text messages were sent everyday to mobile phone users throughout South Africa that contained key information about HIV and TB and directed mobile phone users to a free National AIDS Helpline.
The campaign resulted in an impressive 300% increase in calls to the helpline, from 1000 calls a day to 3000-4000 calls a day. Since the project launch, over 685 million PCM messages were sent to the helpline. Upon receiving the PCM message, staff at the helpline, who are HIV patients themselves, offer counseling and direct callers to HIV and TB testing centers.
3. HIV Self-Test Kit: Developed by FROG is a home-based HIV test kit that has the option of calling the National AIDS Hotline for guidance and assistance. The hope is that this kit will enable South Africans to perform an HIV test, in the privacy of their own homes, with the option of calling a counselor at the National AIDS Helpline via cell phone.
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