Where compliance is king

This is the ninth in our series of FrontlineSMS guest posts. In this latest post Aurelio Gomes, who works out of Universidade Catolica de Mocambique, explains their use of the software in monitoring and improving anti-retroviral treatment (ART) compliance among rural communities in Mozambique

Thanks to the US President’s Emergency Program for AIDS Relief (PEPFAR), increasing numbers of HIV-infected people living in poor countries have been given access to anti-retroviral therapy (ART). Successful treatment of HIV depends upon ART recipients maintaining a compliance rate of 95% or higher to prevent the emergence of drug resistance. The commonly used first-line regimen has a low genetic barrier to resistance when dosing is below recommended levels. Not only does widespread resistance lead to a need for costly second-line regimens, but it also threatens to reverse ART survival gains. Worst still, resistant HIV may also be transmitted to others, severely limiting treatment options.

Clinic, Mozambique (courtesy Aurelio Gomes)

As ART therapy becomes more widely prescribed in Sub-Saharan Africa, suitable systems to ensure patient compliance have to be designed and implemented to maximize ART effectiveness. This is especially necessary in rural areas of Africa. Mozambique exemplifies this situation since 80% of the total Mozambican population are rural. Patients are difficult to locate because formal postal addresses don’t exist in these areas. As in many parts of sub-Saharan Africa, residents are not connected to the electricity grid, and lack regular phone service or access to clean water. Stigma and discrimination increase the challenge of ensuring compliance, as HIV- positive individuals are often very concerned about their privacy.

Following initial technical assistance from our partners at Inveneo, we have been successfully using FrontlineSMS for several months to facilitate communication between the HIV treatment centers and the community health care workers (CHWs) deployed in remote rural areas. These CHWs are armed with mobile phones, enabling communication to flow more quickly and accurately, leading to an improvement in health care delivery.

Our FrontlineSMS-driven communication system is helping us maintain a 95% and higher compliance of ARV therapy, crucial for the patient, the success of our programme and efforts to reduce the chances of development of drug-resistant strains of the virus.

Aurelio Gomes
Project Coordinator
Universidade Catolica de Mocambique
www.ucm.ac.mz

38 thoughts on “Where compliance is king

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  10. Alistair says:

    Another great use of the software. Sounds a bit like what FrontlineSMS: Medic are doing, and something which any clinic could do very easily. It would be great to see this in many more places — I’m sure these kinds of communications problems are quite common all over the developing world.

  11. kiwanja says:

    @Alistair – Thanks. There’s a pretty good spread of FrontlineSMS projects, ranging from quite complex through to those that solve quite simple communication problems (“low hanging fruit”). Josh’s work in Malawi solved a similar problem. I’m pretty amazed how much can be achieved by implementing very simple communication tools, to be honest.

    As for getting it into more places, follow the http://medic.frontlinesms.com team who have a bunch of clinics lined up in the coming months.

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