HIV/AIDS remains a serious and devastating global health threat, with 32 million deaths since the beginning of the epidemic. Adolescent girls and young women are disproportionately at risk, comprising 61% of all young people living with HIV in 2016. Mother-to-child transmission rates range from 15% to as high as 45%, but effective interventions including antiretrovirals started early in pregnancy and exclusive breastfeeding can reduce transmission to below 5%. The Joint United Nations Programme on HIV/AIDS (UNAIDS) aims to end the AIDS pandemic by 2030. Preventing mother to child transmissions (PMTCT) by making these interventions available and accessible is central to that goal.
Pregnant women struggle to access adequate and comprehensive prenatal care, and those who are HIV+ face additional interpersonal, social, and structural barriers to accessing comprehensive treatment. These barriers include social stigma associated with HIV infection and structural barriers to accessing integrated counseling and testing centers (ICTCs). These obstacles to testing and treatment require behavioral interventions that function well in resource-poor settings. In 2017, 2.1 million people were living with AIDS in India. While 97% of HIV-infected women and babies in India receive ART, key regions still struggle with poor outcomes.
A new study by Johns Hopkins public health scientist Nishi Suryavanshi, PhD, in collaboration with emocha, shows mobile technology’s potential as a component of a promising PMTCT intervention.
The Community Home Based India study (COMBIND) study conducted Maharastra state, compared a mobile technology-centered intervention to deliver healthy behavior change training for ICTC-based outreach workers. The tablet-based technology was developed to support outreach workers using tailored “smart forms” that respond automatically with pre-programmed algorithms, as well as informative videos for pregnant and breastfeeding women, SMS alerts for upcoming and missed clinic visits, and one-week residential behavioral training course for outreach workers on engagement with HIV-infected women.
The outreach workers who were interviewed found the tablet-based technology and its companion interventions to be scalable, feasible, and beneficial for PMTCT. While outreach workers were described feeling apprehensive about using tablets, they generally found the message prompts to be critical for collecting clinical data and conveying important health education and informational messages. Support for outreach workers in the fight against HIV/AIDS is critical: interviews with patients who were interviewed as part of the study emphasized the strong role that outreach workers play in the lives of HIV-infected women in India, by providing social support and guidance for women and their families.
emocha’s mobile platform and the COMBIND intervention have the potential to assist outreach workers in effectively engaging and counseling their clients, while providing a high standard of care for HIV-infected women.