TANZANIA: Using SMS Messaging to Promote Healthier Communities
Using SMS messaging for health education and for facilitating follow-up of patients is considered an innovative way and ideal mix to retain clients in care and treatment programs. Roland van de Ven, technical director for EGPAF/Tanzania, says “We expect that the combination of extra health information and reminders will lead to improved retention. Subsequently, the proportion of HIV-positive pregnant women receiving CD4 tests and rapid results will improve, and we anticipate more effective identification of HIV-exposed children as well. This will lead to increased uptake of combination ART, more comprehensive early infant diagnosis services – and fewer children infected over the long term.”
(Photo: EGPAF/James Pursey)
Under Tanzania’s national strategy for the prevention of mother-to-child transmission of HIV, all HIV-positive pregnant women (PW+) who have a CD4 cell count at or below 350, or who have been diagnosed with stage 3 or 4 clinical disease, should be initiated on combination antiretroviral therapy (cART) for their own health and to prevent transmission of the virus to their children. The national target is set at 40% of all HIV-positive pregnant women to be initiated on cART.
Eligibility for cART is primarily dependent on CD4 count, which makes access to CD4 testing and results critical. Although EGPAF supports the Tabora, Kilimanjaro, Arusha, and Lindi regions with both PMTCT and care and treatment (C&T) services, PMTCT services are offered at five times more sites than C&T services. CD4 testing is only offered at less than half of the sites offering C&T – and even then, only on specific days of the week. At present, less than a third of the women expected to need cART are actually receiving it. Improved dialogues between health care workers and pregnant women are imperative, as is collaboration among referring and receiving sites.
(Photo: EGPAF/James Pursey)
To this end, EGPAF/Tanzania builds upon its experience with using mHealth initiatives. The early infant diagnosis (EID) program began using SMS printers to return DBS-PCR results from the zonal laboratories to the districts quickly. Also, EGPAF/Tanzania began sending SMS follow-up reminders to patients with upcoming or missed appointments. During the initial pilot of sending SMS appointment reminders, the initiative resulted in a return of over one-third of patients, and plans are in motion to roll it out more broadly to care and treatment clinics across all four regions. Now, a third component has been added: using SMS to provide health education messages as well to those who stand to benefit from timely information about healthy and safe motherhood practices both before and after delivery.