By Grace Olomiwe and Erica Troncoso
Akwa Ibom, Nigeria — The mobile app on her tablet offers Felicia Monday Uwah new insights into her HIV clients, specifically, their individual risk of missing an appointment to refill their HIV prescription, thereby interrupting their treatment regimen.
For Uwah, an HIV case manager at Cottage Hospital in Akwa Ibom State in southern Nigeria — and for thousands of other health workers in HIV prevention and treatment — missed appointments for multi-month drug refills present a well-documented challenge. Trying to reach clients and support them to return to treatment is time consuming for Uwah. However, stopping treatment is dangerous for clients’ health and can make their HIV infection more transmittable to others.
Fortunately, the mobile app in Uwah’s hand houses a predictive risk assessment tool that uses client-provided data and machine learning to identify the probability of an individual returning for their treatment. The answers to the questions Uwah asks ignite green, yellow or red lights in the mobile app that correspond to that probability. This puts information directly into the hands of case managers during a client visit and allows them to proactively form a plan with clients to prevent an interruption in treatment that could pose a risk to their health and to others.
“It also helps the client to [keep taking] treatment,” Uwah says of the mobile app. “Because when you explain to the client, ‘See, you are in yellow. If you don’t take your drugs [as advised], if you don’t keep to your appointment, you would enter red.’” Red indicates that the client is at risk of interrupting their treatment plan.
The color code, Uwah says, may encourage clients to achieve viral suppression — undetectable amounts of the virus in their blood. This means they can’t transmit the virus.
Uwah is among the many health workers in Nigeria supported by the Reaching Impact, Saturation, and Epidemic Control (RISE) project. Funded by the President’s Emergency Plan for AIDS Relief through the U.S. Agency for International Development, RISE provides comprehensive, evidence-based HIV services across 130 health facilities in five states in Nigeria, working closely with the government and local stakeholders. The RISE consortium is led by Jhpiego, in collaboration with ICAP at Columbia University.
Recognizing the implications of interruptions in treatment, Jhpiego and the RISE Nigeria team partnered with Palindrome Data, data science and machine learning experts, to investigate ways to keep clients on treatment. The result: the predictive HIV Interruption in Treatment assessment tool. In a recent test of hands-on use of the digital tool, case managers and health workers found it was easy to use and helped them to engage with clients and initiate needed conversations.
Initiating people living with HIV on treatment and helping ensure they stay on treatment during their first year are foundational elements to reaching the UNAIDS target goals of 95–95–95 by 2030: 95 percent of all people living with HIV know their HIV status; 95 percent of all people who know their status receive antiretroviral therapy (ART); and 95 percent of all people on ART are virally suppressed, ensuring their immune systems remain strong and the possibility of passing on the virus is effectively eliminated.
Health workers praise mobile app
“There is no doubt, this is a lifesaving tool…. It helps me to monitor [their health] and emphasize the importance of adherence and the consequence of not taking their medications,” said Afuape Ismal Babtunde, a case manager at the Handmaids Hospital in Ibiono. “Some of the patients are also curious. When they come for viral load test, and they see me using this to check their data, they ask questions. And upon being told, they are fascinated and more willing to [prepare] themselves for care.”— Afuape Ismal Babtunde, Case Manager, Handmaids Hospital in Ibiono.
Hannah Castill, the Acting Surge Coordinator for Ikot Ekpene General Hospital, Uyo, Akwa Ibom State, found the mobile app eased her workload.
“When I saw the tool, I felt like it was extra work for my team, another [piece of] paper work, another documentation, another tool. But after going through the entire process, I see that it is a very vital tool,” she said. “The tool will assist us in actually knowing how to manage a client, how to assist a client, how to know what to do. The tool will help us to make proactive, informed decisions [with] our clients.
“It is another way for us to know how to manage our client…. This will assist us to know what better way to manage our clients…to give them the right information on how not to [transmit the virus] and live a healthy life.”
Emem Etim Udo, a case manager at the Handmaids Hospital, said the tool helped him gauge his clients’ knowledge of the services he provides and how he can help them stay healthy.
“It has created an awareness in them that these services are something that they should [be mindful of],” Udo said.
Trifold benefits
“Frontier technologies help us leapfrog challenges and deliver real impact to the client, provider and health system,” says Wendy Taylor, Jhpiego’s Vice President for Technical Leadership and Innovation. “For our clients, an AI-based tool like this can help them make more informed decisions about their care and work to optimize their care.”
A common question among clients is “How can I improve my risk score?” It’s an important — and answerable — question.
For health workers, the mobile app helps transition away from homogenous care towards personalized and precise care that puts an individual client at the center. It assists a health worker in helping clients be proactive about their care. The app allows health workers to know if they might need to spend additional time with those who need more attention and encourage clients who are consistently taking their medication.
The mobile app can be used for precise resource allocation, allowing health administrators to survey the predicted risk in an area and adjust resources as needed across a health system. These insights are vital for planning purposes and can transform outcomes at a higher level.
Health systems frequently collect data, but rarely put data back into the hands of health workers and their clients so they can change health outcomes. This mobile app allows RISE-supported health workers to do exactly that.
“We believe that ending the HIV epidemic will require ensuring more and more recipients of HIV care are virally suppressed and have effectively no risk of transmitting HIV,” says Taylor. “Preventing interruptions in treatment is a critical part of that effort — and this digital tool will bring us many steps closer to that goal.”
Grace Olomiwe is the Knowledge Management and Communications Officer in Jhpiego’s Nigeria office. Erica Troncoso is Jhpiego’s Digital Health and Frontier Solutions Advisor.
