Achieving 95–95–95 with MedTrack -Addressing the Challenges in the fight against HIV/AIDS with eHealth

The world shifted focus during the COVID-19 pandemic that many forgot the already existing scourges on the world’s conscience like HIV/AIDS. The World Health Organisation(WHO) kept tabs on the difficulties people living with HIV/AIDS experienced especially during the lockdown. The difficulties and uncertainties of being at risk of contracting and dying from COVID 19 as well as challenges in obtaining and adhering to a strict medication schedule were well documented.

The treatment basis for HIV/AIDS was initially based on CD4 counts and Viral load, i.e, the strength of your body’s immunity and the amount of individual viral particles in your body. In 2016, the protocols from the World Health Organisation changed regarding treatments. All people living with HIV including children, adolescents, adults, and pregnant and breastfeeding mothers were to take lifelong antiretroviral therapy.

The Joint United Nations Programme on HIV/AIDS launched the three 90s in 2014 meaning 90% of people living with HIV will know their status by 2020, 90% of all people with diagnosed HIV will receive sustained antiretroviral therapy by 2020 and 90% of all people on antiretroviral therapy will have viral suppression. In December 2020, UNAIDS released a new set of ambitious targets raising these targets to 95% of all people living with HIV to know their HIV status, 95% of all people with diagnosed HIV infection to receive sustained antiretroviral therapy, and 95% of all people receiving antiretroviral therapy to have viral suppression by 2025. The ultimate goal of this program is to end HIV/AIDS as a global public health threat and achieve a sustainable development goal by 2030.

According to the Ghana AIDS Commission, Ghana currently has 346,120 (i.e, 1.06%) of its 32.6 million population living with HIV/AIDS, made up of 34% male and 66% female. There is an incidence of 21,000 new infections annually over the past 5 years. Ghana has achieved 71% of people living with HIV/AIDS knowing their status. 99% of patients who know their status are on antiretroviral medication and 79% of people receiving antiretroviral therapy have viral suppression. In the agenda 95–95–95, Ghana has achieved 71–99–79.

The three 90’s program of 2014 was a relative success with 8 countries achieving their targets by 2020 and up to 27.1 million people living with HIV/AIDS on antiretroviral medication. The unequal progress among countries also reflected several challenges but the key among them were financial constraints and access to healthcare. It is estimated that the global funding of HIV/AIDS needs to increase by 30% to help achieve the 2025 targets.

Access to health care remains a challenge for low and middle-income nations and has been the target of a lot of innovation in the global health space. The ease of access to advancing technology in health improves access to healthcare and removes the physical barriers to access to healthcare.

eHealth allows for diagnosing and digitization of this process enabling the commencement and monitoring of treatment to help achieve this agenda 95–95–95 by 2030.

Enter MedTrack

MedTrack Technologies is a health technology company whose aim is to digitize all healthcare interactions at all levels on a common platform and link that to the patient’s biometric data. This is to make this health data accessible, potable and transferable. Its ultimate goal is to digitize Africa’s over 1 billion population.

MedTrack has been piloted in some districts in Ghana, the latest being the Gomoa East District. All patients are captured and their health data is linked to their Biometric Card — Ghana Card. Newly diagnosed HIV patients are therefore captured and their progress is monitored in real-time. The scheduling of their laboratory tests to assess the status of their immunity is documented and their medications are scheduled. They receive SMS alerts to remind them of their pending refill of medication and also their clinical review dates.

Health centers also receive alerts on the expected patient list for each review date. Patients can be contacted by community health care nurses either by mobile phone calls or home visits to re-establish contact and compliance with their medication.

The portability of the platform allows the information to be accessed by other clinicians even when the patient is away from his/her primary facility to allow for continuous, uninterrupted health care.

Monitoring

Red flags on our MedTrack monitoring platform for Diseases of Public Health Interest allow for the monitoring teams at the health directorates at all levels from the facility, sub-district, district, regional and national levels to receive notifications on:

1. New infections/diagnosis
2. Counseling and testing
3. Treatments and compliance
4. Viral Loads and CD4 count monitoring
5. Diagnosis in pregnancy and appropriate interventions
6. Co-morbidities and their treatment
7. Health education and behavioral modification.

These tools will alert and inform the actions to be taken to achieve the sustainable development goal of improving the testing and treatment of HIV/AIDS patients.

Introducing the Medtrack HIV/AIDS Mother and Child Health Tracker

MedTrack believes in continuous digitization of all health data from conception. We hope that obtaining all health records securely on one database allows for tailored and customized health care for each individual. Generic treatments will be replaced by customized patient treatment based on each patient’s unique biomarkers and identifiers.

Test for HIV is one of the routine tests for pregnant women at their antenatal booking visit. This diagnoses new patients and identifies existing patients who have gotten pregnant. Early treatment prevents/reduces significantly the risk of mother-child transfer, which accounts for the majority of HIV/AIDS transmissions among children.

Continuous follow-up of the mothers and their compliance with their medication is documented as well as the health and growth of the fetus.

The facility is reminded to take all perinatal precautions for exposed newborns and their post-exposure prophylaxis is followed through.

The follow-up of medication and testing is done and monitored at all stages.

This allows for individualized monitoring of an individual from birth up to five years of age when our close monitoring ends by the health directorates.

Mother-to-Child transmission accounts for up to 90% of children living with HIV. Mortality rates are exceptionally high in infants and young children living with HIV/AIDS. 52% and 75% of children living with HIV/AIDS die before the age of 2 and 5 respectively in the absence of any intervention. All children living with HIV/AIDS should be on antiretroviral therapy, however, only 52% of these children had access to treatment globally in 2021.

This gives ample justification for the adoption of a tracker by MedTrack for all mothers living with HIV/AIDS. This will:

1. Prevents mother-to-child transmission of HIV/AIDS
2. Ensure early infant diagnosis
3. Enable mothers and their children to be enrolled in a closely monitored program that ensures a healthy mother and baby
4. Ensure baby maintains good immunity to prevent opportunistic infections
5. Ensure baby grows well to achieve all development milestones and achieve normal anthropometric parameters
6. Allows governmental agencies and stakeholders to assess and evaluate policies with real-time data and make policy changes or alterations.
7. Help achieve the sustainable development goal of making HIV/AIDS no longer a disease of Public Health importance.

Conclusion

The use of eHealth can help address the issues of lack of access to healthcare globally and especially in low-resource communities. The current digitization agenda, while commendable, does not address the challenges of the underserved sections of our population. MedTrack hopes to address these challenges using our Chronic Disease management tool and our Maternal and Child Health Care Tracker to address the needs of people living with HIV/AIDS in general, and mothers and their children born with HIV/AIDS specifically. Its adoption will help reduce Mother-to-Child Transmission and early infant diagnosis which results in fewer complications and improves survival.