The distribution of Cell Phones to Mothers of EID HIV positive Infants in Haiti:A model for Increasing Adherence?

Background : EID• Test every infant born to an HIV +ive

mother. • The DNA PCR = HIV Dx from 4 wks of age. • Rapid ELISA = 18 months of age –

Maternal antibodies • Early diagnosis Early treatment • Untreated, mortality is over 50% < 2 years.HIV positive child < 2 years old age to start

ARV treatment upon diagnosis.

• The number of children infected is the ultimate measure of the success of the PMTCT program• Without the EID its impossible to

know when the “Elimination of Transmission From Mother to Child” has been met.

2011 - 20122010

20092008

Pregnant women HIV +ive OPTION

B +ARVs

Birth & Feeding

PlanInfant

Prophylaxis(AZT/NVP

6 WKS)

Infant PCR 4-6

Wks

Positive Infants Start ARVsNegative

Infants re-test after weaning

FP Discussion

Methods May 2010• Given to mothers of newly diagnosed HIV + infants

through the PCR program• Regularly communicate with the mothers about

the child• Mothers who gave consent and signed “Contract” • Consent of Mothers with pre-existing cell phones • Contacted weekly - health status, appointments,

drug adherence.

Results# Sites # Women

Given Phones# Women

Own Phones# Active Phones

20 70 38 76/108(70.4%)

# Phones Inactive

# Phones Stolen

# of Children with phones in active follow up, on ARVs

and Adherent

21/108(19.4%)

11/108(10.2%)

76/76(100%)

QuestionnaireWhy were you given a phone?

50 Respondants of 70 Given

90% to check if my child is healthy/ ok/ to check on my

child’s health

74% ‘ to remind me of my appointments’

60% ‘ to contact someone if my child is sick or needs help’

• Why were you given a phone? • 50

What do you feel when you are called by the team?76 respondents

( 50 donated phones and 26 own phones )

76 Felt Positive about being contacted100%

Does being contacted by the team help you? 76 Respondents

Yes 75 No 1

Why is it helpful to be called?76 Respondents

61 (80%) It was helpful as an appointment reminder

63% It helped them to remember medication for their

children

51% It was helpful when their children were ill.

What problems have you had with the phone?76 Respondents

75% Problems buying credit or minutes for their phones.

40% Difficulty in charging the phone.

25% Poor phone reception

21% Fear of the phone being stolen

Limitations• Small Sample Size :The EID program

diagnoses 150 children per year in Haiti • No biologic markers of adherence • No Pre and Post follow : Given phones

close to the time of diagnosis. • Not a randomized controlled trial. We did

not want to risk losing children to follow up.

Anecdotes LOOK away if Offensive!• Phones given close to the time of diagnosis,

Phones helped start treatment earlier.• When children become acutely ill, mothers can

ask for advice esp : cholera epidemic. • Links to health agents : drugs shortages/

transport issues• One Mother planned to commit suicide, but

because of regular contact she felt more positive about the future.

• One of our mothers was beaten by her partner• Phone as a security deposit for food.

Other uses of Mobile technology in Haiti EID program

• Live, online spreadsheet that is linked to the reference labs.

• In 2010 median of 1 day for result transmission to the providers. 2000 children. Smart Phone Access the spreadsheet

• Communicate with Pregnant Women • Adolescent Outreach

Conclusions• Using cell phones with families of HIV-positive

children has helped monitor these children. • Approx. 20% of PCR positive children identified

are lost to follow up within 12 Months• Phones 20 USD in Haiti; not prohibitively

expensive. The use of cell phones, as part of an active

community tracking program has benefitted the Haiti EID program.

Thanks and AcknowledgmentsMSPP

USAID/ PEPFAR Voila Foundation

Caris Foundation Directors