South African National PMTCT Evaluation (2010 - 2013)

The South African PMTCT Evaluation (SAPMTCTE), a national survey that aims to describe mother-to-child transmission of HIV in South Africa provides one of the most exciting demonstrations of a large-scale, low-cost, mHealth application to inform the country’s top health priority - the prevention of HIV transmission to newborns and to assist the country to achieve the child and maternal health MDGs.

In a clinical study which has now been replicated twice, the South African Medical Research Council - using the Mobenzi platforms has shown the potential to monitor the effectiveness of the national PMTCT programme in a large random sample of 580 public clinics. This is about 10% of all of the clinics throughout the country in all provinces and stratified into all types of settings.

The information provided has shown the remarkable progress the country has made in reducing the number of HIV-infected infants from 70,000 to approximately 10,000 over a decade of effort.

The 2010 SAPMTCT Evaluation was the first national PMTCT clinic-based study in which interviews were conducted with caregiver-infant pairs and infant dry blood spot (DBS) samples taken where consent was given.

Mobenzi was awarded the competitive open tender to provide mobile data collection solutions to the Medical Research Council from 2010 through to the end of 2013. Results from the 2010 evaluation have been released.

The project protocol involved an interview at 6 weeks post birth to determine the rates of early mother to child transmission of HIV. Follow-up interviews continued to monitor these infants with repeated measurements at 6, 9, 12 and 18 months. Over the course of the study, several hundred data fields were collected for each caregiver-infant pair.

The project involved 85 handsets linked to the Mobenzi Researcher platform and the collection of almost 11,000 interviews nationally each year.

Mobenzi Implementation

The Mobenzi team was responsible for converting the survey from the format provided by the MRC to one suitable for conduction via mobile phone. This process included defining screening logic utilising the skip and control flow capabilities offered by Mobenzi Researcher.

The lightweight and optimised design of the Mobenzi Researcher mobile application, allowed entry-level handsets costing just a few hundred Rand (under $70) to be used for the project. These were procured, setup and delivered to the MRC along with SIM cards which had been registered for RICA on behalf of the MRC.

An SMS reminder service was developed which automatically delivered text messages to caregivers who had provided their mobile numbers during their interviews, reminding them to collect their HIV test results when the scheduled date arrived (4 weeks after the interview was conducted).

Mobenzi provided airtime monitoring and recharge services which included both scheduled recharges as well as ad hoc recharge requests.

Participant interviews were linked to dry blood spot (DBS) samples taken as part of the research protocol. Mobenzi generated sticker packs containing uniquely generated participant identifiers (PIDs) for the project which were validated by the mobile application when entered, allowing incorrectly submitted identifiers to be detected and corrected in the field.

Impact

The multi-layered security protocol supported by the system ensured a high degree of patient confidentiality throughout the study. Captured data were transferred via SSL encryption to the Mobenzi Researcher web console which resides on sophisticated enterprise cloud architecture, ensuring redundancy and high data integrity whilst providing real-time access to project research teams.

With near instantaneous access to responses for review and export, daily monitoring to ensure scheduled work plans were being adhered to was possible - reducing latent data problems traditionally associated with paperbased evaluations.

The store-and-forward capability of the Mobenzi mobile application enabled data collection to continue, even without network connectivity. Responses were stored locally until network reception was available.

The MRC’s decision to extend the use of Mobenzi Researcher to the 2012/2013 evaluation bears testimony to the role mobile technology can play in the on-going evaluation of the country’s key health initiatives. The 2012/2013 evaluation  further streamlined the operations of this landmark undertaking through the introduction of additional management and mobile data collection capabilities offered by the Mobenzi platform. This included automated merging of lab results, real-time progress indicators, exceptions management, consolidated dataset generation and operational data reports.

“This survey shows that South Africa has managed to reduce MTCT from between 20% to 30% (in the absence of any PMTCT intervention) to 3.5% by 8 weeks post-delivery. This represents a reduction in MTCT from 70 000 to less than 10 000 babies born HIV positive, per year, over the past 10 years.” Forward to 2010 SAPMTCT report by the Minister of Health - Dr Aaron Motsoaledi

This is a significant finding in light of the country’s commitment to achieving it's millennium development goals.